Significance of nailfold videocapillaroscopy in patients with idiopathic inflammatory myopathies
Significance of nailfold videocapillaroscopy in patients with idiopathic inflammatory myopathies
复制标题
DOI：
10.1093/rheumatology/key257
复制
发表时间：
2019-01-01
期刊：
影响因子：
5.5
通讯作者：
Tanaka, Yoshiya
中科院分区：
文献类型：
--
作者：
Kubo, Satoshi;Todoroki, Yasuyuki;Tanaka, Yoshiya
目标。本研究旨在探讨特发性炎性肌病（IIMs）患者甲襞视频毛细血管镜检查（NVC）异常的临床和免疫学意义。在2014年4月至2017年8月期间，对连续70例未经治疗的iim日本患者进行了前瞻性研究。在基线和免疫抑制治疗1年后，评估DM皮疹的临床特征、NVC结果、免疫沉淀和ELISA的自身抗体谱以及皮肤活检的组织病理学结果。IIM患者中有55.7%（39/70）存在NVC异常，其中DM（65.4%）明显高于PM (27.8%) （P = 0.01）。在按自身抗体特异性分类的患者亚群中，抗mda5（87.5%）和抗转录中介因子1 γ(88.9%)患者的NVC异常患病率明显高于抗氨基酰基- trna合成酶（26.9%,P < 0.001）。NVC异常的DM患者皮疹活检的上真皮层血管周围淋巴细胞浸润更严重（P < 0.05）。出乎意料的是，在免疫抑制治疗1年后，75%的IIM患者的NVC异常消失，而硬皮病患者的NVC变化稳定。甲襞微血管异常在糖尿病患者中很常见，与抗mda5和转录中介因子1 γ抗体以及皮肤组织学上的血管周围炎症有关。IIMs的NVC异常可能成为临床上有用的标志物，用于定义糖尿病亚群和了解这些患者临床特征的发病机制。
Objective. The aim of this study was to investigate the clinical and immunological significance of nailfold videocapillaroscopy (NVC) abnormalities in patients with idiopathic inflammatory myopathies (IIMs).Methods. Seventy consecutive Japanese patients with untreated IIMs, enrolled between April 2014 and August 2017, were prospectively studied. Clinical features, NVC findings, autoantibody profile by immunoprecipitation and ELISA, and histopathological findings of skin biopsies of DM rash were assessed at baseline and after 1-year of immunosuppressive therapy.Results. NVC abnormalities were found in 55.7% (39/70) of IIM patients, with significantly higher prevalence in DM (65.4%) compared with PM (27.8%) (P = 0.01). In subsets of patients classified by autoantibody specificities, the prevalence of NVC abnormalities was significantly higher in patients with anti-MDA5 (87.5%) and anti-transcriptional intermediary factor 1 gamma (88.9%) vs anti-aminoacyl-tRNA synthetase (26.9%, P < 0.001). Perivascular lymphocytic infiltration in the upper dermis of skin rash biopsy of DM was more severe in patients with NVC abnormalities (P < 0.05). Unexpectedly, NVC abnormalities disappeared in 75% of IIM patients after 1-year of immunosuppressive therapy in contrast to stable NVC changes seen in scleroderma patients.Conclusion. Nailfold microvascular abnormalities were common in DM patients, associated with anti-MDA5 and transcriptional intermediary factor 1 gamma antibodies, and perivascular inflammation in skin histology. NVC abnormalities in IIMs may become clinically useful markers for defining subsets of DM and understanding the pathogenesis of the clinical features seen in these patients.