Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden.
Rheumatology (Oxford). 2024 Feb 1;63(2):385-391. doi: 10.1093/rheumatology/kead207.
To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies.
This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation.
Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time.
Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc.
研究与免疫抑制治疗和自身抗体相关的 SSc 患者甲襞毛细血管密度的演变。
这是一项前瞻性研究队列。连续纳入新诊断的 SSc 患者，这些患者在回顾性分析中，在随访的前 48 个月内至少进行了两次甲襞毛细血管显微镜测量。用广角甲襞毛细血管显微镜测量每 3mm 的毛细血管密度。分析每个手指的毛细血管密度改善情况和平均毛细血管密度。用广义估计方程分析平均毛细血管密度的纵向测量值。
80 名患者（68 名女性，12 名男性）符合纳入标准。中位随访时间为 27 个月。28 名患者的每个手指的毛细血管密度都有所改善。MMF 与毛细血管密度恶化的手指数量减少有关。抗拓扑异构酶抗体与低平均毛细血管密度有关。抗 RNA 聚合酶 III 抗体与每个手指的毛细血管密度改善有关，而抗着丝点抗体与毛细血管密度恶化有关。在包括存在抗拓扑异构酶抗体和 MMF 与随访时间的相互作用的适度广义估计方程模型中，MMF 治疗与毛细血管密度下降的速度减缓有关。
在相当一部分 SSc 患者中，甲襞毛细血管密度随时间推移而改善。MMF 治疗对这些患者的毛细血管密度演变有积极影响。SSc 自身抗体表型可能影响毛细血管密度的发展。这些数据支持早期免疫抑制可能有利于 SSc 血管再生的先前假说。
