RESEARCH - Reduced red blood cell velocity in nail-fold capillaries as a sensitive and specific indicator of microcirculation injury in systemic sclerosis

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Rheumatology 2009 48(6):696-703; doi:10.1093/rheumatology/kep066

Reduced red blood cell velocity in nail-fold capillaries as a

sensitive and specific indicator of microcirculation injury in

systemic sclerosis

Naoki Mugii1, Minoru Hasegawa2, Yasuhito Hamaguchi2, Chihiro Tanaka2,

Kenzo Kaji2, Kazuhiro Komura2, Ikuko Ueda-Hayakawa2, Sho Horie1,

Munehiro Ikuta3, Katsuhiko Tachino3, Fumihide Ogawa4, Shinichi Sato4,

Manabu Fujimoto2 and Kazuhiko Takehara2

1Department of Rehabilitation, Kanazawa University Hospital,

2Department of Dermatology, 3Division of Rehabilitation Science,

Kanazawa University Graduate School of Medical Science, Kanazawa and

4Department of Dermatology, Nagasaki University Graduate School of

Biomedical Science, Nagasaki, Japan.

Abstract

Objective. To assess red blood cell velocity in finger nail-fold

capillaries using video capillaroscopy in patients with SSc and other

collagen diseases.

Methods. This study included 127 patients with SSc as well as patients

with SLE (n = 33), DM/PM (n = 21), RA (n = 13) and APS (n = 12), and

20 healthy subjects. Red blood cell velocity was evaluated using

frame-to-frame determination of the position of capillary plasma gaps.

Results. The mean red blood cell velocity was significantly decreased

in patients with SSc compared to healthy controls (63.0% reduction)

and patients with other conditions. Mean blood velocity was similar

between patients with dcSSc and lcSSc. Importantly, even SSc patients

with normal or non-specific nail-fold video capillaroscopic (NVC)

patterns or a scleroderma early NVC pattern exhibited a significantly

lower red blood cell velocity compared to healthy controls (51.7 and

61.4% reduction, respectively) or patients with other conditions,

despite normal or mild capillary changes. Patients with the

scleroderma active and late NVC pattern showed a more decreased blood

velocity (65.5 and 66.2% reduction, respectively). This reduced blood

velocity was significantly associated with NVC findings, including

capillary ramification and capillary loss. Although remarkably reduced

velocity was observed in SSc patients with intractable digital ulcers

(72.1% reduction), it was significantly improved by lipo-prostaglandin

E1 (lipo-PGE1) infusion.

Conclusion. Our results suggest that reduced blood velocity is a

hallmark of SSc. Furthermore, measurement of red blood cell velocity

may be useful in evaluating therapeutic effects on microcirculation.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/6/696?etoc

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