Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Via Balbi 5, Genoa, Italy.
Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
Autoimmun Rev. 2018 Apr;17(4):344-352. doi: 10.1016/j.autrev.2017.11.025. Epub 2018 Feb 8.
Nailfold capillaroscopy is an easy, non-invasive technique to assess microvascular involvement in rheumatic diseases. Multiple studies describe capillaroscopic changes in systemic lupus erythematosus (SLE), including a wide range of non-specific findings. On behalf of the European League Against Rheumatism (EULAR) study group on microcirculation in rheumatic diseases, a systematic review was done to obtain all original research studies (in English) in which SLE patients had capillaroscopy. Forty such studies are identified. This article firstly provides a résumé of the results of these studies according to capillaroscopic parameters (density, dimensions, morphology, haemorrhages), semi-quantitative assessment and qualitative assessment of capillaroscopy in SLE patients. Secondly, the correlations between capillaroscopic parameters in SLE patients and clinical and laboratory parameters (including auto-immune parameters) are outlined. The following capillaroscopic parameters are found to be significantly more prevalent in SLE patients compared to healthy controls: tortuous capillaries, abnormal morphology and haemorrhages. Hairpin-shaped capillaries are significantly less prevalent than in healthy persons. The semi-quantitatively determined nailfold capillaroscopic score (NFC score) in SLE patients is also higher than in healthy controls. Several correlations between clinical and laboratory parameters and capillaroscopic parameters are identified in the review. Disease activity is correlated with NFC score in seven studies, with abnormal morphology (i.e. "meandering") in one study and with haemorrhages in one study. Frequent attacks of Raynaud's phenomenon (RP) and gangrene are significantly correlated with dilated capillaries. In two studies a possible correlation between anti-SSA antibodies and lower density of capillaries is withheld. About other immune parameters conflicting results are found. In one study a significant negative correlation is found between 24-hour proteinuria and abnormal morphology (i.e. "meandering"). For the first time, an overview of the nailfold capillaroscopic changes that have been described in SLE and their correlations with clinical and laboratory findings is given. Further large-scale research on the identification of capillaroscopic changes in SLE and their correlations with standardised clinical and laboratory parameters, is ongoing at the EULAR study group on microcirculation in rheumatic diseases.
甲襞毛细血管显微镜检查是一种评估风湿性疾病微血管受累的简单、非侵入性技术。多项研究描述了系统性红斑狼疮（SLE）的毛细血管变化，包括广泛的非特异性发现。代表欧洲抗风湿病联盟（EULAR）风湿性疾病微循环研究小组，进行了一项系统综述，以获取所有关于 SLE 患者进行毛细血管镜检查的原始研究（英文）。确定了 40 项此类研究。本文首先根据毛细血管参数（密度、尺寸、形态、出血）、SLE 患者毛细血管镜检查的半定量评估和定性评估，总结这些研究的结果。其次，概述了 SLE 患者毛细血管参数与临床和实验室参数（包括自身免疫参数）之间的相关性。与健康对照组相比，SLE 患者中以下毛细血管参数更为常见：扭曲的毛细血管、异常形态和出血。发夹状毛细血管明显少于健康人。SLE 患者的指甲褶皱毛细血管镜检查半定量评分（NFC 评分）也高于健康对照组。在综述中确定了几个与临床和实验室参数与毛细血管参数之间的相关性。在七项研究中，疾病活动与 NFC 评分相关，在一项研究中与异常形态（即“蜿蜒”）相关，在一项研究中与出血相关。频繁的雷诺现象（RP）发作和坏疽与扩张的毛细血管显著相关。在两项研究中，抗 SSA 抗体与毛细血管密度降低之间可能存在相关性。关于其他免疫参数则存在相互矛盾的结果。在一项研究中，24 小时蛋白尿与异常形态（即“蜿蜒”）之间存在显著负相关。首次概述了在 SLE 中描述的甲襞毛细血管镜变化及其与临床和实验室发现的相关性。EULAR 风湿性疾病微循环研究小组正在进行关于 SLE 毛细血管变化的识别及其与标准化临床和实验室参数的相关性的进一步大规模研究。
