Restricted accessResearch articleFirst published online 2021-7
Nailfold capillaroscopy findings in cutaneous lupus erythematosus patients with or without digital lesions and comparison with dermatomyositis patients: A prospective study
Differential diagnosis between cutaneous lupus erythematosus (CLE) and dermatomyositis (DM) may be challenging if digital lesions occur.
Objectives
To compare nailfold capillaroscopy (NFC) findings in CLE patients with or without digital involvement, and to compare capillaroscopic findings between CLE patients with digital lesions and DM patients.
Methods
Prospective monocentric study including CLE and DM patients. NFC was performed and standardized items were recorded.
Results
Fifty-one CLE patients and 10 DM patients with digital lesions were included. A scleroderma pattern was found in 6 patients (12%): in 5 out of 17 patients with digital lesions, compared with only 1 out of 34 patients without digital lesions (p = 0.01). In multivariate analysis, CLE digital lesions and digital ulcerations were statistically associated with scleroderma pattern. CLE digital lesions were significantly associated with architectural disorganization (p = 0.0003) and capillary rarefaction (p = 0.0038). A scleroderma pattern was significantly more frequent in DM patients (80%) than in CLE patients with digital lesions (30%, p = 0.018). Capillaroscopic findings were not significantly different between CLE patients with digital lesions and DM patients.
Conclusion
Although scleroderma pattern is more frequent in DM patients than in CLE patients with digital lesions, NFC cannot formally distinguish CLE from DM.
CutoloMSulliASecchiMEOlivieri M and Pizzorni C.
The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol2007;
21: 1093–1108.
2.
WigleyFMFlavahanNA.Raynaud's phenomenon. N Engl J Med2016;
375: 556–565.
3.
KoenigMJoyalFFritzlerMJ, et al.
Autoantibodies and microvascular damage are independent predictive factors for the progression of Raynaud's phenomenon to systemic sclerosis: a twenty-year prospective study of 586 patients, with validation of proposed criteria for early systemic sclerosis. Arthritis Rheum2008;
58: 3902–3912. (12):
4.
IngegnoliFBoracchiPGualtierottiR, et al.
Prognostic model based on nailfold capillaroscopy for identifying Raynaud's phenomenon patients at high risk for the development of a scleroderma spectrum disorder: PRINCE (prognostic index for nailfold capillaroscopic examination). Arthritis Rheum2008;
58: 2174–2182.
5.
RiccieriVVasileMIannaceN, et al.
Systemic sclerosis patients with and without pulmonary arterial hypertension: a nailfold capillaroscopy study. Rheumatology (Oxford)2013;
52: 1525–1528.
6.
Van den HoogenFKhannaDFransenJ, et al.
2013 Classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis2013;
72: 1747–1755.
7.
BertolazziCCutoloMSmithV and Gutierrez M.
State of the art on nailfold capillaroscopy in dermatomyositis and polymyositis. Semin Arthritis Rheum2017;
47: 432–444.
8.
CutoloMMelsensKWijnantS, et al.
Nailfold capillaroscopy in systemic lupus erythematosus: a systematic review and critical appraisal. Autoimmun Rev2018;
17: 344–352.
9.
RiccieriVSpadaroACeccarelliFScrivo R, Germano V and Valesini G.
Nailfold capillaroscopy changes in systemic lupus erythematosus: correlations with disease activity and autoantibody profile. Lupus2005;
14: 521–525.
10.
MoneibHASalemSAAlyDGKhedr HT, Wafaey HA and Hassan HE.
Assessment of serum vascular endothelial growth factor and nail fold capillaroscopy changes in systemic lupus erythematosus with and without cutaneous manifestations. J Dermatol2012;
39: 52–57.
11.
ShenavandehSHabibiS.Nailfold capillaroscopic changes in patients with systemic lupus erythematosus: correlations with disease activity, skin manifestation and nephritis. Lupus2017;
26: 959–966.
12.
CasparyLSchmeesCSchoetensackI, et al.
Alterations of the nailfold capillary morphology associated with Raynaud phenomenon in patients with systemic lupus erythematosus. J Rheumatol1991;
18: 559–566.
13.
RagabOAshmawyAAbdoM and Mokbel A.
Nailfold capillaroscopy in systemic lupus erythematosus. Egypt Rheumatol2011;
33: 61–67.
14.
ObermoserGSontheimerRDZelgerB.Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates. Lupus2010;
19: 1050–1070.
15.
Da SilvaDMPatelBWerthVP.Dermatomyositis: a diagnostic dilemma. J Am Acad Dermatol2018;
79: 371–373. Aug
16.
MagroCMSegalJPCrowsonAN and Chadwick P.
The phenotypic profile of dermatomyositis and lupus erythematosus: a comparative analysis. J Cutan Pathol2010;
37: 659–671.
17.
ShenavandehSZarei NezhadM.Association of nail fold capillary changes with disease activity, clinical and laboratory findings in patients with dermatomyositis. Med J Islam Repub Iran2015;
29: 233.
18.
ConchaJSSPenaSGaffneyRG, et al.
Developing classification criteria for skin-predominant dermatomyositis: the Delphi process. Br J Dermatol2020;
182: 410–417.
19.
KuhnALandmannA.The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun2014;
48–49: 14–19.
20.
ElmanSAJoyceCNybergF, et al.
Development of classification criteria for discoid lupus erythematosus: results of a Delphi exercise. J Am Acad Dermatol2017;
77: 261–267.
21.
BohanAPeterJB.Polymyositis and dermatomyositis (first of two parts). N Engl J Med1975;
292: 344–347.
22.
BohanAPeterJB.Polymyositis and dermatomyositis (second of two parts). N Engl J Med1975;
292: 403–407.
23.
SontheimerRD.Cutaneous features of classic dermatomyositis and amyopathic dermatomyositis. Curr Opin Rheumatol1999;
11: 475–482.
24.
LundbergIETjärnlundABottaiM, et al.
2017 European League against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis2017;
76: 1955–1964.
25.
BoulonCDevosSManginM, et al.
Reproducibility of capillaroscopic classifications of systemic sclerosis: results from the SCLEROCAP study. Rheumatology (Oxford)2017;
56: 1713–1720.
26.
BoulonCBlaiseSLazarethI, et al.
Reproducibility of the scleroderma pattern assessed by wide-field capillaroscopy in subjects suffering from Raynaud's phenomenon. Rheumatology (Oxford)2017;
56: 1780–1783.
27.
CutoloMSulliAPizzorniCAccardoS.Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol2000;
27: 155–160.
28.
PetriMOrbaiAMAlarcónGS, et al.
Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum2012;
64: 2677–2686.
29.
Pavlov-DolijanovicSDamjanovNVujasinovic StuparNZMarcetic DR, Sefik-Bukilica MN and Petrovic RR.
Is there a difference in systemic lupus erythematosus with and without Raynaud's phenomenon?Rheumatol Int2013;
33: 859–865.
30.
ManfrediASebastianiMCassoneG, et al.
Nailfold capillaroscopic changes in dermatomyositis and polymyositis. Clin Rheumatol2015;
34: 279–284.
31.
PatelBKhanNWerthVP.Applicability of EULAR/ACR classification criteria for dermatomyositis to amyopathic disease. J Am Acad Dermatol2018;
79: 77–83.
32.
BouazizJDBareteSLe PelletierFAmouraZPietteJCFrancèsC.Cutaneous lesions of the digits in systemic lupus erythematosus: 50 cases. Lupus2007;
16: 163–167.
