Nailfold videocapillaroscopy alterations in dermatomyositis, antisynthetase syndrome, overlap myositis, and immune-mediated necrotizing myopathy
The aim of our study was to investigate possible differences in nailfold videocapillaroscopy (NVC) features between patients with dermatomyositis (DM), overlap myositis (OM), antisynthetase syndrome (ASS), and immune-mediated necrotizing myopathy (IMNM).
We performed a cross-sectional monocentric study. All patients with inflammatory myopathies (IMs) over a 6-month period were analyzed by NVC for giant and ramified capillaries, tortuosities, capillary density, disorganization, and scleroderma pattern. Clinical, biological, and pathological characteristics were retrospectively recorded. Patients were classified as having DM, OM, ASS, or IMNM for comparison. Patients were also compared with a group of patients with systemic sclerosis (SSc).
NVC was analyzed in DM (n = 17), OM (n = 8), ASS (n = 12), and IMNM (n = 6). Vascular disorganization and avascular zones were observed only in DM (11.8%) and OM (62.5%). The percentage of patients with giant capillaries was higher in OM (n = 4/8) than in DM (n = 3/17) and absent in ASS and IMNM. Frequency of ramified capillaries, tortuosities, hemorrhages, or thrombosis was not different between subgroups. A scleroderma pattern was only observed in OM patients.
• Nailfold videocapillaroscopy abnormalities are different in subgroups of inflammatory myopathies.
• Giant capillaries, disorganization, and major capillary loss are observed in overlap myositis and dermatomyositis but not in antisynthetase syndrome (ASS) or immune-mediated necrotizing myopathy.
• Nailfold videocapillaroscopy abnormalities in overlap myositis (with the exclusion of ASS) are close to systemic sclerosis.
KeywordsAntisynthetase syndrome Dermatomyositis Immune-mediated necrotizing myopathy Inflammatory myopathies Nailfold capillaroscopy Overlap myositis
We thank Pr Nathalie Bardin for providing results for autoantibodies testing and Pr Christophe Chagnaud for magnetic resonance imaging in IMs patients.
Compliance with ethical standards
The study was performed in accordance with the ethical standards of the Helsinki Declaration. According to the French law (no. 2004–806, August 9, 2004), and because the data were collected retrospectively and patient management was not modified, this study did not require a specific research ethics committee approval.
- 1.van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA Jr, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Csuka ME, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE (2013) 2013 Classification Criteria for Systemic Sclerosis: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative: ACR/EULAR Classification Criteria for SSc. Arthritis Rheum 65:2737–2747. https://doi.org/10.1002/art.38098 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Soulaidopoulos S, Triantafyllidou E, Garyfallos A, Kitas GD, Dimitroulas T (2017) The role of nailfold capillaroscopy in the assessment of internal organ involvement in systemic sclerosis: a critical review. Autoimmun Rev 16:787–795. https://doi.org/10.1016/j.autrev.2017.05.019 CrossRefPubMedGoogle Scholar
- 4.Smith V, Decuman S, Sulli A, Bonroy C, Piettte Y, Deschepper E, de Keyser F, Cutolo M (2012) Do worsening scleroderma capillaroscopic patterns predict future severe organ involvement? A pilot study. Ann Rheum Dis 71:1636–1639. https://doi.org/10.1136/annrheumdis-2011-200780 CrossRefPubMedGoogle Scholar
- 5.Ingegnoli F, Ardoino I, Boracchi P, Cutolo M, Airò P, Ananieva LP, Ancuta C, Andrade LE, Becvar R, Benenati A, Caramaschi P, Carreira PE, Cuomo G, Damjanov N, Distler O, Foti R, Guiducci S, Hachulla E, Highton J, Kayser C, Lubatti C, Cerinic MM, Meier F, Meroni PL, Mihai CM, Morgiel E, Müller-Ladner U, Loyo E, Ortiz V, Riccieri V, Scheja A, Skacelova S, Smith V, Stamenkovic B, Stebbings S, Stoica V, Sulli A, Szechinski J, Tyndall A, Valentini G, Walker U, Zeni S, Zlatanovic M (2013) Nailfold capillaroscopy in systemic sclerosis: data from the EULAR scleroderma trials and research (EUSTAR) database. Microvasc Res 89:122–128. https://doi.org/10.1016/j.mvr.2013.06.003 CrossRefPubMedGoogle Scholar
- 7.Ingegnoli F, Ughi N, Crotti C, Mosca M, Tani C (2017) Outcomes, rates and predictors of transition of isolated Raynaud’s phenomenon: a systematic review and meta-analysis. Swiss Med Wkly 147. https://doi.org/10.4414/smw.2017.14506
- 11.Szabo N, Csiki Z, Szanto A, Danko K, Szodoray P, Zeher M (2008) Functional and morphological evaluation of hand microcirculation with nailfold capillaroscopy and laser Doppler imaging in Raynaud’s and Sjögren’s syndrome and poly/dermatomyositis. Scand J Rheumatol 37:23–29. https://doi.org/10.1080/03009740701640209 CrossRefPubMedGoogle Scholar
- 16.Mariampillai K, Granger B, Amelin D, Guiguet M, Hachulla E, Maurier F, Meyer A, Tohmé A, Charuel JL, Musset L, Allenbach Y, Benveniste O (2018) Development of a new classification system for idiopathic inflammatory myopathies based on clinical manifestations and myositis-specific autoantibodies. JAMA Neurol 75:1528–1537. https://doi.org/10.1001/jamaneurol.2018.2598 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Hamaguchi Y, Fujimoto M, Matsushita T, Kaji K, Komura K, Hasegawa M, Kodera M, Muroi E, Fujikawa K, Seishima M, Yamada H, Yamada R, Sato S, Takehara K, Kuwana M (2013) Common and distinct clinical features in adult patients with anti-aminoacyl-tRNA synthetase antibodies: heterogeneity within the syndrome. PLoS One 8:e60442. https://doi.org/10.1371/journal.pone.0060442 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Mescam-Mancini L, Allenbach Y, Hervier B, Devilliers H, Mariampillay K, Dubourg O, Maisonobe T, Gherardi R, Mezin P, Preusse C, Stenzel W, Benveniste O (2015) Anti-Jo-1 antibody-positive patients show a characteristic necrotizing perifascicular myositis. Brain 138:2485–2492. https://doi.org/10.1093/brain/awv192 CrossRefPubMedGoogle Scholar
- 25.Kubo S, Todoroki Y, Nakayamada S, Nakano K, Satoh M, Nawata A, Satoh Y, Miyagawa I, Saito K, Smith V, Cutolo M, Tanaka Y (2019) Significance of nailfold videocapillaroscopy in patients with idiopathic inflammatory myopathies. Rheumatology (Oxford) 58:120–130. https://doi.org/10.1093/rheumatology/key257 CrossRefGoogle Scholar
- 27.Sebastiani M, Triantafyllias K, Manfredi A, González-Gay MA, Palmou-Fontana N, Cassone G, Drott U, Delbrück C, Rojas-Serrano J, Bertolazzi C, Nuño L, Giannini M, Iannone F, Vicente EF, Castañeda S, Selva-O’Callaghan A, Trallero Araguas E, Emmi G, Iuliano A, Bauhammer J, Miehle N, Parisi S, Cavagna L, Codullo V, Montecucco C, Lopez-Longo FJ, Martínez-Barrio J, Nieto-González JC, Vichi S, Confalonieri M, Tomietto P, Bergner R, Sulli A, Bonella F, Furini F, Scirè CA, Bortoluzzi A, Specker C, Barsotti S, Neri R, Mosca M, Caproni M, Weinmann-Menke J, Schwarting A, Smith V, Cutolo M, The American and European Network of Antisynthetase Syndrome Collaborative Group (2019) Nailfold capillaroscopy characteristics of antisynthetase syndrome and possible clinical associations: results of a multicenter international study. J Rheumatol 46:279–284. https://doi.org/10.3899/jrheum.180355 CrossRefGoogle Scholar
- 28.Pavlov-Dolijanovic S, Damjanov NS, Stojanovic RM, Vujasinovic Stupar NZ, Stanisavljevic DM (2012) Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: a follow-up study of 3,029 patients with primary Raynaud’s phenomenon. Rheumatol Int 32:3039–3045. https://doi.org/10.1007/s00296-011-2109-2 CrossRefPubMedGoogle Scholar
- 29.Manfredi A, Sebastiani M, Campomori F, Pipitone N, Giuggioli D, Colaci M, Praino E, Ferri C (2016) Nailfold videocapillaroscopy alterations in dermatomyositis and systemic sclerosis: toward identification of a specific pattern. J Rheumatol 43:1575–1580. https://doi.org/10.3899/jrheum.160122 CrossRefPubMedGoogle Scholar