PO:14:207 | Nailfold capillaroscopy in systemic lupus erythematosus: microvascular alterations and their clinical relevance

Giulia Cassone¹, Filippo Santoro², Maria Grazia Malandra², Bruno Biasi², Elena Vanni², Caterina Vacchi¹, Alesandra Carobbio³, Dilia Giuggioli^1|2. | ¹Reumatologia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy; ²Università di Modena e Reggio Emilia, Modena, Italy; ³Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Univeristà di Modena e Reggio Emilia, Modena, Italy.

Background. Nailfold videocapillaroscopy (NVC) is a valuable tool for assessing microvascular abnormalities in connective tissue diseases. While well established in systemic sclerosis, its role in systemic lupus erythematosus (SLE) remains less defined. This study aims to systematically analyze capillaroscopic patterns in SLE patients, describe their most frequent features, and compare them with findings observed in individuals with primary Raynaud’s phenomenon (pRP).

Methods. We retrospectively analyzed NVC images from 64 SLE patients (mean age 49.5 years) and a matched control group of 70 pRP patients. Parameters assessed included capillary density, giant capillaries, microhemorrhages, neoangiogenesis, ectasias, tortuosity, and capillary loss. Findings were correlated with clinical and serological markers, including organ involvement and autoimmune markers (ANA, ENA, antiphospholipid antibodies).

Results. NVC abnormalities were observed in 58 (90.6%) of SLE patients. The most frequent alterations in SLE were tortuosity (76.6%), ectasia (42.2%), microhemorrhages (29.7%), neoangiogenetic features (20.3%), and giant capillaries (10.9%). Compared to pRP patients, SLE patients exhibited a significantly higher prevalence of giant capillaries and angiogenetic features (p = 0.028 and p < 0.001, respectively). An SSc-like pattern was detected in 7.8% of cases, though no direct correlation was found with autoimmunity markers or clinical manifestations. Notably, both neoangiogenetic features and giant capillaries demonstrated a strong positive correlation with interstitial lung disease (ILD) (p = 0.012 and p = 0.021, respectively), highlighting the potential role of capillaroscopic markers in identifying lupus patients at risk for pulmonary involvement.

Conclusion. Capillaroscopic alterations serve as key microvascular markers in SLE, providing insights into their prevalence and clinical significance. The strong correlation between neoangiogenesis, giant capillaries, and ILD underscores vascular involvement in pulmonary manifestations. NVC emerges as a valuable non-invasive tool for early ILD identification, potentially improving diagnosis and risk stratification. The detection of an SSc-like pattern in some cases reinforces the concept of shared vascular dysfunction among autoimmune diseases, highlighting the need for further research. Future studies should focus on refining the predictive role of capillaroscopic parameters, evaluating their impact on ILD progression, and integrating NVC into routine clinical assessments to improve early detection and personalized management strategies for patients with SLE and other connective tissue diseases.