The Experts below are selected from a list of 2133 Experts worldwide ranked by ideXlab platform
Maurizio Cutolo - One of the best experts on this subject based on the ideXlab platform.
-
Capillaroscopy in childhood onset systemic lupus erythematosus a first systematic review
Clinical and Experimental Rheumatology, 2020Co-Authors: Dieneke Schonenbergmeinema, Karin Melsens, Maurizio Cutolo, Taco W Kuijpers, Amara Nassarsheikh Rashid, Merlijn J Van Den Berg, Vanessa SmithAbstract:OBJECTIVES: Recently, a systematic review indicated that, compared to healthy controls, adult patients with systemic lupus erythematosus (SLE) show a significantly more abnormal capillary morphology and greater number of haemorrhages in nailfold Capillaroscopy and that these capillary changes are associated with disease activity. As yet, no systematic literature evaluation of Capillaroscopy in childhood-onset SLE (cSLE) has been performed. Therefore, we aimed to systematically review the literature on nailfold capillary characteristics in cSLE. METHODS: Search terms "SLE or Lupus", "Capillaroscopy" and "Juvenile or Childhood or Paediatric or Child" were used in PubMed, Embase and Web of Science. Capillary findings were evaluated according to the current international consensus-based definitions for analysis of capillaroscopic characteristics from the European League against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases (SG MC/RD). RESULTS: After screening eighty search hits, six articles were retained, two of which were case-control studies and four case series. For capillary density, no difference was found between cSLE and healthy controls (one study). Differences in capillary diameter, capillary morphology, haemorrhages and semi-quantitative score were inconclusive or non-interpretable. A scleroderma pattern was not detected in the case control studies but was reported in a minority of cSLE patients in 3 out of 4 case series. CONCLUSIONS: Literature on nailfold capillary findings in cSLE is scarce and inconclusive. To evaluate capillary characteristics in cSLE, prospective longitudinal studies are needed. Future studies should use uniform definitions for capillary characteristics and findings should be compared with healthy controls, matched for age and ethnicity. The EULAR SG MC/RD is stepping up to this need.
-
nailfold Capillaroscopy how many fingers should be examined to detect abnormality
Rheumatology, 2019Co-Authors: Graham Dinsdale, Maurizio Cutolo, Michael Berks, Chris Roberts, Tonia L Moore, Joanne Manning, John F Allen, Marina E Anderson, Roger Hesselstrand, Kevin HowellAbstract:Objectives: Nailfold Capillaroscopy is being increasingly used by rheumatologists in the diagnosis of SSc. However, assessment of all nailfolds can be time-consuming in a busy outpatient clinic. Our aim was to answer the question as to how many (and which) fingers a clinician should routinely assess to capture accurately the true state. Methods: A total of 2994 assessments (by an international panel of expert observers) of 1600 images from 173 participants (101 with SSc, 22 with primary RP and 50 healthy controls) were included in this analysis. Seven single-finger or finger combinations (derived from the middle and ring fingers) were then tested for sensitivity for the presence of two markers of capillary abnormality [presence of giant capillaries and an SSc grade (early, active or late)] compared with assessment of all eight fingers. Results: For the eight-finger gold standard, sensitivity against the diagnostic criteria was 74.6% (53.0% for the presence of giants alone and 73.1% for image grade alone). Examining only one finger gave low sensitivity (ranging from right middle 31.7% to left ring 46.6%). Examining both ring fingers gave a sensitivity of 59.8%, whereas examining the four-finger combination of both ring and both middle fingers gave a sensitivity of 66.7%. Conclusion: During routine capillaroscopic examination, ideally all eight nailbeds (excluding thumbs) should be examined, otherwise some abnormalities will be missed. Examining only four fingers reduces Capillaroscopy sensitivity.
-
ab1088 capillary hemosiderin deposits or extravasations a subtype of haemorrhagethat acquires separate attention in quantitative analysis of nailfold Capillaroscopy in childhood onset sle
Annals of the Rheumatic Diseases, 2018Co-Authors: Dieneke Schonenbergmeinema, Maurizio Cutolo, M M Van Den Berg, A Nassarsheikhrashid, M Boumans, Taco W Kuijpers, Vanessa SmithAbstract:Background Quality of images in nailfold Capillaroscopy has improved in the last years by introduction of videoCapillaroscopy. Microangiopathy, as observed in Capillaroscopy of SLE-patients,1–3 can now be described by more detailed quantitative analysis. Recently, in a small cohort (n=22) of childhood-onset SLE (cSLE), we described capillary bleedings by two different subtypes: large haemorrhages and small point-shaped haemorrhages with a total count of resp. 0.2/1.5 per analysed image per patient.4 These small point shaped haemorrhages have also been described as hemosiderin deposits.5 Objectives To describe the reliability of assessment of two subtypes in capillary haemorrhages by inter-observer agreement. Methods Three observers, DS (paediatric rheumatologist with experience in Capillaroscopy), AN (fellow paediatric rheumatology without experience in Capillaroscopy) and MB (trainee in adult rheumatology with experience in Capillaroscopy), scored Capillaroscopy images from patients with Raynaud’s phenomenon and with cSLE. The observers were blinded for patient name and diagnosis. The number of haemorrhages were scored per subtype. Hemosiderin deposits were defined as small point-shaped extravasations surrounding the capillary apex (see image). Large haemorrhages were defined according to the Atlas of Capillaroscopy.6 Reliability was calculated by the intra-class correlation coefficient (ICC) with 95% confidence interval (CI). Statistical analyses was performed by IBM SPSS Statistics version 24. Results Two-hundred images from 50 patients (diagnosed with Raynaud’s phenomenon and/or cSLE) were scored by the three independent observers. ICC for the number of capillaries with hemosiderin deposits was 0.77 (95% CI 0.69–0.82). ICC for the number of large capillary haemorrhages was 0.97 (95% CI 0.96–0.98). Conclusions Reliability of the observation ‘hemosiderin deposits’ in nailfold videoCapillaroscopy was good with an ICC of 0.77. This study shows that capillary haemorrhages can be described in 2 subtypes: ‘large haemorrhages’ and ‘hemosiderin deposits’ which are small point-shaped extravasations surrounding the capillary apex. References [1] Ingegnoli F, Herrick AL. Nailfold Capillaroscopy in pediatrics. Arthritis Care & Research2013;65(9): 1393–1400. [2] Ingegnoli F, Zeni S, Gerloni V, Fantani F. Capillaroscopic observations in childhood onset rheumatic diseases and healthy controls. Clinical and experimental rheumatology2005;23(6): 905–911. [3] Piotto DGP, Len CA, Hilario MOE, Terreri MTRA. Nailfold Capillaroscopy in children and adolescents with rheumatic diseases. Rev Bras Reumatol2012;52(5):722–732. [4] Schonenberg-Meinema D, van den Berg JM, Nassar-Sheikh-Rashid A, de Bree GJ, Hak AE, van Onna M, Melsen K, Cutolo M, Kuijpers TW, Smith V. Capillaroscopy findings in childhood-onset systemic lupus erythematosus, a Dutch experience of 20 children and adolescents. EULAR2017, poster 4704. [5] Meroni M, Pizzorni C, Sulli A, Rossi P, Stobbione P, Cutolo M. Selected nailfold videoCapillaroscopy changes are linked to SLE-onet in a cohort of UCTD subjects. ACR2017, poster 698. [6] Cutolo M. Atlas of Capillaroscopy in rheumatic diseases. Milan: Elsevier;2010. Disclosure of Interest None declared
-
nailfold Capillaroscopy in systemic lupus erythematosus a systematic review and critical appraisal
Autoimmunity Reviews, 2018Co-Authors: Maurizio Cutolo, Kristof Thevissen, Filip De Keyser, Karin Melsens, Francesca Ingegnoli, Sara R A Wijnant, Saskia Decuman, Ulf MullerladnerAbstract: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 resume 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.
-
Capillaroscopy in routine diagnostics potentials and limitations
Current Rheumatology Reviews, 2018Co-Authors: Francesca Ingegnoli, Vanessa Smith, A Sulli, Maurizio CutoloAbstract:Background Nailfold Capillaroscopy is a safe and useful investigational tool that allows an early detection and a qualitative description of the microvascular abnormalities in patients with Raynaud's phenomenon secondary to scleroderma-spectrum disorders. Nowadays, the role of Capillaroscopy in the diagnosis of systemic sclerosis is well known. Capillaroscopy has been included in the new 2013 classification criteria for systemic sclerosis and is considered a key investigation in the very early phases of the disease. Conclusion Because of its potential value in monitoring disease progression and treatment response, nailfold Capillaroscopy may also have a role in the management of overt systemic sclerosis. Results Its application in scleroderma-spectrum disorders in which a microvascular component is suspected may also provide new insights into their pathophysiology.
Francesca Ingegnoli - One of the best experts on this subject based on the ideXlab platform.
-
nailfold Capillaroscopy in systemic lupus erythematosus a systematic review and critical appraisal
Autoimmunity Reviews, 2018Co-Authors: Maurizio Cutolo, Kristof Thevissen, Filip De Keyser, Karin Melsens, Francesca Ingegnoli, Sara R A Wijnant, Saskia Decuman, Ulf MullerladnerAbstract: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 resume 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.
-
Capillaroscopy in routine diagnostics potentials and limitations
Current Rheumatology Reviews, 2018Co-Authors: Francesca Ingegnoli, Vanessa Smith, A Sulli, Maurizio CutoloAbstract:Background Nailfold Capillaroscopy is a safe and useful investigational tool that allows an early detection and a qualitative description of the microvascular abnormalities in patients with Raynaud's phenomenon secondary to scleroderma-spectrum disorders. Nowadays, the role of Capillaroscopy in the diagnosis of systemic sclerosis is well known. Capillaroscopy has been included in the new 2013 classification criteria for systemic sclerosis and is considered a key investigation in the very early phases of the disease. Conclusion Because of its potential value in monitoring disease progression and treatment response, nailfold Capillaroscopy may also have a role in the management of overt systemic sclerosis. Results Its application in scleroderma-spectrum disorders in which a microvascular component is suspected may also provide new insights into their pathophysiology.
-
an international survey on non invasive techniques to assess the microcirculation in patients with raynaud s phenomenon sunshine survey
Rheumatology International, 2017Co-Authors: Francesca Ingegnoli, Maurizio Cutolo, Annalisa Orenti, Patrizia Boracchi, A Sulli, Ivan Foeldvari, Yannick Allanore, N Ughi, Graham Dinsdale, Vanessa SmithAbstract:To canvas opinion concerning the role of non-invasive techniques in the assessment of patients with Raynaud's phenomenon (Rp) in clinical and research settings: four nailfold Capillaroscopy methods [videoCapillaroscopy (NVC), dermoscopy, stereomicroscopy, digital USB microscopy], four laser Doppler methods (laser Doppler flowmetry, imaging, anemometry/velocimetry, laser speckle contrast analysis), thermographic imaging, and upper limb arterial Doppler ultrasound. Emails with a link to the survey were sent to physicians from the European Scleroderma Trials and Research group (EUSTAR), the EULAR Study Group on Microcirculation in Rheumatic Diseases (SG_MC/RD) and members of the pediatric rheumatology Email board. The main descriptive analysis related to physicians looking after adult patients, with some analysis also of opinions from paediatric rheumatologists. 106 'adult physicians' responded (a response rate of 25.8%), of whom 68.9% were European, and 81.1% practising for more than 10 years. Nineteen paediatricians responded. The most widely available technique was NVC (72.7%). Nailfold Capillaroscopy was most frequently performed by the physician him/herself, using different types of equipment relating to availability. Most rheumatologists reported high levels of appropriateness for NVC in both clinical and research settings for global assessment and differential diagnosis of Rp. Other techniques were less used. Of all the different techniques, nailfold Capillaroscopy was the one most used in both clinical and research settings by adult physicians, the majority of whom use NVC in their everyday practice. The low proportion of clinicians using other techniques suggests that these are currently mainly research tools, available only in specialist centres.
-
thu0252 nailfold Capillaroscopy in systemic lupus erythematosus a systematic review and critical appraisal
Annals of the Rheumatic Diseases, 2017Co-Authors: Sara R A Wijnant, Kristof Thevissen, Karin Melsens, Francesca Ingegnoli, F De Keyser, Saskia Decuman, Ellen Deschepper, Oliver Distler, Ulf Mullerladner, Yves PietteAbstract:Background Systemic lupus erythematosus (SLE) is a rheumatic disease with common vascular involvement. Nailfold capillaroscopic changes have been described in SLE. Although, until today there is no clear role yet for Capillaroscopy in classifying or staging the disease. Objectives To systematically review and critically appraise the literature on capillaroscopic changes described in SLE. Methods A sensitive search, on behalf of the EULAR study group on microcirculation in Rheumatic Diseases, was developed in Web Of Science, PubMed and Embase to identify all original research studies in which SLE patients had Capillaroscopy. Two reviewers identified titles, abstracts and full texts. Exclusion criteria were: ACR criteria for SLE were not met, less than 5 patients were included in the study, there was no information on Capillaroscopy in SLE, no original research or non-English language. All included articles underwent quality appraisal. Results were summarised according to density, dimensions, morphology, haemorrhages, semi quantitative assessment, qualitative assessment (see table) and correlation of capillaroscopic changes with clinical and laboratory parameters. Results From 172 articles captured, 36 articles were included in this review. The following capillaroscopic parameters were significantly more prevalent in SLE patients compared to healthy controls (see table): tortuous capillaries, abnormal morphology, haemorrhages, nailfold capillaroscopic score, “non-specific patterns” and “scleroderma like pattern”. Hairpin shaped capillaries were significantly more prevalent in healthy controls compared to SLE patients. For clinical and laboratory parameters, Raynaud9s phenomenon (RP), gangrene and 24 hours proteinuria were significantly correlated with capillaroscopic changes. Conclusions This first systematic review on Capillaroscopy in SLE attests conclusive significant differences in morphology, haemorrhages, semi quantitative assessment, qualitative assessment and some clinical and laboratory parameters. Further large scale research is ongoing through the EULAR study group on microcirculation in Rheumatic Diseases to further define its role. Disclosure of Interest None declared
-
a comparison between nailfold Capillaroscopy patterns in adulthood in juvenile and adult onset systemic sclerosis a eustar exploratory study
Microvascular Research, 2015Co-Authors: Francesca Ingegnoli, Vanessa Smith, Maurizio Cutolo, Roberta Gualtierotti, Patrizia Boracchi, Ivan Foeldvari, Paolo Airo, Juan Jose Alegresancho, Yannick Allanore, L AnanievaAbstract:Objective: Qualitative Capillaroscopy patterns in juvenile- and adult-onset systemic sclerosis (SSc) were studied in adulthood using data from the EULAR Scleroderma Trials and Research (EUSTAR) database. Methods: Data collected between June 2004 and April 2013 were examined with focus on Capillaroscopy. In this retrospective exploratory study, series of patients with juvenile-onset SSc were matched with series of adult-onset SSc having the same gender and autoantibody profile. Results: 30 of 123 patients with juvenile-onset and 2108 of 7133 with adult-onset SSc had data on Capillaroscopy. Juvenile-onset SSc showed scleroderma pattern more frequently than adult-onset SSc (93.3% and 88%). The OR was 2.44 and 95% Cl 0.57-10.41. An active scleroderma pattern was present in 58% of juvenile- and 61% of adult-onset SSc. The OR was 0.91 and 95% Cl 0.28-2.93. The late scleroderma pattern was present in 61% of juvenile- and 55.5% of adult-onset SSc. The OR was 1.06 and 95% Cl 0.34-3.56. Conclusion: This is the first exploratory study on the comparison of Capillaroscopy between juvenile- and adult-onset SSc in adulthood. Juvenile-onset SSc had an increase prevalence of sderoderma pattern, but a similar distribution of the three patterns was suggested. Further studies are needed to define this issue. (C) 2015 Elsevier Inc. All rights reserved.
Vanessa Smith - One of the best experts on this subject based on the ideXlab platform.
-
Capillaroscopy in childhood onset systemic lupus erythematosus a first systematic review
Clinical and Experimental Rheumatology, 2020Co-Authors: Dieneke Schonenbergmeinema, Karin Melsens, Maurizio Cutolo, Taco W Kuijpers, Amara Nassarsheikh Rashid, Merlijn J Van Den Berg, Vanessa SmithAbstract:OBJECTIVES: Recently, a systematic review indicated that, compared to healthy controls, adult patients with systemic lupus erythematosus (SLE) show a significantly more abnormal capillary morphology and greater number of haemorrhages in nailfold Capillaroscopy and that these capillary changes are associated with disease activity. As yet, no systematic literature evaluation of Capillaroscopy in childhood-onset SLE (cSLE) has been performed. Therefore, we aimed to systematically review the literature on nailfold capillary characteristics in cSLE. METHODS: Search terms "SLE or Lupus", "Capillaroscopy" and "Juvenile or Childhood or Paediatric or Child" were used in PubMed, Embase and Web of Science. Capillary findings were evaluated according to the current international consensus-based definitions for analysis of capillaroscopic characteristics from the European League against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases (SG MC/RD). RESULTS: After screening eighty search hits, six articles were retained, two of which were case-control studies and four case series. For capillary density, no difference was found between cSLE and healthy controls (one study). Differences in capillary diameter, capillary morphology, haemorrhages and semi-quantitative score were inconclusive or non-interpretable. A scleroderma pattern was not detected in the case control studies but was reported in a minority of cSLE patients in 3 out of 4 case series. CONCLUSIONS: Literature on nailfold capillary findings in cSLE is scarce and inconclusive. To evaluate capillary characteristics in cSLE, prospective longitudinal studies are needed. Future studies should use uniform definitions for capillary characteristics and findings should be compared with healthy controls, matched for age and ethnicity. The EULAR SG MC/RD is stepping up to this need.
-
ab1088 capillary hemosiderin deposits or extravasations a subtype of haemorrhagethat acquires separate attention in quantitative analysis of nailfold Capillaroscopy in childhood onset sle
Annals of the Rheumatic Diseases, 2018Co-Authors: Dieneke Schonenbergmeinema, Maurizio Cutolo, M M Van Den Berg, A Nassarsheikhrashid, M Boumans, Taco W Kuijpers, Vanessa SmithAbstract:Background Quality of images in nailfold Capillaroscopy has improved in the last years by introduction of videoCapillaroscopy. Microangiopathy, as observed in Capillaroscopy of SLE-patients,1–3 can now be described by more detailed quantitative analysis. Recently, in a small cohort (n=22) of childhood-onset SLE (cSLE), we described capillary bleedings by two different subtypes: large haemorrhages and small point-shaped haemorrhages with a total count of resp. 0.2/1.5 per analysed image per patient.4 These small point shaped haemorrhages have also been described as hemosiderin deposits.5 Objectives To describe the reliability of assessment of two subtypes in capillary haemorrhages by inter-observer agreement. Methods Three observers, DS (paediatric rheumatologist with experience in Capillaroscopy), AN (fellow paediatric rheumatology without experience in Capillaroscopy) and MB (trainee in adult rheumatology with experience in Capillaroscopy), scored Capillaroscopy images from patients with Raynaud’s phenomenon and with cSLE. The observers were blinded for patient name and diagnosis. The number of haemorrhages were scored per subtype. Hemosiderin deposits were defined as small point-shaped extravasations surrounding the capillary apex (see image). Large haemorrhages were defined according to the Atlas of Capillaroscopy.6 Reliability was calculated by the intra-class correlation coefficient (ICC) with 95% confidence interval (CI). Statistical analyses was performed by IBM SPSS Statistics version 24. Results Two-hundred images from 50 patients (diagnosed with Raynaud’s phenomenon and/or cSLE) were scored by the three independent observers. ICC for the number of capillaries with hemosiderin deposits was 0.77 (95% CI 0.69–0.82). ICC for the number of large capillary haemorrhages was 0.97 (95% CI 0.96–0.98). Conclusions Reliability of the observation ‘hemosiderin deposits’ in nailfold videoCapillaroscopy was good with an ICC of 0.77. This study shows that capillary haemorrhages can be described in 2 subtypes: ‘large haemorrhages’ and ‘hemosiderin deposits’ which are small point-shaped extravasations surrounding the capillary apex. References [1] Ingegnoli F, Herrick AL. Nailfold Capillaroscopy in pediatrics. Arthritis Care & Research2013;65(9): 1393–1400. [2] Ingegnoli F, Zeni S, Gerloni V, Fantani F. Capillaroscopic observations in childhood onset rheumatic diseases and healthy controls. Clinical and experimental rheumatology2005;23(6): 905–911. [3] Piotto DGP, Len CA, Hilario MOE, Terreri MTRA. Nailfold Capillaroscopy in children and adolescents with rheumatic diseases. Rev Bras Reumatol2012;52(5):722–732. [4] Schonenberg-Meinema D, van den Berg JM, Nassar-Sheikh-Rashid A, de Bree GJ, Hak AE, van Onna M, Melsen K, Cutolo M, Kuijpers TW, Smith V. Capillaroscopy findings in childhood-onset systemic lupus erythematosus, a Dutch experience of 20 children and adolescents. EULAR2017, poster 4704. [5] Meroni M, Pizzorni C, Sulli A, Rossi P, Stobbione P, Cutolo M. Selected nailfold videoCapillaroscopy changes are linked to SLE-onet in a cohort of UCTD subjects. ACR2017, poster 698. [6] Cutolo M. Atlas of Capillaroscopy in rheumatic diseases. Milan: Elsevier;2010. Disclosure of Interest None declared
-
Capillaroscopy in routine diagnostics potentials and limitations
Current Rheumatology Reviews, 2018Co-Authors: Francesca Ingegnoli, Vanessa Smith, A Sulli, Maurizio CutoloAbstract:Background Nailfold Capillaroscopy is a safe and useful investigational tool that allows an early detection and a qualitative description of the microvascular abnormalities in patients with Raynaud's phenomenon secondary to scleroderma-spectrum disorders. Nowadays, the role of Capillaroscopy in the diagnosis of systemic sclerosis is well known. Capillaroscopy has been included in the new 2013 classification criteria for systemic sclerosis and is considered a key investigation in the very early phases of the disease. Conclusion Because of its potential value in monitoring disease progression and treatment response, nailfold Capillaroscopy may also have a role in the management of overt systemic sclerosis. Results Its application in scleroderma-spectrum disorders in which a microvascular component is suspected may also provide new insights into their pathophysiology.
-
state of the art on nailfold Capillaroscopy in dermatomyositis and polymyositis
Seminars in Arthritis and Rheumatism, 2017Co-Authors: Chiara Bertolazzi, Vanessa Smith, Maurizio Cutolo, Marwin GutierrezAbstract:Abstract Objectives To provide an overview of the main nailfold Capillaroscopy (NFC) changes described in dermatomyositis (DM) and polymyositis (PM) and to discuss the current evidence supporting its clinical relevance and applications in daily practice. Methods All relevant literature in the field of NFC and DM and PM published in the last 30 years has been systematically reviewed. A systematic research was performed in the electronic databases PubMed and EMBASE. Results A total of 540 publications were identified according to the proposed filters and 27 were included for the review. The articles have been critically analyzed with a focus on technical aspects, examined anatomical areas, main pathological Capillaroscopy findings ,and the relationship between NFC alterations and critical parameters of DM and PM. Conclusions The overview confirms that NFC is a safe and noninvasive tool able to help the clinician in the diagnosis of DM and PM and to better characterize the phase of disease activity of these patients.
-
an international survey on non invasive techniques to assess the microcirculation in patients with raynaud s phenomenon sunshine survey
Rheumatology International, 2017Co-Authors: Francesca Ingegnoli, Maurizio Cutolo, Annalisa Orenti, Patrizia Boracchi, A Sulli, Ivan Foeldvari, Yannick Allanore, N Ughi, Graham Dinsdale, Vanessa SmithAbstract:To canvas opinion concerning the role of non-invasive techniques in the assessment of patients with Raynaud's phenomenon (Rp) in clinical and research settings: four nailfold Capillaroscopy methods [videoCapillaroscopy (NVC), dermoscopy, stereomicroscopy, digital USB microscopy], four laser Doppler methods (laser Doppler flowmetry, imaging, anemometry/velocimetry, laser speckle contrast analysis), thermographic imaging, and upper limb arterial Doppler ultrasound. Emails with a link to the survey were sent to physicians from the European Scleroderma Trials and Research group (EUSTAR), the EULAR Study Group on Microcirculation in Rheumatic Diseases (SG_MC/RD) and members of the pediatric rheumatology Email board. The main descriptive analysis related to physicians looking after adult patients, with some analysis also of opinions from paediatric rheumatologists. 106 'adult physicians' responded (a response rate of 25.8%), of whom 68.9% were European, and 81.1% practising for more than 10 years. Nineteen paediatricians responded. The most widely available technique was NVC (72.7%). Nailfold Capillaroscopy was most frequently performed by the physician him/herself, using different types of equipment relating to availability. Most rheumatologists reported high levels of appropriateness for NVC in both clinical and research settings for global assessment and differential diagnosis of Rp. Other techniques were less used. Of all the different techniques, nailfold Capillaroscopy was the one most used in both clinical and research settings by adult physicians, the majority of whom use NVC in their everyday practice. The low proportion of clinicians using other techniques suggests that these are currently mainly research tools, available only in specialist centres.
Ariane L Herrick - One of the best experts on this subject based on the ideXlab platform.
-
quantitative nailfold Capillaroscopy update and possible next steps
Rheumatology, 2021Co-Authors: Ariane L Herrick, Michael Berks, C TaylorAbstract:We review the exciting potential (and challenges) of quantitative nailfold Capillaroscopy, focusing on its role in systemic sclerosis. Quantifying abnormality, including automated analysis of nailfold images, overcomes the subjectivity of qualitative/descriptive image interpretation. First we consider the rationale for quantitative analysis, including the potential for precise discrimination between normal and abnormal capillaries and for reliable measurement of disease progression and treatment response. We discuss nailfold image acquisition and interpretation, and describe how early work on semi-quantitative and quantitative analysis paved the way for semi-automated and automated analysis. Measurement of red blood cell velocity is described briefly. Finally we give a personal view on 'next steps'. From a clinical perspective, increased uptake of nailfold Capillaroscopy by general rheumatologists could be achieved via low-cost hand-held devices with cloud-based automated analysis. From a research perspective, automated analysis could facilitate large-scale prospective studies using capillaroscopic parameters as possible biomarkers of systemic sclerosis-spectrum disorders.
-
comparison between low cost usb nailfold Capillaroscopy and videoCapillaroscopy a pilot study
Rheumatology, 2020Co-Authors: Michael Berks, Graham Dinsdale, C Taylor, Elizabeth Marjanovic, Andrea Murray, Ariane L HerrickAbstract:Objectives Universal serial bus (USB) microscopy (Capillaroscopy) could provide all rheumatologists with an easy-to-use, low-cost tool to examine the nailfold capillaries to facilitate early diagnosis of SSc. The objectives of this pilot study were to examine the feasibility of acquiring and analysing images using USB microscopy and to compare results to videoCapillaroscopy. Methods VideoCapillaroscopy and USB microscope images were obtained from the right and left ring fingers of 20 patients with SSc and 20 healthy control subjects. In addition to generating panoramic capillary mosaics from across the whole nailbed, custom software made fully automated measurements of vessel structure including capillary width and density. The area under the receiver operating characteristic curve (AZ) was used to measure separation between the SSc and healthy control groups. Results High quality images could be generated from the USB microscope, with reconstructed USB images comparing very favourably with those obtained using videoCapillaroscopy. Using USB microscope images, the receiver operating characteristic curve AZ for group separation based on mean width was 0.81 (standard error 0.120) compared with 0.81 (standard error 0.095) for the (gold standard) videoCapillaroscopy. The receiver operating characteristic curve AZ for group separation using capillary density was 0.48 (standard error 0.16) for USB microscope images, compared with 0.70 (standard error 0.10) for videoCapillaroscopy. Conclusion In this pilot study, USB Capillaroscopy was able to discriminate between patients with SSc and controls as well as videoCapillaroscopy on the basis of capillary width. This finding, together with the high-quality images obtained, highlights the potential of USB Capillaroscopy as a low-cost, easily accessible clinical and research tool.
-
the role of Capillaroscopy and thermography in the assessment and management of raynaud s phenomenon
Autoimmunity Reviews, 2018Co-Authors: Ariane L Herrick, A MurrayAbstract:Most patients with Raynaud's phenomenon (RP) have "benign" primary RP (PRP), but a minority have an underlying cause, for example a connective tissue disease such as systemic sclerosis (SSc). Secondary RP can be associated with structural as well as functional digital vascular changes and can be very severe, potentially progressing to digital ulceration or gangrene. The first step in management is to establish why the patient has RP. This short review discusses the role of nailfold Capillaroscopy and thermography in the assessment of RP. Nailfold Capillaroscopy examines microvascular structure, which is normal in PRP but abnormal in most patients with SSc: the inclusion of abnormal nailfold capillaries into the 2013 classification criteria for SSc behoves clinicians diagnosing connective tissue disease to be familiar with the technique. For those without access to the gold standard of high magnification videoCapillaroscopy, a low magnification dermatoscope or USB microscope can be used. Thermography measures surface temperature and is therefore an indirect measure of blood blow, assessing digital vascular function (abnormal in both PRP and SSc). Until now, the use of thermography has been mainly confined to specialist centres and used mainly in research: this may change with development of mobile phone thermography.
-
automated structure and flow measurement a promising tool in nailfold Capillaroscopy
Microvascular Research, 2018Co-Authors: Michael Berks, Graham Dinsdale, C Taylor, Andrea Murray, Tonia L Moore, Joanne Manning, Ariane L HerrickAbstract:Abstract Objectives Despite increasing interest in nailfold Capillaroscopy, objective measures of capillary structure and blood flow have been little studied. We aimed to test the hypothesis that structural measurements, capillary flow, and a combined measure have the predictive power to separate patients with systemic sclerosis (SSc) from those with primary Raynaud's phenomenon (PRP) and healthy controls (HC). Methods 50 patients with SSc, 12 with PRP, and 50 HC were imaged using a novel Capillaroscopy system that generates high-quality nailfold images and provides fully-automated measurements of capillary structure and blood flow (capillary density, mean width, maximum width, shape score, derangement and mean flow velocity). Population statistics summarise the differences between the three groups. Areas under ROC curves (A Z ) were used to measure classification accuracy when assigning individuals to SSc and HC/PRP groups. Results Statistically significant differences in group means were found between patients with SSc and both HC and patients with PRP, for all measurements, e.g. mean width (μm) ± SE: 15.0 ± 0.71, 12.7 ± 0.74 and 11.8 ± 0.23 for SSc, PRP and HC respectively. Combining the five structural measurements gave better classification (A Z = 0.919 ± 0.026) than the best single measurement (mean width, A Z = 0.874 ± 0.043), whilst adding flow further improved classification (A Z = 0.930 ± 0.024). Conclusions Structural and blood flow measurements are both able to distinguish patients with SSc from those with PRP/HC. Importantly, these hold promise as clinical trial outcome measures for treatments aimed at improving finger blood flow or microvascular remodelling.
-
quantitative nailfold video Capillaroscopy in patients with idiopathic inflammatory myopathy
Rheumatology, 2010Co-Authors: Louise K Mercer, Hector Chinoy, Robert G. Cooper, Tonia Moore, A Murray, Andy Vail, Ariane L HerrickAbstract:Objectives. To quantify nailfold capillary density and dimensions in patients with idiopathic inflammatory myopathy (IIM) and compare them with those in healthy controls; to look for associations with microvascular disease in IIM; and to determine whether nailfold capillary density and dimensions change over time. Methods. Nailfold video microscopy (x300 magnification) was performed on 24 patients with IIM and 35 healthy controls. Capillary density and dimensions (total width and apical width) were quantified. Patients were clinically assessed and disease activity recorded using the Myositis Disease Activity Assessment Tool. Disease severity and physical function were assessed using the myositis damage index and Stanford HAQ, respectively. Findings were analysed using linear and logistic regression, adjusted for age and sex. In a subgroup of 16 patients with IIM and 27 controls, the process was repeated 6-12 months later and the results were analysed using Student's t-test. Results. Capillary density was lower and dimensions were higher in patients with IIM compared with healthy controls (P < 0.001 for all). Anti-Jo-1 antibody was associated with reduced capillary density. In the longitudinal cohort, the mean change in capillary density was -1.4 in patients vs -0.4 in controls (P = 0.07). Mean change in capillary dimensions did not differ between patients and controls, but some patients demonstrated pronounced changes in capillary morphology over time. Conclusions. Reduced capillary density and increased dimensions in patients with IIM can be quantified using nailfold Capillaroscopy, suggesting that nailfold Capillaroscopy may be useful as an outcome measure of microvascular disease in studies of IIM.
Patrizia Boracchi - One of the best experts on this subject based on the ideXlab platform.
-
an international survey on non invasive techniques to assess the microcirculation in patients with raynaud s phenomenon sunshine survey
Rheumatology International, 2017Co-Authors: Francesca Ingegnoli, Maurizio Cutolo, Annalisa Orenti, Patrizia Boracchi, A Sulli, Ivan Foeldvari, Yannick Allanore, N Ughi, Graham Dinsdale, Vanessa SmithAbstract:To canvas opinion concerning the role of non-invasive techniques in the assessment of patients with Raynaud's phenomenon (Rp) in clinical and research settings: four nailfold Capillaroscopy methods [videoCapillaroscopy (NVC), dermoscopy, stereomicroscopy, digital USB microscopy], four laser Doppler methods (laser Doppler flowmetry, imaging, anemometry/velocimetry, laser speckle contrast analysis), thermographic imaging, and upper limb arterial Doppler ultrasound. Emails with a link to the survey were sent to physicians from the European Scleroderma Trials and Research group (EUSTAR), the EULAR Study Group on Microcirculation in Rheumatic Diseases (SG_MC/RD) and members of the pediatric rheumatology Email board. The main descriptive analysis related to physicians looking after adult patients, with some analysis also of opinions from paediatric rheumatologists. 106 'adult physicians' responded (a response rate of 25.8%), of whom 68.9% were European, and 81.1% practising for more than 10 years. Nineteen paediatricians responded. The most widely available technique was NVC (72.7%). Nailfold Capillaroscopy was most frequently performed by the physician him/herself, using different types of equipment relating to availability. Most rheumatologists reported high levels of appropriateness for NVC in both clinical and research settings for global assessment and differential diagnosis of Rp. Other techniques were less used. Of all the different techniques, nailfold Capillaroscopy was the one most used in both clinical and research settings by adult physicians, the majority of whom use NVC in their everyday practice. The low proportion of clinicians using other techniques suggests that these are currently mainly research tools, available only in specialist centres.
-
a comparison between nailfold Capillaroscopy patterns in adulthood in juvenile and adult onset systemic sclerosis a eustar exploratory study
Microvascular Research, 2015Co-Authors: Francesca Ingegnoli, Vanessa Smith, Maurizio Cutolo, Roberta Gualtierotti, Patrizia Boracchi, Ivan Foeldvari, Paolo Airo, Juan Jose Alegresancho, Yannick Allanore, L AnanievaAbstract:Objective: Qualitative Capillaroscopy patterns in juvenile- and adult-onset systemic sclerosis (SSc) were studied in adulthood using data from the EULAR Scleroderma Trials and Research (EUSTAR) database. Methods: Data collected between June 2004 and April 2013 were examined with focus on Capillaroscopy. In this retrospective exploratory study, series of patients with juvenile-onset SSc were matched with series of adult-onset SSc having the same gender and autoantibody profile. Results: 30 of 123 patients with juvenile-onset and 2108 of 7133 with adult-onset SSc had data on Capillaroscopy. Juvenile-onset SSc showed scleroderma pattern more frequently than adult-onset SSc (93.3% and 88%). The OR was 2.44 and 95% Cl 0.57-10.41. An active scleroderma pattern was present in 58% of juvenile- and 61% of adult-onset SSc. The OR was 0.91 and 95% Cl 0.28-2.93. The late scleroderma pattern was present in 61% of juvenile- and 55.5% of adult-onset SSc. The OR was 1.06 and 95% Cl 0.34-3.56. Conclusion: This is the first exploratory study on the comparison of Capillaroscopy between juvenile- and adult-onset SSc in adulthood. Juvenile-onset SSc had an increase prevalence of sderoderma pattern, but a similar distribution of the three patterns was suggested. Further studies are needed to define this issue. (C) 2015 Elsevier Inc. All rights reserved.
-
uniphasic blanching of the fingers abnormal Capillaroscopy in nonsymptomatic digits and autoantibodies expanding options to increase the level of suspicion of connective tissue diseases beyond the classification of raynaud s phenomenon
Clinical & Developmental Immunology, 2015Co-Authors: Francesca Ingegnoli, Pier Luigi Meroni, Roberta Gualtierotti, Annalisa Orenti, T Schioppo, Giovanni Marfia, Rolando Campanella, C Mastaglio, Patrizia BoracchiAbstract:In patients with Raynaud's phenomenon (RP), the role of medical history, Capillaroscopy, and autoantibodies in order to provide an early diagnosis of connective tissue disease (CTD) were examined. 115 consecutive adults with uni-, bi-, or triphasic colour changes of the fingers were studied. RP was bilateral in 92.7% of patients. The middle finger was significantly more affected. A lack of association between fingers affected by RP and fingers with capillary abnormalities was observed OR = 0.75 (0.34–1.66). RP with the cyanotic phase had a higher risk at Capillaroscopy to have hemorrhages OR = 4.46 (1.50–13.30) and giant capillaries OR = 24.85 (1.48–417.44). The thumb and triphasic involvement have an OR of 1.477 and 1.845, respectively. RP secondary to systemic sclerosis (SSc) had greater value of VAS pain (p = 0.011). The presence of anti-centromere antibodies was significantly associated with a higher risk of SSc (p < 0.001). 44.3% of subjects had uniphasic blanching of the fingers, and among these, 27% was diagnosed as having an overt or suspected CTD. Markers of a potential development of CTDs include severe RP symptoms, positive autoantibodies, and capillary abnormalities. These data support the proposal to not discharge patients with uniphasic blanching of the fingers to avoid missing the opportunity of an early diagnosis.
-
nailfold capillary patterns in healthy subjects a real issue in Capillaroscopy
Microvascular Research, 2013Co-Authors: Francesca Ingegnoli, Roberta Gualtierotti, Patrizia Boracchi, C Lubatti, Chiara Bertolazzi, Marwin Gutierrez, Marco Fornili, Rossella AngelisAbstract:Nailfold Capillaroscopy has been extensively applied in a broad spectrum of pathologic conditions, but very few data have been published in healthy individuals. The aim of this study was to describe the nailfold capillary findings on a large series of healthy subjects using the video-Capillaroscopy technique. Nailfold capillaries were studied based on their morphology, dimensions and density. Then, to evaluate jointly the association between different capillary findings in groups of subjects which were homogeneous for their characteristics, cluster analysis was performed. The results (median) of capillary measurements were as follows: loop length 207μm, external diameter 39μm, internal diameter 17μm, apical diameter 17μm, and intercapillary distance 143μm. Based on the cluster analysis three major "normal" morphologic capillaroscopic patterns were depicted: 1) the "normal" pattern mainly with 2 to 5 U-shaped loops/mm and ≤2 tortuous loops/mm; 2) the "perfect normal" pattern with ≥5 U-shaped loops/mm and 3) the "unusual normal" with at least 1 meandering or bushy loop, or at least 1 microhemorrhage, or with >4 crossed loops/mm. Regarding the loop measurements, the majority of subjects had a median of 7capillaries/mm with a median length of 198μm.
-
nailfold Capillaroscopy in systemic sclerosis data from the eular scleroderma trials and research eustar database
Microvascular Research, 2013Co-Authors: Francesca Ingegnoli, Patrizia Boracchi, Ilaria Ardoino, Maurizio CutoloAbstract:OBJECTIVE: The aims of this study were to obtain cross-sectional data on Capillaroscopy in an international multi-center cohort of Systemic Sclerosis (SSc) and to investigate the frequency of the capillaroscopic patterns and their disease-phenotype associations. METHODS: Data collected between June 2004 and October 2011 in the EULAR Scleroderma Trials and Research (EUSTAR) registry were examined. Patients' profiles based on clinical and laboratory data were obtained by cluster analysis and the association between profiles and Capillaroscopy was investigated by multinomial logistic regression. RESULTS: 62 of the 110 EUSTAR centers entered data on Capillaroscopy in the EUSTAR database. 376 of the 2754 patients (13.65%) were classified as scleroderma pattern absent, but non-specific capillary abnormalities were noted in 55.48% of the cases. Four major patients' profiles were identified characterized by a progressive severity for skin involvement, as well as an increased number of systemic manifestations. The "early" and "active" scleroderma patterns were generally observed in patients with mild/moderate skin involvement and a low number of disease manifestations, while the "late" scleroderma pattern was found more frequently in the more severe forms of the disease. CONCLUSION: These data indicate the importance of Capillaroscopy in SSc management and that capillaroscopic patterns are directly related to the extent of organ involvement.
