Prognostic significance of nailfold capillary microscopy in patients with Raynaud's phenomenon and scleroderma-pattern abnormalities a six-year follow-up study

Summary The aim of this study was to assess the prognostic significance of scleroderma capillary pattern (SD-pattern) in patients with Raynaud's phenomenon. Thirty patients with a capillaroscopy examination suggestive of scleroderma (megacapillaries and/or avascularity) but without clinical criteria of scleroderma (ARA criteria) were reevaluated 6 years after the initial clinical and capillaroscopy examinations. SD-pattern abnormalities were classified according to a semiquantitative method. Eight out of the 28 evaluated patients (28%) developed a scleroderma spectrum disorder (SDS). The presence of avascularity and/or a mean of more than two megacapillaries digit greatly enhanced the percentage of evolution toward SDS (70% / 88% respectively). Most of the patients with few enlarged capillaries and no capillary rarefaction at entry had primary acrocyanosis (11/15). None of them developed SDS. The microangiopathy disappeared during the follow-up period in most of these patients (14/15). These results confirm the prognostic value of SD-pattern capillary abnormalities for SDS. Primary acrocyanosis, a benign clinical entity should be considered in presence of few megacapillaries and without capillary rarefaction.     

Comparison of quantitative and semiquantitative estimates of nailfold capillary abnormalities in scleroderma spectrum disorders

In this study, 82 photomacrographs of nailfold capillary beds from 60 patients with scleroderma spectrum disorders (scleroderma, undifferentiated connective tissue disease, and dermatomyositis) and from 16 normal controls were analyzed blindly, using both semiquantitative and quantitative methods, to estimate the capillary size and the extent of "avascularity." A good correlation was found between results obtained by the two methods. Defining these semiquantitative classifications in quantitative terms should facilitate comparison of results from different investigators.     

Effects of a combination treatment of an intensive rehabilitation program and etanercept in patients with ankylosing spondylitis: a pilot study

OBJECTIVE: To determine the effects of a combination treatment including rehabilitation and etanercept versus rehabilitation only, on function, disability, and quality of life in a group of patients with active ankylosing spondylitis (AS). METHODS: Nineteen patients with AS consecutively admitted to a rehabilitation inpatient clinic were enrolled. Patients first participated in an intensive rehabilitation program and after a 6-month interval started etanercept therapy. After 3 weeks, they started a combination of rehabilitation and etanercept. The primary outcome measure was an improvement of the Bath Ankylosing Spondylitis Functional Index (BASFI) defined as the difference (Delta) between the 2 measurements (beginning and end). The difference between the 2 measurements for the first rehabilitation program was expressed as Delta1 and for the second as Delta2; the comparison between Delta1 and Delta2 for each outcome measure was taken into account. Secondary outcome measures included an improvement in the Revised Leeds Disability Questionnaire (LDQ), anthropometric measures, EuroQol (EQ-5Dvas), and the 6 minute walking test (6-MWT). RESULTS: A statistically significant improvement was observed both for BASFI (Delta1 = -0.71 +/- 0.23; Delta2 = -1.19 +/- 0.36, p < 0.001) and for LDQ (Delta1 = -0.28 +/- 0.08; Delta2 = -0.46 +/- 0.17, p = 0.001). All anthropometric measures as well as 6-MWT were statistically improved. Finally, EQ5Dvas showed a statistically significant difference (Delta1 = 6.63 +/- 2.81; Delta2 = 20.26 +/- 4.89, p < 0.001). No adverse effects were seen during treatment with etanercept. CONCLUSION: This combination treatment seems to improve function, disability, and quality of life in patients with active AS.     

Detection by nailfold capillary microscopy of early morphologic capillary changes in children with insulin dependent diabetes mellitus

Nailfold capillary microscopy (NCM) is a non invasive method to investigate digital microcirculation. The NCM pattern of 70 children with diabetes (duration varying from less than one month to 18 years) and of 35 healthy children was studied. Several capillary loops anomalies were observed: haemorrhages, disorganisation, dystrophies, microaneurysms. The anomalies were more frequent in children with diabetes (61.4%) than in the controls (20%; p less than 0.001). Haemorrhages and nailbed disorganisation were seen in both groups. Dystrophies were found more frequently in the diabetic group (46%) than in the controls (17%; p less than 0.01). Microaneurysms were observed only in diabetic children (27%; p less than 0.001); they were present in 18.5% of the children with a diabetes duration of less than 2 years and their frequency did not increase with the duration of the disease. Sex ratio, age and HbA1c were not different between the diabetic children with or without microaneurysms. No relationship was found between retinal angiography and NCM detection of the microaneurysms. In conclusion, NCM is able to detect frequent anomalies of the digital microcirculation, especially microaneurysms, early in the course of diabetes in children. The follow up of this pediatric population will provide further information on the prognostic value of these lesions.     

Syndrome characterized by loss of muscle strength experienced by athletes during intensive training program

A syndrome of heaviness in the legs and loss of power and resiliency when running has been investigated in football players during a conditioning program. A transient but significant loss of static leg strength was documented. No changes in muscle or serum sodium, potassium and magnesium concentrations were found. A significant doubling of the myofibrillar nitrogen fraction was observed during the 2 wk of observation. The loss of strength during rapid hypertrophy of muscle is consistent with earlier reports in experimental animals. The occurrence of alterations in intracellular protein nitrogen concentrations without concomitant changes in muscle electrolyte composition leads us to question the universal applicability of noncollagen nitrogen as a reference unit for the expression of muscle electrolyte composition.     

Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study

Clinical Rheumatology - Microvascular dysfunction is the key element in the pathogenesis of systemic sclerosis (SSc), whereas the contribution of large and medium size vessel abnormalities is yet...     

Grey matter abnormalities in social anxiety disorder: a pilot study

While a number of studies have explored the functional neuroanatomy of social anxiety disorder (SAD), data on grey matter integrity are lacking. We conducted structural MRI scans to examine the cortical thickness of grey matter in individuals with SAD. 13 unmedicated adult patients with a primary diagnosis of generalized social anxiety disorder and 13 demographically (age, gender and education) matched healthy controls underwent 3T structural magnetic resonance imaging. Cortical thickness and subcortical volumes were estimated using an automated algorithm (Freesurfer Version 4.5). Compared to controls, social anxiety disorder patients showed significant bilateral cortical thinning in the fusiform and post central regions. Additionally, right hemisphere specific thinning was found in the frontal, temporal, parietal and insular cortices of individuals with social anxiety disorder. Although uncorrected cortical grey matter volumes were significantly lower in individuals with SAD, we did not detect volumetric differences in corrected amygdala, hippocampal or cortical grey matter volumes across study groups. Structural differences in grey matter thickness between SAD patients and controls highlight the diffuse neuroanatomical networks involved in both social anxiety and social behavior. Additional work is needed to investigate the causal mechanisms involved in such structural abnormalities in SAD.