The use of ultrasonography in the diagnosis of nail disease among patients with psoriasis and psoriatic arthritis: a systematic review

Abstract Background: Nail involvement has been described as a key clinical feature for both psoriasis (PsO) and psoriatic arthritis (PsA) and is an important risk factor in PsA. Thus, early diagnosis of nail involvement may be essential for better management of PsO and PsA. Ultrasonography is considered a highly promising method to visualize nail disease. The main aim of this review was to evaluate the use of ultrasonography for the diagnosis of nail disease in patients with PsO and PsA by reviewing ultrasound parameters with the best diagnostic accuracy. Main body of the abstract: A systematic search was performed in MEDLINE via the PubMed and LILACS databases. Conference proceedings of relevant rheumatology scientific meetings were also screened. Results: After applying eligibility criteria, only 13 articles and 5 abstracts were included in this review. The selected studies showed a huge variability in evaluation methods (and therefore in the results) and were mainly focused on the assessment of nails ultrasound parameters that may differ among patients and healthy controls, especially the morphological aspects in B-mode ultrasonography and vascularization of the nail bed by Doppler ultrasonography. Our research indicated that the evaluation of nail disease in PsO and PsA is still underrepresented in the literature, probably reflecting a restricted use in clinical practice, despite the widespread use of ultrasonography in the management of chronic arthritis. Short conclusions: Despite the potential relevance of ultrasonography for the diagnosis of nail disease, additional studies are needed to determine which features are more reliable and clinically pertinent to ensure accuracy in the evaluation of nail involvement in PsO and PsA.

Periungual capillaroscopy in psoriasis / Capilaroscopia periungueal em psoríase

BACKGROUND: Nailfold capillaroscopy is a useful technique for evaluating changes in microcirculation. OBJECTIVE: To investigate changes at nailfold capillaroscopy in psoriatic patients compared with controls. METHODS: Nailfold capillaroscopy was performed in 46 psoriatic patients and 50 controls to assess microscopic morphological changes, capillary density and the presence of areas with devascularization. RESULTS: Patients with psoriasis had lower capillary density (p=0.0005), increased avascular areas (p=0.0035) and an increased number of morphologically abnormal capillaries (coiled, p<0.0001) compared to controls. No association was found between capillary density and the duration of the disease (p = 0.92) or the extent of skin involvement, as measured by the psoriasis area and severity index (PASI) score (p = 0.59). The presence of avascular areas was more common in psoriatic individuals whose nails were affected by the condition (p = 0.047). CONCLUSION: Patients with psoriasis have decreased capillary density and a greater presence of morphologically abnormal capillaries when compared to controls.

FUNDAMENTOS: A capilaroscopia periungueal é um método utilizado no estudo de alterações da microcirculação. OBJETIVO: Verificar alterações na capilaroscopia periungueal de pacientes com psoríase, comparando-os com controles saudáveis. MÉTODOS: A capilaroscopia periungueal foi realizada em 46 pacientes com psoríase e 50 controles, utilizando-se um estereomicroscópio e observando-se alterações morfológicas, densidade capilar e presença de áreas com desvascularização. RESULTADOS: Pacientes com psoríase tinham menor densidade capilar (p=0,0005), maior presença de áreas avasculares (p=0,0035) e de capilares morfologicamente alterados (enrodilhados; p<0.0001) do que os controles. Não se encontrou associação entre densidade capilar e tempo de doença (p=0.92) ou grau de envolvimento cutâneo medido pelo PASI (p=0.59). A presença de áreas avasculares foi mais comum em indivíduos com psoríase que tinham envolvimento ungueal (p=0,047). CONCLUSÃO: Pacientes com psoríase têm menor densidade capilar e presença de capilares morfologicamente alterados em relação aos controles.

Uso da capilaroscopia ungueal como método diagnóstico e prognóstico de rosácea / Nailfold capillaroscopy as a diagnostic and prognostic method in rosacea

FUNDAMENTOS: Não há um método adequado e fidedigno de avaliação e seguimento da severidade na rosácea. OBJETIVO: Determinar a importância da capilaroscopia periungueal como método diagnóstico e prognóstico em pacientes portadores de rosácea. MÉTODOS: Estudo transversal onde foram submetidos ao exame da capilaroscopia periungueal 8 pacientes com rosácea e 8 controles no período entre maio e julho de 2009. Foram coletados dados clínicos relacionados ao sexo, idade, fototipo, classificação da rosácea de acordo com a classificação de Plewig e Kligman e a classificação da National Rosacea Society. Adicionalmente, avaliamos o tempo de evolução da doença e tratamentos previamente utilizados. RESULTADOS: A grande maioria das pacientes avaliadas (6 das 8 pacientes) apresentavam rosácea grau I (vascular) ou eritêmato-teleangiectásica. A idade média de duração da rosácea foi de 5,96 anos, sendo que 87,5 por cento faziam tratamento com metronidazol tópico. Nenhum paciente tanto do grupo rosácea como controle demonstrou evidência de desvascularização ao exame capilaroscópico. CONCLUSÃO: A capilaroscopia periungueal apresenta um padrão inespecífico e não parece auxiliar no diagnóstico ou prognóstico da rosácea.

BACKGROUND: There is no appropriate and reliable method of evaluating and monitoring severity in rosacea. OBJECTIVE: To determine the importance of nailfold capillaroscopy as a diagnostic and prognostic method for patients with rosacea. METHODS: A cross-sectional study where eight patients with rosacea and 8 control subjects were submitted to nailfold capillaroscopy from May to July 2009. We collected clinical data related to gender, age, skin phototype, and rosacea stage according to Plewig and Kligman classification and the classification of the National Rosacea Society. Additionally, we evaluated the progression of the disease and treatment therapies previously used. RESULTS: The majority of the patients evaluated (6 out of 8 patients) had rosacea subtype I (vascular) or erythematotelangiectatic rosacea. The mean duration of the disorder was 5.96 years, and 87.5 percent of the patients were under treatment with topical metronidazole. Nailfold cappilaroscopy showed that evidence of devascularization was absent in both groups. CONCLUSION: Nailfold capillaroscopy presents a nonspecific pattern and does not seem to help in the diagnosis or prognosis of rosacea.

Fenómeno de Raynaud por exposición a cloruro de vinilo / Raynaud's phenomenon secondary to vinyl chloride exposure

El policloruro de vinilo (PVC) es el polímero que ocupa el tercer puesto en el mercado de producción de plásticos a nivel mundial. Como consecuencia de la exposición crónica, los operarios pueden desarrollar cambios óseos degenerativos, Raynaud, trastornos circulatorios en extremidades, trombocitopenia y lesiones cutáneas semejantes a esclerodermia; esto se conoce como “enfermedad por cloruro de vinilo”. Presentamos un paciente masculino de 24 años de edad que presenta fenómeno de Raynaud, cefaleas, malestar en manos y pies, sensación de frío, fatiga y pérdida de apetito asociado a exposición a policloruro de vinilo. El estudio de la microcirculación cutánea periungueal por videocapilaroscopía muestra alteraciones estructurales y funcionales características. Se recomienda un seguimiento multidisciplinario estricto de los trabajadores expuestos a PVC.

Treatment of essential hypertension does not normalize capillary rarefaction

OBJECTIVES: To determine if capillary rarefaction persists when hypertension is treated with angiotensin converting enzyme inhibitor, thiazidic diuretic and/or beta-blocker, and to identify which microcirculatory alterations (structural and functional) persist after anti-hypertensive treatment. METHODS: We evaluated 28 well-controlled essential hypertensive patients and 19 normotensive subjects. Nailfold videocapillaroscopy examination of the fourth finger of the left hand was used to determine the functional capillary densities at baseline, during post-occlusive hyperemia, and after venous congestion. Capillary loop diameters (afferent, apical and efferent) and red blood cell velocity were also quantified. RESULTS: Compared with normotensive subjects, hypertensive patients showed lower mean functional capillary density at baseline (25.1±1.4 vs. 33.9±1.9 cap/mm², p<0.01), during post-occlusive reactive hyperemia (29.3±1.9 vs. 38.2±2.2 cap/mm², p<0.01) and during venous congestion responses (31.4±1.9 vs. 41.1±2.3 cap/mm², p<0.01). Based on the density during venous congestion, the estimated structural capillary deficit was 25.1 percent. Mean capillary diameters were not different at the three local points, but red blood cell velocity at baseline was significantly lower in the hypertensive group (0.98±0.05 vs. 1.17±0.04 mm/s, p<0.05). CONCLUSIONS: Patients treated for essential hypertension showed microvascular rarefaction, regardless of the type of therapy used. In addition, the reduced red blood cell velocity associated with capillary rarefaction might reflect the increased systemic vascular resistance, which is a hallmark of hypertension.

Inflammatory myopathies in childhood: correlation between nailfold capillaroscopy findings and clinical and laboratory data

OBJECTIVE: Nailfold capillaroscopy is an important tool for the diagnosis and follow-up of patients with rheumatic diseases, in particular dermatomyositis and scleroderma. A relationship has been observed in adults between improved capillaroscopic findings and reduced disease activity. Our aim was to correlate disease activity (clinical and laboratory data) and nailfold capillaroscopy findings in 18 patients with inflammatory myopathies. METHODS: This prospective study included 13 juvenile dermatomyositis patients (Bohan and Peter criteria) (mean age of 8.8 years) and five patients with overlap syndrome (mean age of 15.7 years). We evaluated disease activity (skin abnormalities and muscle weakness, muscle enzymes and acute phase reactants) and its correlation with nailfold capillaroscopy findings (dilatation of isolated loops, dropout of surrounding vessels and giant capillary loops). We used a microscope with special light and magnification of 10 to 16X. RESULTS: Eighteen patients underwent a total of 26 capillaroscopic examinations, seven of them on two or more occasions (13 were performed during the active disease phase and 13 during remission). Twelve of the 13 examinations performed during the active phase exhibited scleroderma pattern and 8 of the 13 examinations performed during remission were normal. Therefore, in 20 of the 26 examinations clinical and laboratory data and nailfold capillaroscopy findings correlated (p = 0.01). CONCLUSIONS: Nailfold capillaroscopy is a non-invasive examination that offers satisfactory correlation with disease activity and could be a useful tool for the diagnosis and follow-up of inflammatory myopathies.

Raynaud primario y secundario a síndromes esclerodermiformes: comunicación de 97 pacientes estudiados por capilaroscopía periungueal / Primary Raynaud and secondary to sclerodermoform syndromes: a communication of 97 patients studies with periungueal capilaroscopy

La detección temprana de síndromes esclerodermoformes es de gran relevancia para el pronóstico del paciente. Nuestro objetivo es determinar la utilidad de la capilaroscopía periungueal en el diagnóstico diferencial entre Raynaud primario y secundario a síndromes esclerodermiformes. Se estudian pacientes con Raynaud primario (21), Raynaud secundario a síndromes esclerodermia sistémica (57) y Raynaud secundario a síndromes de superposición con esclerodermia (19). El grupo control de sujetos sin Raynaud estudiados fue de 40 personas. Todos los grupos fueron estudiados por capilaroscopía periungueal de dedos de ambas manos por medio de microscopio esteroscópico de 40 aumentos. La especificidad del método para detección de patrón SD (esclerodermiforme) fue de 100 por ciento y la sensibilidad asciende 82,5 por ciento para esclerodermia sistémica y 57 por ciento para síndromes de superposición

Estudo da microcirculaçäo em descendentes de diabéticos através da capilaroscopia / The microcirculation study in diabetic descendents by capillaroscopy

No presente trabalho, fizemos uma revisäo a respeito da importância da microangiopatia diabética e do método de investigaçäo utilizado - capilaroscopia do bordo ungueal. Pretendemos correlacionar as alteraçöes encontradas nos capilares com os resultados de curva de tolerância à glicose, em indivíduos descendentes de diabéticos em primeira e segunda geraçöes. Foram examinados 72 indivíduos do grupo albo e 83 do grupo controle. Encontramos alteraçöes compatíveis com as ja descritas para o diabetes mellitus, tais como: edema capilares curtos e microectasia. Estes demonstraram que os descendentes de diabéticos desenvolveram alteraçöes vasculares precoces independentes dos índices de glicemia no momento. É sugeriram que a capilaroscopia poderá vir a ser um marcador precoce para a microangiopatia diabética

Capilaroscopia em pacientes portadores de diabetes tipo II / Capillaroscopy in diabetic type II patients

Este trabalho apresenta o estudo das alteraçöes dos capilares da prega ungueal de pacientes diabéticos, através da capilaroscopia. Pretendeu-se comparar as alteraçöes capilares encontradas nestes pacientes com as já descritas na literatura mundial. Foram examinados 37 pacientes portadores de diabetes tipo II, de ambos os sexos, e 41 indivíduos normais. Concluiu-se que as alteraçöes capliares encontradas nos pacientes estudados säo compatíveis com as já descritas pela literatura mundial e se caracterizaram por: palidez do campo, edema, dilataçäo do ramo venular e microectasia

Nailford capillaroscopy in diabetes mellitus: morphological abnormalities and relationship with microangiopathy

the morphology and density of nailfold capillaries were evaluated in patients with Type I and Type II diabetes mellitus and in healthy controls, using videocapillaroscopy. A protocol of well-defined capillary patterns was used. Diabetic patients had more tortuous and enlarged capillaries than controls. Nodular apical elongation was found only in diabetics and was more frequent in patients with a longer history of disease. Type II diabetic patientes with chronic clinical complications had a higher frequency of enlarged capillaries and nodular apical elongation. Glycemic control was without influence. Capillary densitu did not differ among the groups