Department of Dermato-Venereology, Bispebjerg and Frederiksberg Hospital, University Hospitals of Copenhagen, Denmark.
Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, University Hospitals of Copenhagen, The Parker Institute, Denmark.
Microvasc Res. 2023 May;147:104476. doi: 10.1016/j.mvr.2023.104476. Epub 2023 Jan 16.
Up to 30 % of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), and diagnosis can be difficult. Nailfold capillaroscopy (NC) is an easily applicable, non-invasive procedure to assess skin microcirculation. This systematic review investigates NC as diagnostic tool for PsO and PsA, including correlations between NC outcome measures to clinical and laboratory outcome measures. This systematic review was built on the PICO and PRISMA guidelines. In total 22 relevant studies were found Searching in the Web of Science, PubMed and Embase, latest update June 13th, 2022. The following NC outcome measures are found to be significantly more prevalent in PsO patients than healthy controls: reduced density, reduced length and more abnormal morphology. Likewise, in PsA patients, reduced density, more abnormal morphology, more microhaemorrhages and fewer hairpin shapes are found to be significantly more prevalent. Results were non-conclusive in terms of disease activity and duration with NC findings. Random-effects meta-analysis showed a significant reduction of density in PsO patients compared to healthy controls (studies: 6, n = 249; SMD = -0.91; 95 % CI [-1.41, -0.40], p = 0.0058, heterogeneity I=74 %, AUC = 0.740) and in PsA patients compared to healthy controls (studies: 5, n = 130; SMD = -1.22; 95 % CI [-2.38, -0.06], p = 0.0432, heterogeneity I=89 %, AUC = 0.806). No NC outcome measures were overall conclusive in differentiating PsO from PsA. Considering the conflicting results and small sample sizes further large-scale research on the identification of capillaroscopic changes in PsO and PsA and correlations with standardised clinical and laboratory outcome measures are necessary.
高达 30%的银屑病（PsO）患者会发展为银屑病关节炎（PsA），且诊断较为困难。甲襞毛细血管显微镜检查（NC）是一种易于应用的、非侵入性的评估皮肤微循环的方法。本系统综述旨在调查 NC 作为诊断工具在 PsO 和 PsA 中的应用，包括 NC 结果与临床和实验室结果之间的相关性。本系统综述基于 PICO 和 PRISMA 指南。通过在 Web of Science、PubMed 和 Embase 中搜索，截至 2022 年 6 月 13 日，共发现 22 项相关研究。与健康对照组相比，以下 NC 结果在 PsO 患者中更为常见：密度降低、长度缩短和形态异常增多。同样，在 PsA 患者中，密度降低、形态异常增多、微出血增多和发夹状减少更为常见。在 NC 结果与疾病活动度和持续时间方面，结果尚无定论。随机效应荟萃分析显示，与健康对照组相比，PsO 患者的密度显著降低（研究：6 项，n=249；SMD=-0.91；95%CI[-1.41，-0.40]，p=0.0058，异质性 I=74%，AUC=0.740），与健康对照组相比，PsA 患者的密度也显著降低（研究：5 项，n=130；SMD=-1.22；95%CI[-2.38，-0.06]，p=0.0432，异质性 I=89%，AUC=0.806）。没有任何 NC 结果可以明确区分 PsO 和 PsA。考虑到存在冲突的结果和较小的样本量，有必要进一步开展大规模研究，以确定 PsO 和 PsA 中毛细血管变化的特征，并与标准化的临床和实验室结果进行相关性分析。
