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Vol. 21. Issue 3.
(March 2025)
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Vol. 21. Issue 3.
(March 2025)
Original Article
Nailfold capillaroscopy changes in systemic lupus erythematosus patients: Correlation with disease activity and anti-uridin1-ribonucleoprotein antibodies
Cambios en la capilaroscopia ungueal en los pacientes con lupus eritematoso sistémico: correlación con la actividad de la enfermedad y los anticuerpos anti-uridina1-ribonucleoproteína
Yasmine S. Makarema,
Corresponding author
yasmine.saad@aun.edu.eg

Corresponding author.
, Zahraa I. Selima, Sherif Ismailb, Amera Imam Mekkawya, Hanan Galalc, Fatma H. El Noubya
a Rheumatology & Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
b Rheumatology & Rehabilitation, Department of Internal Medicine, Medical Research and Clinical Studies Institute, National Research Center, Egypt
c Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Tables (4)
Table 1. Baseline laboratory data of the studied SLE patients.
Tables
Table 2. Correlation between the capillaroscopic findings and the age, disease duration, and clinical data in the studied SLE patients.
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Table 3. Correlation between the capillaroscopic findings and the laboratory data from the studied SLE patients.
Tables
Table 4. Correlation between the anti-U1-RNP antibodies, the incidence of Raynaud's phenomenon, and different clinical and laboratory parameters in studied SLE patients.
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Abstract
Introduction

Systemic lupus erythematosus (SLE) is an autoimmune disease that causes multiple vascular complications, including endothelial cell damage. Nailfold capillaroscopy is the most effective non-invasive imaging technique for assessing the morphology of nailfold capillaries, and approximately half of the SLE patients have non-specific nailfold capillaroscopy abnormalities. Anti-uridin1-ribonucleoprotein antibodies are present in systemic lupus erythematosus patients with Raynaud's phenomenon, pulmonary artery hypertension, esophageal dysmotility, myopathy, and no severe renal involvement.

Aim

To detect different patterns of nailfold capillaroscopic changes in SLE patients, their correlation with SLE disease activity, and anti-U1-RNP antibodies.

Patients and methods

A case–control study included eighty-six SLE patients, and disease activity was assessed using the SLEDAI-2K. All patients had a nailfold capillaroscopic examination. Anti-uridin1-ribonucleoprotein antibodies were measured in all patients.

Results

Anti-uridin1-ribonucleoprotein antibodies had a significant inverse correlation with microhemorrhages and a significant direct relationship between anti-dsDNA antibody positivity and the presence of microhemorrhage. Additionally, a significant direct correlation was found between giant capillaries, venous plexus visibility, and higher ESR and CRP. Raynaud's phenomenon was significantly correlated with SLEDAI-2K, swollen joints, tender joints, and anti-dsDNA. Multiple linear regression analysis revealed that microhemorrhages and giant capillaries were the most significant predictors of lupus disease activity.

Conclusion

Our findings highlight the prevalence of microvascular abnormalities in systemic lupus erythematosus, including tortuosity, crossing, elongation, microhemorrhages, and giant capillaries, emphasizing the importance of NFC in assessing microcirculation and disease activity. Also, it adds to the growing body of evidence supporting the prognostic value of capillary abnormalities, particularly microhemorrhages and giant capillaries, as predictors of disease activity in systemic lupus erythematosus patients. Nailfold capillaroscopic examination can assess lupus activity and potentially predict the risk of serious complications.

Keywords:
Systemic lupus erythematosus
Nailfold capillaroscopy
Anti-U1-RNP
Resumen
Introducción

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune que causa múltiples complicaciones vasculares, incluido el daño de las células endoteliales. La capilaroscopia del pliegue ungueal es la técnica de imagen no invasiva más eficaz para evaluar la morfología de los capilares del pliegue ungueal, y aproximadamente la mitad de los pacientes con LES tienen anomalías inespecíficas de la capilaroscopia del pliegue ungueal. Los anticuerpos anti-uridina1-ribonucleoproteína están presentes en los pacientes con lupus eritematoso sistémico con fenómeno de Raynaud, hipertensión de la arteria pulmonar, dismotilidad esofágica, miopatía y sin afectación renal grave.

Objetivo

Detectar diferentes patrones de cambios capilaroscópicos en el pliegue ungueal en los pacientes con LES, su correlación con la actividad de la enfermedad del LES y los anticuerpos anti-U1-RNP.

Pacientes y métodos

Un estudio de casos y controles incluyó a 86 pacientes con LES y la actividad de la enfermedad se evaluó mediante el SLEDAI-2K. A todos los pacientes se les realizó un examen capilaroscópico del lecho ungueal. Se midieron anticuerpos anti-uridin1-ribonucleoproteína en todos los pacientes.

Resultados

Los anticuerpos anti-uridina1-ribonucleoproteína tuvieron una correlación inversa significativa con las microhemorragias y una relación directa significativa entre la positividad del anticuerpo anti-dsDNA y la presencia de microhemorragias. Además, se encontró una correlación directa significativa entre los capilares gigantes, la visibilidad del plexo venoso y una VSG y una PCR más altas. El fenómeno de Raynaud se correlacionó significativamente con SLEDAI-2K, articulaciones inflamadas, articulaciones sensibles y anti-ADNbc. El análisis de regresión lineal múltiple reveló que las microhemorragias y los capilares gigantes eran los predictores más importantes de la actividad de la enfermedad del lupus.

Conclusión

Nuestros hallazgos resaltan la prevalencia de anomalías microvasculares en el LES, incluyendo tortuosidad, cruce, elongación, microhemorragias y capilares gigantes, enfatizando la importancia de NFC en la evaluación de la microcirculación y la actividad de la enfermedad. Además, se suma al creciente conjunto de evidencia que respalda el valor pronóstico de las anomalías capilares, en particular las microhemorragias y los capilares gigantes, como predictores de la actividad de la enfermedad en los pacientes con LES. El examen capilaroscópico del pliegue ungueal puede evaluar la actividad del lupus, y potencialmente predecir el riesgo de complicaciones graves.

Palabras clave:
Lupus eritematoso sistémico
Capilaroscopia ungueal
Anti-U1-RNP

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