Increased capillary permeability in systemic rheumatoid vasculitis: detection by dynamic fluorescence nailfold videomicroscopy.

OBJECTIVE: Several histological studies suggest a vascular involvement in rheumatoid arthritis (RA). We evaluated morphological and functional changes of skin capillaries in patients with RA. METHODS: We studied capillary permeability by nailfold fluorescence videomicroscopy in patients with RA with and without systemic vasculitis to establish the sensitivity, specificity, and the prognostic value of the technique for the diagnosis of systemic rheumatoid vasculitis (SRV). Nine patients with SRV, 22 patients with active RA without signs of vasculitis, and 16 controls were evaluated. RESULTS: No difference in conventional capillaroscopy was observed when we compared patients with SRV and RA. Using fluorescence videomicroscopy after intravenous injection of fluorescein sodium, we observed an increase of transcapillary dye diffusion in 9/9 patients with SRV, in 13/22 patients with RA without vasculitis and in 4/16 control patients. Our results give a sensitivity of 100% in SRV, a specificity of 44%, a positive predictive value of 34% and a negative predictive value of 100%. CONCLUSION: Our present study points out the functional alteration of the capillary wall in patients with RA with or without vasculitis and suggests the usefulness of dynamic fluorescence nailfold capillaroscopy in patients with RA when systemic vasculitis is suspected, not as a diagnostic tool, but because of the high negative predictive value of the technique.

[Significance of arterial Doppler in Horton's disease. Prospective study of 59 case reports]. / Intérêt du Doppler artériel dans la maladie de Horton. Etude prospective de 59 observations.

Several preliminary studies drew attention to the value of Doppler examination in temporal arteritis. This study involving 59 cases aimed to define the value of Doppler examination in the diagnosis of the disease, evaluation of ophthalmic risk and in the monitoring of treatment. The study involved 59 patients and 47 controls with no evidence of temporal arteritis, but of comparable mean age. The following arteries were investigated before treatment: arteries of limbs, subclavian, vertebral, carotid, temporal, occipital, facial and ophthalmic recorded via the internal nasal branch and also transocularly. The results were expressed in the form of a score from 0 to 3 describing the degree of deterioration of the curves. A mean score corresponding to the mean of the scores of the cephalic arteries was calculated for each patient and each control. The specificity and sensitivity of the investigation were studied, based on this mean score by ROC analysis. The progression under treatment was monitored for more than 24 months in 20 patients divided into 3 groups: group I: 6 patients cured; group II: 6 patients with late recurrence of temporal arteritis after steroid withdrawal; group III: 8 patients with progressive disease. 81.5% of temporal arteries were pathological, including 60% with tight stenosis (score 2 and 3). Morphological anomalies in the curves were also noted at the level of the occipital arteries (69%), facial arteries (80%), as well as the ophthalmic artery at both recording sites (internal nasal: 84.5%, transocular: (73%) (table I).(ABSTRACT TRUNCATED AT 250 WORDS)