Nailfold Capillary Changes in Adult Bangladeshi Patients with Systemic Lupus Erythematosus: Correlation with Disease Activity

Abstract

Background: Peripheral microangiopathy is an important feature in systemic lupus erythematosus (SLE). Nailfold capillary (NFC) changes observed by nailfold videocapillaroscopy (NVC) may play a role in the early detection of microangiopathy and assessment of disease activity in SLE. Objectives: This study aimed to evaluate nailfold capillary alterations and their diagnostic precision in Bangladeshi patients with Systemic Lupus Erythematosus (SLE) compared to healthy individuals. Additionally, it sought to establish the correlation between these capillary changes and SLE disease activity. Methods: A cross-sectional study with a comparison group was conducted at Chittagong Medical College Hospital (CMCH) in Chattogram, Bangladesh. The study included 27 Bangladeshi SLE patients diagnosed according to the ACR 1997 revised criteria and 27 age- and sex-matched healthy subjects. Participants underwent thorough history taking, clinical examinations, laboratory tests, and nailfold video capillaroscopy (NVC) examinations. SLE disease activity was measured using the SLE Disease Activity Index (SLEDAI), and nailfold capillary changes were evaluated based on NVC patterns. Results: The average age of the SLE patient group was 31.2 (±7.8) years, with a female-to-male ratio of approximately 6:1. Among the patients, 23 out of 27 (85.2%) exhibited multiple phenotypes, and 18 (66.6%) had high or very high disease activity. The sub-papillary venous plexus (SPVP) was more prominently visible in SLE patients, and capillary density was lower compared to healthy controls. Nailfold capillary changes were observed in 26 out of 27 (96.3%) patients. Major and scleroderma patterns were identified in 51.9% and 11.1% of the SLE patients, respectively. Common abnormal morphological changes included crossed capillaries (66.7%), tortuous capillaries (63%), and meandering capillaries (37%). There was a significant positive correlation between SLE disease activity and NVC-pattern changes (r = 0.443, p = 0.021). Conclusion: Abnormal nailfold capillary changes are prevalent among SLE patients and are positively correlated with disease activity in SLE.