Capillaroscopy, Autoantibody Findings Predict Raynaud's Progression PDF Print E-mail
Thursday, 26 May 2011 14:35
Abnormal findings on nailfold capillary microscopy and the presence of scleroderma-specific autoantibodies in patients presenting with new-onset Raynaud’s phenomenon without overt connective tissue disease are powerful independent predictors of progression to definite scleroderma.

A landmark Canadian prospective study in 586 consecutive patients presenting with isolated Raynaud’s phenomenon showed that 13% of them developed scleroderma during 3,197 person-years of follow-up. Another 1% developed other connective tissue diseases. Fewer than 2% of those with normal nailfold capillaries and no scleroderma-specific antibodies went on to develop definite scleroderma during 15-20 years, and the majority who did progress to scleroderma did so within the first year or two, noted Dr. Fredrick M. Wigley at a symposium sponsored by the American College of Rheumatology.

In contrast, 80% of patients with baseline evidence of microvascular damage on nailfold microscopy together with one or more scleroderma-specific autoantibodies developed scleroderma. Two-thirds of patients with these baseline findings in the University of Montreal study (Arthritis Rheum. 2008;58:3902-12) progressed to definite scleroderma within the first 5 years of follow-up, added Dr. Wigley, professor of medicine and director of the scleroderma center at Johns Hopkins University, Baltimore.

Raynaud’s patients with one or more scleroderma-specific autoantibodies but no nailfold capillary abnormalities had a 35% rate of progression to scleroderma, with 60% of cases being diagnosed within the first 5 years. Patients with nailfold capillary abnormalities but no scleroderma-specific autoantibodies had a 26% long-term rate of progression to scleroderma, with roughly 90% of cases occurring within 5 years.

Nailfold microscopy is a simple matter. It can be carried out using a drop of immersion oil and an ophthalmoscope set at diopter 40. The microvascular damage that portends subsequent definite scleroderma follows a characteristic chronologic sequence consisting of enlarged capillary loops, followed by capillary loss, and capillary telangiectasias, Dr. Wigley explained.

The scleroderma-specific autoantibodies that proved predictive in the large Canadian study were anticentromere (anti-CENP-B) anti-TH/To, anti-topoisomerase I, and anti-RNA polymerase III.

The findings in the Canadian study, which was the first large prospective study of predictors of scleroderma in patients with Raynaud’s phenomenon, were remarkably consistent with those obtained earlier through a literature search by investigators at Dartmouth-Hitchcock Medical Center, Lebanon, N.H. They analyzed 10 published articles including 639 patients with primary Raynaud’s phenomenon, and determined that 12.6% of them developed a connective tissue disease during 2,531 person-years of follow-up, compared with 13.6% of patients in the Montreal study. Scleroderma accounted for the great majority of the cases of connective tissue disease in the Dartmouth-Hitchcock analysis, Dr. Wigley noted.

The mean rate of transition from isolated Raynaud's to scleroderma or another connective tissue disease in this series was 3.2 cases per 100 person-years. The best predictors were abnormal nailfold capillaries and the presence of antinuclear antibodies (Arch. Intern. Med. 1998;158:595-600).

Dr. Wigley declared that he receives consulting fees and/or research grants from Actelion, Amira, KineMed, MedImmune, Novartis, Orion, Pfizer, and United Therapeutics.

Source: Skin and Allergy News  (2011), "Capillaroscopy, Autoantibody Findings Predict Raynaud's Progression", original article can be found here.
 
More articles :

» Researchers Testing Intense Pulsed Light As An Alternative Treatment for Telangiectatases

Telangiectatases are knot-like clusters of blood vessels on the skin which can occur in 30 to 50 per cent of patients with Systemic Sclerosis, also known as . Telangiectases tend to occur on the face, neck, and upper limbs and can cause...

» Second Systemic Sclerosis World Congress a Success

Great success for the second Systemic Sclerosis World Congress that was held in February at the Palacio de Congresos de Madrid.After the positive experience of 2010 in Florence, organised the second edition the congress, on behalf of World...

» Scleroderma Research Foundation To Host Patient Webinar Series

The announced the first in a series of free informational Webinars for people living with and others directly or indirectly affected by the disease. The first Webinar will highlight new clinical trials and results from recent studies.The 2011/2012...

» The Inspirational Story of Haley Pilkington

Haley Pilkington is a remarkable singer for reasons far beyond her 14 years and the dynamic voice that so effortlessly uplifts anyone who hears her sing. Haley is a student of Deborah “Zuke” Smith, a Brett Manning Associate whose students...

» Anticoagulation of Systemic Sclerosis Patients In Question

Australia is in a state of ‘clinical equipoise’ over whether to anticoagulate systemic sclerosis patients with pulmonary hypertension, experts say. And with observational studies showing the treatment is associated with a  fivefold...

» A New Marker of Silent Cardiovascular Disease in Diffuse Scleroderma

Patients with diffuse systemic sclerosis (SSc) and no clinical evidence of (CVD) may, in fact, have subclinical CVD and , and it is detectable. This is the conclusion of a small pilot study from Italy, which showed that elevated plasma levels of ...

Add comment

Do feel free to leave your comments, as they would add value and knowledge to the community. However, please refrain from making any disparaging, uninformed, or unrelated comments. Thanks :)

Security code
Refresh