Taller de concordancia en la evaluación de imágenes capilaroscópicas / Reliability of nailfold videocapillaroscopy workshop

Introducción: la capilaroscopia es un método no invasivo que permite observar la microvasculatura en el área periungueal. Los resultados informados pueden ser altamente variables entre distintos observadores. A lo largo del tiempo surgieron métodos cuantitativos y semicuantitativos para mejorar la reproducibilidad. Objetivos: conocer el nivel de acuerdo intra e interobservador al informar los diferentes patrones capilaroscópicos en individuos con diferente nivel de entrenamiento. Materiales y métodos: estudio de corte transversal. Participaron médicos reumatólogos especialistas y en formación que habían realizado previamente un curso virtual de capacitación en capilaroscopia. Recibieron 40 imágenes capilaroscópicas proyectadas en una presentación de PowerPoint y debían responder a través de un cuestionario digital. Se evaluó la concordancia de respuestas intra e interobservador. Resultados: se encontró un alto nivel de concordancia global con un kappa 0,66 IC 95% (0,63-0,70) p<0,0000. También en otros grupos como reumatólogos en formación: kappa 0,65 IC 95% (0,60-0,71) p=0,0000, y médicos reumatólogos: kappa 0,67 IC 95% (0,62-0,72) p=0,0000. Conclusiones: el nivel de concordancia encontrado fue globalmente alto, independientemente del nivel de entrenamiento de los profesionales, y de ser o no reumatólogo. La concordancia fue superior cuando se comparó a quienes tenían más de 4 años de experiencia en la realización de videocapilaroscopia.

Introduction: videoapillaroscopy is a non-invasive method that allows the observation of the microvasculature in the periungual area. Reported results can be highly variable between different observers. Over time, quantitative and semi-quantitative methods emerged to improve reproducibility. Objetives: to know the level of intra and interobserver agreement when reporting the different capillaroscopic patterns in individuals with different levels of training. Materials and methods: cross section study. Specialist rheumatologists and those in training who had previously completed a virtual capillaroscopy training course participated. They received 40 capillaroscopic images projected in a PowerPoint presentation and had to issue their response through a digital questionnaire. Concordance of intra and interobserver responses was evaluated. Results: a high level of global agreement was found with a kappa 0.66 CI 95% (0.63-0.70) p<0.0000, also in other groups such as rheumatologists in training: kappa 0.65 CI 95% (0.60-0.71) p=0.0000, physicians rheumatologists: kappa 0.67 95% CI (0.62-0.72) p=0.0000. Conclusions: the level of agreement found was globally high, regardless of the level of training of the professionals, and whether or not they were a rheumatologist. Concordance was higher when compared to those who had more than 4 years of experience performing videocapillaroscopy.

Hallazgos capilaroscópicos y características clínicas en pacientes con fenómeno de Raynaud primario y secundario / Capillaroscopic findings and clinical characteristics in patients with primary and secondary Raynaud's phenomenon

Objetivos: describir hallazgos de videocapilaroscopía (VCP) en pacientes con fenómeno de Raynaud primario (FRP) y secundario (FRS); comparar características demográficas y clínicas entre ambos. Materiales y métodos: estudio observacional, analítico, transversal. Se documentaron edad, ocupación, tiempo de evolución del FR, enfermedad del tejido conectivo (ETC) y características capilaroscópicas. Las VCP se informaron como patrón normal, inespecífico o SD temprano, activo y tardío. Se realizó estadística descriptiva. Para variables categóricas se empleó Chi² o test exacto de Fisher; para variables continuas, t test o Man Whitney, considerando estadísticamente significativa p<0,05. Resultados: se realizaron 290 VCP. En pacientes con FRP (n:122), 18% (n:23) fue normal y 81% (n:99) con patrón inespecífico. En pacientes con FRS (n:168), 8% fue normal, 42% con patrón inespecífico y 51% con patrón SD (25% temprano, 44% activo, 31% tardío). Se hallaron diferencias estadísticamente significativas: tiempo de evolución de FR en meses (12 vs 36, p<0,01), VCP normal (18,85% vs 7,4%, p<0,01), patrón inespecífico (81,14% vs 41%, p<0,01) en pacientes con FRP vs. FRS. Conclusiones: en pacientes con FRS predominó el patrón SD, mientras que en aquellos con FRP fue superior el patrón normal e inespecífico. El FRS se asoció a mayor tiempo de evolución.

Objectives: to describe videocapillaroscopy (VCP) findings in patients with primary Raynaud's phenomenon (PRP) and secondary (SRP); compare demographic and clinical characteristics between both. Materials and methods: observational, analytical, cross-sectional study. Age, occupation, evolution time of RP, connective tissue disease (CTD) and capillaroscopic characteristics were documented. The VCP were reported as normal, nonspecific or early, active, and late SD pattern. Descriptive statistics were performed. Chi² or Fisher's exact test were used for categorical variables; for continuous variables t test or Man Whitney, considering statistically significant p<0.05. Results: 290 VCP were performed. In patients with PRP (n:122), 18% (n:23) were normal and 81% (n:99) non-specific. In patients with SRP (n:168), 8% were normal, 42% non-specific and 51% with SD pattern (25% early, 44% active, 31% late). We found statistically significant differences: time of evolution of RP in months (12 vs. 36, p<0.01), normal VCP (18.85% vs 7.4%, p<0.01), non-specific pattern (81.14% vs 41%, p<0.01) in patients with PRP vs SRP. Conclusions: in patients with FRS predominated the SD pattern, while in those with FRP the normal and nonspecific pattern was superior. FRS was associated with a longer evolution time.

La videocapilaroscopía en la enfermedad psoriásica / The videocapillaroscopy in psoriasis disease

The videocapillaroscopy (VCP) has become a valuable tool for early diagnosis of different diseases that affect connective tissue, becoming a reproducible, noninvasive method of high sensitivity that allows assessment of vascular involvement in some connective tissue disease. Its use has been extended to the study of other diseases such as psoriatic arthritis where it has been shown to play an important role in evaluating the psoriatic plaque as monitoring of the disease, highlighting its potential as a powerful tool for evaluation clinical and...

La Videocapilaroscopia (VCP) se ha convertido en una herramienta valiosa para el diagnóstico precoz de diferentes patologías que afectan el tejido conectivo, convirtiéndose en un método no invasivo, reproducible, de alta sensibilidad que permite la evaluación del compromiso vascular en algunas colagenopatías, sin embargo su utilización se ha extendido al estudio de otras patologías como la artritis psoriásica, en donde se ha demostrado que juega un papel importante en la evaluación de la placa psoriásica como en el monitoreo de la enfermedad, destacando su potencial como una herramienta poderosa para la evaluación clínica y de investigación...

Presencia de patrón esclerodérmico capilaroscópico en pacientes sin conectivopatías: descripción de dos casos clínicos / Scleroderma pattern in patients without connective tissue disorders: cases reports

Videocapillaroscopy (VCP) is a consolidated imaging technique that helps the clinician in the assessment of connective tissue disorders (CTD). Their findings have demonstrated predictive value, and a potential role in the differential diagnosis and treatment monitoring of CTD. To date, the scleroderma pattern has been described mainly in CTD. We describe two cases in which the presence of scleroderma pattern, evidenced by ATP, is not only present in CTD.

La videocapilaroscopia (VCP) es una técnica de imagen fácil, inocua y sencilla que se ha consolidado como ayuda diagnóstica para las enfermedades del tejido conectivo. Los hallazgos de VCP demostraron tener valor predictivo de patología microangiopática, siendo útil para el diagnóstico diferencial, seguimiento y monitoreo de respuesta al tratamiento. La presencia de patrón esclerodérmico hasta ahora ha sido descrita en patologías asociadas al tejido conectivo. Presentamos dos casos clínicos en los cuales la presencia de patrón esclerodérmico evidenciado por medio de la VCP no es exclusiva de las enfermedades del tejido conectivo.

Videocapilaroscopia periungueal. Su relevancia en el diagnóstico muy temprano de la esclerosis sistémica / Periungual videocapillaroscopy. Its relevante in the early dignosis of Systemic Sclerosis

La videocapilaroscopia es una técnica sencilla, inocua (no invasivo) y económica que debería incluirse en el protocolo de estudio de todo paciente que presente una clínica compatible con un fenómeno de Raynaud, sabiendo que esta manifestación se presenta casi en el 95% de los pacientes, incluso décadas antes del diagnóstico de esclerosis sistémica. La videocapilaroscopia en pacientes con esclerosis sistémica reporta alteraciones de la morfología capilar muchos años antes que las manifestaciones clínicas y/o de laboratorio de la enfermedad se hagan presentes. Estas consisten en agrandamientos capilares y hemorragias en los primeros estadios de la enfermedad. La alteración en los patrones videocapilaroscópicos periungueales constituye un elemento diagnóstico en patologías iniciales o latentes; en el presente trabajo haremos hincapié en su aplicación respecto al diagnóstico muy precoz de la esclerosis sistémica

Videocapillaroscopy is a simple, safe (non-invasive) and inexpensive technique and should be included in the study protocol for every patient presenting with a clinical picture compatible with Raynaud's phenomenon, knowing that this event occurs almost in 95% of patients even decades before the diagnosis of systemic sclerosis.Videocapillaroscopy in patients with systemic sclerosis reported capil-lary morphology changes many years before the clinical and/or labora-tory of the disease become present. These consist of enlargement of capillaries and bleeding in the early stages of the disease. The alteration in the periungual videocapillaroscopic patterns constitutes a diagnostic element in early or late disease; in the present work we will place emphasis on its application with regard to the very early diagnosis of systemic sclerosis.

Avaliação do efeito da sobrecarga lipídica na reatividade microvascular em mulheres obesas / Evaluation of the effect of lipid overload in microvascular reactivity in obese women

As mudanças nos hábitos alimentares têm causado efeitos impressionantes na saúde pública, diretamente relacionados ao aumento da ingestão de refeições ricas em gorduras, principalmente gorduras saturadas. A principal consequência desse consumo é o estado prolongado e excessivo da lipemia pós-prandial (LPP), considerada um dos fatores relacionados às anormalidades metabólicas e aos danos vasculares. O objetivo do estudo foiavaliar o efeito da sobrecarga lipídica na reatividade microvascular em mulheres obesas. Das 41 participantes deste estudo, 21 apresentavam o diagnóstico de obesidade, com IMC de 32,4±1,6 kg/m2 (média ±SD) e idade 31,6±5 anos e 20 mulheres saudáveis, com IMC de 21,9±1,7 kg/m2 e idade 27,2±5,5 anos. Após a avaliação clínica e laboratorial, as participantes tiveram a microcirculação examinada por dois métodos: a dinâmica do leito periungueal, para avaliação da densidade capilar funcional (DCF), velocidade de deslocamento das hemácias no basal (VDH) e após uma isquemia de 1 min (VDHmax) e tempo de reperfusão (TVDHmax). A segunda técnica foi a do dorso do dedo para avaliação da DCF no repouso, durante a hiperemia reativa e após oclusão venosa. Foi feita a coleta de sangue para avaliação do colesterol total (CT), triglicerídeos (TG), HDL-c e ácidos graxos livres (AGL), glicose, insulina e viscosidade plasmática em 30 e 50 rotações por minuto (rpm). Também foram medidas a pressão arterial sistólica (PAS), diastólica (PAD) e frequência cardíaca (FC). Após essas análises no repouso, todas as participantes receberam uma refeição rica em lipídios, e após 30, 60, 120 e 180 minutos da ingestão da refeição, os exames de videocapilaroscopia e a coleta de sangue foram novamente realizados.As participantes com obesidade apresentaram, após a sobrecarga lipídica, valores significativamente menores do que no jejum para: DCF basal do dorso do dedo (p=0,02); DCF durante hiperemia reativa (p=0,02), DCF pós-oclusão venosa (p=0,02), HDL-c (p<0,0001)...

Changes in eating habits have caused striking effects on public health, directly related to increased intake of food rich in fat, mainly saturated fat. The main consequence of this consumption is the excessive and prolonged state of postprandial lipemia (PPL), considered one an important factor related to metabolic abnormalities and vascular damage. The aim of this study was to assess effects of fat overload on microvascular reactivity in obese women. Of the 41 study participants, 21 had the diagnosis of obesity, with BMI of 32.4 ± 1.6 kg/m2 (mean ± SD) and age of 31.6 ± 5 years and 20 healthy women with BMI of 21.9 ± 1.7 kg/m2and age 27.2 ± 5.5 years. After clinical and laboratorial assessment, participants had the microcirculation examined by two methods: dynamic, using the nailfold bed to assess functional capillary density (FCD), red blood cell velocity in in control conditions (RBCV) and peak (RBCVmax) and time (TRBCVmax) to reach it after 1 min arterial occlusion. The second technique was the finger dorsum to assess FCD at rest and during the reactive hyperemia response and after venous occlusion. Blood sampling was performed to determine total cholesterol (TC), triglycerides (TG), HDL- c and free fatty acids (FFA), glucose, insulin and plasma viscosity at 30 and 50 rotations per minute (rpm). Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were also measured. After these measurements at rest, all participants received a meal rich in lipids, and after 30, 60, 120 and 180 min after ingestion, videocapillaroscopy exams and blood samples were taken again. Results - Obese participants, after fat overload, presented significantly lower values than at rest at finger dorsum of FCD (p = 0.02), FCD during reactive hyperemia (p = 0.02) and post- venous occlusion (p = 0.02), HDL-C (p <0.0001), LDL-C (p <0.0001) and FFA (p <0.0001) and high values for: RBCV at rest (p<0 ,0001), RBCVmax (p = 0.003), TRBCVmax (p = 0.004), glucose (p <0.0001)...