RESUMO
OBJECTIVE: The role of vascular damage in cognitive dysfunction (CD) in SLE is not entirely understood. Nailfold capillaroscopy (NFC) is a noninvasive method that may aid the description of further vascular contributions to CD in SLE. Therefore, the aim of our study was to examine and compare finger nailfold capillary morphology in subjects with SLE with and without CD. METHODS: We conducted a cross-sectional study in patients with SLE. Demographic, clinical, and laboratory characteristics were collected. We evaluated nailfold capillary findings including avascular zones, hemorrhage, dilated and tortuous capillaries, disarrangement, crossing, subpapillary venular plexus, branched loops, and shortened loops by NFC. The Montreal Cognitive Assessment (MoCA) scale was used to screen cognitive function. CD was defined as a score < 26/30. RESULTS: Sixty-five females (97.0%) and 2 males (3%) with SLE were analyzed. Means of age and disease duration were 44.3 ± 12.0 years and 15.5 ± 7.6 years, respectively. Thirty-five (54.7%) patients had CD. The rate of patients with ≥ 1 NFC abnormality was 50% in both patients with and without CD (P = 0.14). Eight (22.8%) patients with CD compared to 1 without (3.5%) displayed dilated capillaries (P = 0.036). Other NFC abnormalities differed between patients with and without CD, but the possible relationships between dilated capillaries and CD disappeared after adjusting by age, diabetes, and hypertension. CONCLUSIONS: NFC findings were not associated with mild CD in patients with SLE. Our exploratory data do not support systemic microvasculopathy measured by NFC related to CD in patients with SLE.
Assuntos
Disfunção Cognitiva , Lúpus Eritematoso Sistêmico , Capilares , Disfunção Cognitiva/complicações , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Angioscopia Microscópica/métodos , Unhas/irrigação sanguíneaRESUMO
OBJECTIVE: The aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice. METHODS: A written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina. RESULTS: The participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus. CONCLUSION: This is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique. KEY POINTS: ⢠The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases. ⢠This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology. ⢠The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.
Assuntos
Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Doenças Reumáticas/diagnóstico por imagem , Reumatologia , Consenso , Humanos , Unhas/diagnóstico por imagemRESUMO
BACKGROUND/OBJECTIVE: Digital ulcers (DUs) represent a frequent complication of systemic sclerosis (SSc). The aim of this study was to evaluate clinical, serological and capillaroscopy features that are associated with DUs in patients with SSc. METHODS: In this bicentric cross-sectional study, 70 patients with SSc were consecutively selected from March 2016 to April 2017. Demographic and clinical features, including the presence of active DUs, were collected. Videocapillaroscopy was performed in all patients. RESULTS: Among the 70 patients included (mean age of 46.8 years, mean disease duration of 9.41 years), 14 (20%) had active DUs. Based on multivariate analysis, the presence of anti-Scl-70 antibodies, the HAQ-DI score, and the capillary loss score were independently associated with DUs with odds ratios of 7.96 (95% CI 1.32-47.99), 55.77 (95% CI 1.76-1764.28), and 16.66 (95% CI 2.07-133.81), respectively. CONCLUSIONS: The presence of avascular areas in capillaroscopy, elevation of HAQ-DI score and anti-Scl-70 antibodies were independent factors associated with DUs in patients with SSc.
Assuntos
Dedos , Escleroderma Sistêmico/complicações , Úlcera Cutânea/etiologia , Adulto , Estudos Transversais , Feminino , Dedos/irrigação sanguínea , Dedos/diagnóstico por imagem , Humanos , Masculino , Angioscopia Microscópica/métodos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Escleroderma Sistêmico/imunologia , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/imunologiaRESUMO
Nailfold capillaroscopy (NFC) has gained remarkable interest among rheumatologists because of its utility in both clinical practice and research activity. Nevertheless, there has been scarce attention on its potential in other rheumatic disorders such as vasculitis. We perform a systematic review of literature on NFC in noninfectious vasculitides, with the aim to provide an overview of the main NFC changes described, to discuss the current evidence supporting its clinical impact and applications in daily practice and to provide future research fields.
Assuntos
Capilares/diagnóstico por imagem , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Vasculite/diagnóstico por imagem , Humanos , Unhas/diagnóstico por imagemRESUMO
Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma ("SD") pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.
Assuntos
Angioscopia Microscópica/métodos , Doenças Reumáticas/diagnóstico por imagem , Artrite Reumatoide/diagnóstico por imagem , Brasil , Capilares/diagnóstico por imagem , Capilares/patologia , Dermatomiosite/diagnóstico por imagem , Dermatomiosite/patologia , Diagnóstico Precoce , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/patologia , Angioscopia Microscópica/instrumentação , Angioscopia Microscópica/normas , Doença Mista do Tecido Conjuntivo/diagnóstico por imagem , Doença Mista do Tecido Conjuntivo/patologia , Doença de Raynaud/diagnóstico por imagem , Doença de Raynaud/patologia , Doenças Reumáticas/patologia , Reumatologia , Escleroderma Sistêmico/diagnóstico por imagem , Escleroderma Sistêmico/patologia , Sociedades Médicas , Vasculite Sistêmica/diagnóstico por imagem , Terminologia como AssuntoRESUMO
OBJECTIVE: To evaluate the systemic microcirculation of patients with infective endocarditis (IE). METHODS: This is a comparative study of patients with definite IE by the modified Duke criteria admitted to our center for treatment. A reference group of sex- and age-matched healthy volunteers was included. Microvascular flow was evaluated in the forearm using a laser speckle contrast imaging system, for noninvasive measurement of cutaneous microvascular perfusion, in combination with skin iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) to test microvascular reactivity. Microvascular density was evaluated using skin video-capillaroscopy. RESULTS: We studied 22 patients with IE; 15 were male and seven female. The mean age and standard deviation (SD) were 45.5⯱â¯17.3â¯years. Basal skin microvascular conductance was significantly increased in patients with IE, compared with healthy individuals (0.36⯱â¯0.13 versus 0.21⯱â¯0.08 APU/mmHg; Pâ¯<â¯0.0001). The increase in microvascular conductance induced by ACh in patients was 0.21⯱â¯0.17 and in the reference group, it was 0.37⯱â¯0.14â¯APU/mmHg (Pâ¯=â¯0.0012). The increase in microvascular conductance induced by SNP in patients was 0.18⯱â¯0.14 and it was 0.29⯱â¯0.15â¯APU/mmHg (Pâ¯=â¯0.0140) in the reference group. The basal mean skin capillary density of patients (135⯱â¯24â¯capillaries/mm2) was significantly higher, compared with controls (97⯱â¯21â¯capillaries/mm2; Pâ¯<â¯0.0001). CONCLUSIONS: The main findings in the microcirculation of patients with IE were greater basal vasodilation and a reduction of the endothelium-dependent and -independent microvascular reactivity, as well as greater functional skin capillary density compared to healthy individuals.
Assuntos
Capilares/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Endotélio Vascular/diagnóstico por imagem , Fluxometria por Laser-Doppler , Microcirculação , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Pele/irrigação sanguínea , Gravação em Vídeo , Administração Cutânea , Adulto , Velocidade do Fluxo Sanguíneo , Capilares/efeitos dos fármacos , Capilares/fisiopatologia , Estudos de Casos e Controles , Endocardite/fisiopatologia , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Feminino , Antebraço , Humanos , Iontoforese , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Vasodilatação , Vasodilatadores/administração & dosagemRESUMO
PURPOSE: To evaluate the relationship between glaucoma diagnosis and the nailfold capillaroscopy pattern in patients with systemic sclerosis. METHODS: An observational study in a cohort of patients with SSc was conducted. Patients with at least one nailfold videocapillaroscopy and one ophthalmology examination at the same year were included. Data collected were: age, sex; type of systemic sclerosis according to the degree of skin impairment, self-reported ethnicity, disease duration, current use and dosage of systemic corticosteroid, current use and dosage of bosentan®, intraocular pressure, central corneal thickness, diagnosis of glaucoma and capillaroscopy pattern. RESULTS: Thirty-one patients with systemic sclerosis were enrolled, 23% had glaucoma. There was no statistically significant association between glaucoma diagnosis and the capillaroscopic pattern (p = 0.86). There was also no significant difference (p = 0.66) regarding intraocular pressure between patients with mild (13.9 ± 3.8 mmHg) and severe capillaroscopic pattern (14.4 ± 2.8 mmHg). The odds ratio of glaucoma for severe capillaroscopic pattern compared to mild was 1.6 (95% confidence interval: 0.3-9.5). CONCLUSION: Up to 23% of patients with SSc have glaucoma. The high prevalence of glaucoma in SSc suggests a possible systemic vascular disturbance as the cause. However, there seems to be no significant association between the capillaroscopy pattern and glaucoma in systemic sclerosis. Further research is required to improve the understanding of glaucoma in the context of systemic sclerosis.
Assuntos
Capilares/diagnóstico por imagem , Glaucoma/etiologia , Angioscopia Microscópica/métodos , Medição de Risco/métodos , Escleroderma Sistêmico/complicações , Adulto , Idoso , Brasil/epidemiologia , Progressão da Doença , Feminino , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Unhas/irrigação sanguínea , Projetos Piloto , Prevalência , Escleroderma Sistêmico/diagnóstico , Tonometria Ocular/métodosRESUMO
The objective of this study is to test the association of the severity of nailfold capillaroscopy (NFC) abnormalities with mortality in systemic sclerosis (SSc). One hundred and seventy SSc patients underwent an extensive evaluation (including high-resolution computed tomography, pulmonary function tests, and Doppler echocardiography) at baseline following a standard protocol. Capillary loss on NFC was evaluated using the avascular score (AS, ranging from 0 to 3), and the mean number of ectasias, megacapillaries, and hemorrhages per finger was also recorded. After a mean period of 10.1 ± 4.9 years, the life status of the patients was ascertained. Univariate and multivariate Cox proportional hazards models were used for statistical analysis. Overall, 73 patients died. By univariate Cox analysis, the AS was significantly associated with mortality (hazard ratio [HR] = 1.64, 95% CI 1.22 to 2.19, p = 0.001). In our study, this association was stronger than that of race, gender, anticentromere antibodies, anti-topoisomerase I antibodies, and form of disease and had similar strength to that of skin score in univariate analyses. However, after controlling for a combination of variables (age, skin score, gender, race, signs of peripheral ischemia, and extent of interstitial lung disease, all independently associated with mortality), the association of AS with mortality was blunted (HR = 1.15, 95% CI 0.80 to 1.65, p = 0.445). Other NFC variables were not related to mortality. AS was associated with higher risk of death and, despite not having an independent association with mortality after controlling for a set of demographic and clinical variables, may be a useful tool in prognostic evaluation of SSc.
Assuntos
Capilares/diagnóstico por imagem , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Escleroderma Sistêmico/diagnóstico por imagem , Escleroderma Sistêmico/mortalidade , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Taxa de SobrevidaRESUMO
OBJECTIVE: Infective endocarditis is a severe condition with high in-hospital and 5-year mortality. There is increasing incidence of infective endocarditis, which may be related to healthcare and changes in prophylaxis recommendations regarding oral procedures. Few studies have evaluated the microcirculation in patients with infective endocarditis, and so far, none have utilized laser-based technology or evaluated functional capillary density. The aim of the study is to evaluate the changes in the systemic microvascular bed of patients with both acute and subacute endocarditis. This is a cohort study that will include adult patients with confirmed active infective endocarditis according to the modified Duke criteria who were admitted to our center for treatment. A control group of sex- and age-matched healthy volunteers will be included. Functional capillary density, which is defined as the number of spontaneously perfused capillaries per square millimeter of skin, will be assessed by video-microscopy with an epi-illuminated fiber optic microscope. Capillary recruitment will be evaluated using post-occlusive reactive hyperemia. Microvascular flow will be evaluated in the forearm using a laser speckle contrast imaging system for the noninvasive and continuous measurement of cutaneous microvascular perfusion changes. Laser speckle contrast imaging will be used in combination with skin iontophoresis of acetylcholine, an endothelium-dependent vasodilator, or sodium nitroprusside (endothelium independent) to test microvascular reactivity. RESULTS: The present study will contribute to the investigation of microcirculatory changes in infective endocarditis and possibly lead to an earlier diagnosis of the condition and/or determination of its severity and complications. Trial registration ClinicalTrials.gov ID: NCT02940340.
Assuntos
Endocardite/diagnóstico por imagem , Endotélio Vascular/diagnóstico por imagem , Fluxometria por Laser-Doppler/métodos , Angioscopia Microscópica/métodos , Pele/irrigação sanguínea , Pele/diagnóstico por imagem , Brasil , Estudos de Casos e Controles , Humanos , Estudos ProspectivosRESUMO
Due to mounting evidences of interaction between Hansen's bacilli with endothelial cells and the paucity of studies addressing the presence of nailfold capillaroscopic alterations in patients with Hansen's disease, a study was carried out in order to verify the presence of capillaroscopic alterations in patients with leprosy in its various forms and its correlation with clinical parameters. Ten patients were evaluated at a specialized university service. Sixty percent of those had some capillaroscopic change, such as micro-hemorrhages, ectatic, bushy and corkscrew capillaries. Such changes were unspecific, which suggests there is not a specific pattern for this disease.