Nailfold and labial in vivo capillary microscopy in systemic sclerosis

ABSTRACT

Systemic sclerosis [SSc] is characterized by a wide spread vascular disease. This study was designed to assess the vas cular damage in patients with SSc by in vivo capillary microscopy of the conventional site; the nailfold, as well as a second window the labial mucosa. The study included 17 patients [all females] suffering from SSc as well as 5 healthy controls. Nailfold and labial capillary microscopy was done to assess loop length, loop width [lumen included], loop density number/linear than, enlarged capillaries, avascualr areas, hemorrhages, and the architectural arrangement of the capillary network. Conventional nailfold capillary microscopy revealed shorter loop length, wider loop, and decreased number of capillaries/linear mm in SSc. than normal control. The SSc. patients capillaries were markedly tortuous, with frequent megacapillaries, avascular areas, and less frequently hemorrhages. Labial capillary microscopy proved as valuable as conventional nailfold examination. Labial capillaries were far easier to examine than nailfold capillaries due to the transparency of labial mucosa. In SSc patients there was loss of the normal organized architectural pattern of the capillaries. Hemorrhages were detected more frequently in labial mucosa than in nailfold, also enlarged capillaries, avascular areas, and very short capillaries were also noted. Howevere, measurements of capillary loop length and width were not as accurately recorted as those of the nailfold capillaries, but still were shorter and wider than healthy controls, respectively. Nailfold capillary microscopy is a valuable means of assessment of microvasculature in vivo for patients with SSc. It is noninvasive, informative, and reproducible. Labial capillaroscopy can be used when the nailfold is damaged or pigmented. Also, it is less affected by cold stress, chemical or mechanical factors. Patients with SSc showed a typical scleroderma pattern of microvascular changes when compared to controls