PO:15:219 | Nailfold capillaroscopic abnormalities in systemic lupus erythematosus: comparison with healthy controls and clinical-immunological correlations. Preliminary data

Chiara Orlandi^1|2, Alessia Loda², Cesare Tomasi^1|2, Silvia Ebe Lucia Della Pina^1|2, Claudia Barison^1|2, Cecilia Nalli¹, Ilaria Cavazzana^1|2, Micaela Fredi^1|2, Franco Franceschini^1|2. | ¹Rheumatology and Clinical Immunology Unit - ERN ReCONNET , ASST Spedali Civili of Brescia, Brescia, Italy; ²Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Background. This study aims to evaluate capillaroscopic abnormalities in systemic lupus erythematosus (SLE) patients versus healthy controls and investigate correlations between microvascular changes and clinical or immunological features. It also seeks to support the diagnostic and prognostic value of nailfold videocapillaroscopy (NVC) in SLE, following prior evidence of heterogeneous microvascular involvement (1).

Methods. This observational, case-control study included 105 patients diagnosed with SLE and 59 healthy controls, evaluated between January and June 2025. All participants underwent NVC performed by trained operators using standardized protocols. Capillaroscopic parameters assessed included average capillary density, presence of tortuous, dilated, and giant capillaries, neoangiogenesis, hemorrhages, and scleroderma or scleroderma-like pattern. Clinical data were collected through structured interviews and medical chart reviews, including vascular manifestations such as acrocyanosis, Raynaud’s phenomenon (RP), and digital ulcers, as well as smoking status, beta-blocker use, and autoantibody profiles. Statistical analyses included chi-square and t-tests for group comparisons, Fisher’s exact test for categorical variables, and calculation of odds ratios with 95% confidence intervals to explore associations between capillaroscopic findings and clinical-immunological variables.

Results. Compared to controls, SLE patients more frequently presented with Raynaud’s phenomenon (p=0.001) and acrocyanosis (p=0.003), while no significant differences were observed in smoking habits. Capillaroscopy revealed a significantly lower capillary density in SLE patients (p<0.001), and a higher frequency of tortuous (p=0.043), dilated (p=0.001), and giant capillaries (p=0.014). Neoangiogenesis (p<0.001) and scleroderma-like patterns (p=0.027) were exclusively observed in SLE patients (Table 1). Within the SLE cohort, associations between capillaroscopic abnormalities and clinical or immunological features were evaluated, only statistically significant associations are reported here. Acrocyanosis was associated with giant capillaries (p=0.030), while RP was significantly correlated with dilated (p=0.007), giant capillaries (p=0.045), and scleroderma-like patterns (p=0.013). Patients with vasculitis or digital ulcers showed an increased prevalence of capillary density <7/mm (p=0.025), giant capillaries (p=0.002), and scleroderma-like patterns (p=0.040). Anti-Sm antibody positivity was associated with neoangiogenesis (p=0.043) and dilated capillaries (p=0.012), while anti-U1RNP positivity correlated with neoangiogenesis (p=0.043) (Table 2).

Conclusions. SLE patients display distinct and significant nailfold capillaroscopic abnormalities when compared to healthy controls. Specific alterations, such as neoangiogenesis, giant capillaries, and scleroderma-like patterns, show meaningful associations with vascular symptoms and autoantibody profiles. These preliminary findings highlight the potential of NVC as a non-invasive, supportive tool for microvascular assessment, disease monitoring, and clinical stratification in SLE.

References. Cutolo M, Paolino S, Pizzorni C, Smith V. Vitamin D, steroid hormones, and autoimmunity. Ann N Y Acad Sci. 2018;1411(1):107-119. doi:10.1111/nyas.13524