Clinical study
Skin capillary abnormalities as indicators of organ involvement in scleroderma (systemic sclerosis), Raynaud's syndrome and dermatomyositis

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Abstract

Forty-four study patients with scleroderma (systemic sclerosis) (28 patients), Raynaud's syndrome (13 patients) or dermatomyositis (three patients) were observed for skin capillary abnormalities by widefield microscopy and compared with three control groups of 20 subjects each: (1) patients with other rheumatic disease, (2) hospitalized patients with nonrheumatic conditions, and (3) healthy volunteers. The distinctive microvascular pattern (dilated and distorted capillary loops alternating with avascular areas) previously reported in scleroderma and dermatomyositis was observed almost exclusively in the study patients. The severity of capillary abnormalities varied among the diagnostic subgroups, and a positive correlation was found between the degree and extent of abnormal microvascular patterns and multisystem involvement.

On this basis, widefield nailfold capillary observations are proposed as a simple, inexpensive, reproducible technic for making an improved early diagnosis and predicting multisystem involvement in scleroderma, Raynaud's syndrome and dermatomyositis, presently a group of loosely associated and overlapping connective tissue disorders which often defy early and precise diagnosis.

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      It has gained remarkable interest among rheumatologists because of its utility in both clinical practice and research activity [8–10]. To date, several studies have demonstrated the diagnostic and prognostic role of NFC in rheumatic disorders, especially in systemic sclerosis (SSc) and Raynaud phenomenon (RP) [11–15]. IMs, especially DM, offer an ideal scenario for the use of NFC due to its active involvement of vascular endothelium that induces a complement-mediated microangiopathy [2–4].

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    This work was supported in part by the Sidney and Charlotte Lifschultz Foundation Gift for the Study of Scleroderma, the South Carolina State Appropriation for Research, the National Institutes of Health (Grant AM 18904), the R.G.K. Foundation Gift for the Study of Scleroderma, a grant from the Arthritis Foundation, Inc., New York Chapter, and the Grace J. Pezrow Grant for the Study of Raynaud's Syndrome.

    2

    From the Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

    1

    From the Department of Medicine, College of Physicians & Surgeons of Columbia University, New York, New York.

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