Distinct changes in nailfold capillaries are associated with the clinical and serological features of patients with systemic lupus erythematosus

BACKGROUND: The role of nailfold videocapillaroscopy (NVC) in systemic lupus erythematosus (SLE) remains undefined. Prognostic tools are needed for SLE as the phenotypes differ in prognosis and treatment. Recent studies have reported a high prevalence of capillary abnormalities in SLE. This study investigated whether distinct NVC patterns are associated with distinct SLE phenotypes.

METHODS: We did NVC and comprehensive clinical characterisation in 56 patients with SLE. Correlations within NVC findings were tested using Spearman's rho. Subsets of patients with similar NVC changes were identified through hierarchical cluster analysis of principal components based on Z-normalised scores, and associations with clinical phenotypes were analysed using multinomial logistic regression.

RESULTS: The cohort included 56 patients with SLE who had a median SLEDAI score of 6 (interquartile range: 3-10). The capillaroscopic alterations observed were ramifications (66%), disorganisation (89%), tortuous appearance (75%), low density (86%), meandering appearance (52%), dilatations (23%), and microhaemorrhages (29%). Cluster analysis identified three clusters: one dominated by ramifications (n = 16), one dominated by dilations (n = 10), and an unspecific reference cluster. The cluster dominated by ramifications correlated with chronic cutaneous lupus and Raynaud's phenomenon, while the cluster dominated by dilatations correlated with antiphospholipid syndrome and the presence of ≥2 antiphospholipid antibodies.

CONCLUSIONS: Capillaroscopic alterations are common in patients with SLE, and capillary ramifications and dilations are linked to distinct SLE phenotypes. The potential of NVC as a prognostic tool for specific organ involvement in patients with SLE should be further explored, hopefully paving the way for early prevention of severe manifestations and damage.