Nailfold Capillaroscopy Characteristics of Antisynthetase Syndrome and Possible Clinical Associations: Results of a Multicenter International Study

Marco Sebastiani; Konstantinos Triantafyllias; Andreina Manfredi; Miguel Angel González-Gay; Natalia Palmou-Fontana; Giulia Cassone; Ulrich Drott; Christiane Delbrück; Jorge Rojas-Serrano; Chiara Bertolazzi; Laura Nuño; Margherita Giannini; Florenzo Iannone; Esther F Vicente; Santos Castañeda; Albert Selva-O'Callaghan; Ernesto Trallero Araguas; Giacomo Emmi; Annamaria Iuliano; Jutta Bauhammer; Nikolaus Miehle; Simone Parisi; Lorenzo Cavagna; Veronica Codullo; Carlomaurizio Montecucco; Francisco Javier Lopez-Longo; Julia Martínez-Barrio; Juan Carlos Nieto-González; Silvia Vichi; Marco Confalonieri; Paola Tomietto; Raoul Bergner; Alberto Sulli; Francesco Bonella; Federica Furini; Carlo Alberto Scirè; Alessandra Bortoluzzi; Christof Specker; Simone Barsotti; Rossella Neri; Marta Mosca; Marzia Caproni; Julia Weinmann-Menke; Andreas Schwarting; Vanessa Smith; Maurizio Cutolo; American and European Network of Antisynthetase Syndrome Collaborative Group

doi:10.3899/jrheum.180355

Nailfold Capillaroscopy Characteristics of Antisynthetase Syndrome and Possible Clinical Associations: Results of a Multicenter International Study

J Rheumatol. 2019 Mar;46(3):279-284. doi: 10.3899/jrheum.180355. Epub 2018 Nov 15.

Authors

Marco Sebastiani^{1

2}, Konstantinos Triantafyllias^{3

4}, Andreina Manfredi^{1

2}, Miguel Angel González-Gay^{1

2}, Natalia Palmou-Fontana^{1

2}, Giulia Cassone^{1

2}, Ulrich Drott^{1

2}, Christiane Delbrück^{1

2}, Jorge Rojas-Serrano^{1

2}, Chiara Bertolazzi^{1

2}, Laura Nuño^{1

2}, Margherita Giannini^{1

2}, Florenzo Iannone^{1

2}, Esther F Vicente^{1

2}, Santos Castañeda^{1

2}, Albert Selva-O'Callaghan^{1

2}, Ernesto Trallero Araguas^{1

2}, Giacomo Emmi^{1

2}, Annamaria Iuliano^{1

2}, Jutta Bauhammer^{1

2}, Nikolaus Miehle^{1

2}, Simone Parisi^{1

2}, Lorenzo Cavagna^{1

2}, Veronica Codullo^{1

2}, Carlomaurizio Montecucco^{1

2}, Francisco Javier Lopez-Longo^{1

2}, Julia Martínez-Barrio^{1

2}, Juan Carlos Nieto-González^{1

2}, Silvia Vichi^{1

2}, Marco Confalonieri^{1

2}, Paola Tomietto^{1

2}, Raoul Bergner^{1

2}, Alberto Sulli^{1

2}, Francesco Bonella^{1

2}, Federica Furini^{1

2}, Carlo Alberto Scirè^{1

2}, Alessandra Bortoluzzi^{1

2}, Christof Specker^{1

2}, Simone Barsotti^{1

2}, Rossella Neri^{1

2}, Marta Mosca^{1

2}, Marzia Caproni^{1

2}, Julia Weinmann-Menke^{1

2}, Andreas Schwarting^{1

2}, Vanessa Smith^{1

2}, Maurizio Cutolo^{1

2}; American and European Network of Antisynthetase Syndrome Collaborative Group

Affiliations

¹ From the Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy; ACURA Rheumatology Center, Bad Kreuznach, Germany; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDiVAL, University of Cantabria, Santander, Spain; Rheumatology Division, University Hospital of Frankfurt, Frankfurt, Germany; Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Mexico City, Mexico; Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain; Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Bari, Italy; Rheumatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria (IIS) Princesa, Madrid; Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Universidad Autonoma de Barcelona, on behalf of the GEAS group, Barcelona, Spain; Department of Experimental and Clinical Medicine, and Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence; Unità Operativa Complessa (UOC) Reumatologia, Ospedale San Camillo-Forlanini, Rome; ACURA Centre for Rheumatic Diseases, Baden-Baden, Germany; Rheumatology Department, Città Della Salute e della Scienza, Torino; Division of Rheumatology, University and Institute for Research and Health Care (IRCCS) Policlinico S. Matteo Foundation, Pavia, Italy; Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Dermatology Clinic, University Hospital of Trieste; Department of Pneumology and Respiratory Intermediate Care Unit, University Hospital of Cattinara, Trieste; Rheumatology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy; Medizinische Klinik A, Klinikum der Stadt, Ludwigshafen, Germany; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital IRCCS Genoa, Genoa, Italy; Interstitial and Rare Lung Disease Unit, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany; UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Italy; Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic, Essen, Germany; Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa; Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg, Mainz, Germany; University of Ghent, Ghent University Hospital, Ghent, Belgium.
² M. Sebastiani, MD, Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia; A. Manfredi, MD, Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia; G. Cassone, MD, Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia; K. Triantafyllias, MD, ACURA Rheumatology Center; A. Schwarting, MD, Professor, ACURA Rheumatology Center; M.A. González-Gay, MD, Professor, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDiVAL, University of Cantabria; N. Palmou-Fontana, MD, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDiVAL, University of Cantabria; U. Drott, MD, Rheumatology Division, University Hospital of Frankfurt; C. Delbrück, MD, Rheumatology Division, University Hospital of Frankfurt; J. Rojas-Serrano, MD, Professor, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas; C. Bertolazzi, MD, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas; L. Nuño, MD, Servicio de Reumatología, Hospital Universitario La Paz; M. Giannini, MD, DIM, Rheumatology Unit, University of Bari; F. Iannone, MD, Professor, DIM, Rheumatology Unit, University of Bari; E.F. Vicente, MD, Rheumatology Department, Hospital Universitario de la Princesa, IIS Princesa; S. Castañeda, MD, Professor, Rheumatology Department, Hospital Universitario de la Princesa, IIS Princesa; A. Selva-O'Callaghan, MD, Professor, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Universidad Autonoma de Barcelona, on behalf of the GEAS group; E. Trallero Araguas, MD, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Universidad Autonoma de Barcelona, on behalf of the GEAS group; G. Emmi, MD, Department of Experimental and Clinical Medicine, University of Florence; A. Iuliano, MD, UOC Reumatologia, Ospedale San Camillo-Forlanini; J. Bauhammer, MD, ACURA Centre for Rheumatic Diseases; N. Miehle MD, ACURA Centre for Rheumatic Diseases; S. Parisi, MD, Rheumatology Department, Città Della Salute e della Scienza; L. Cavagna, MD, Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation; V. Codullo, MD, Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation; C. Montecucco, MD, Professor, Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation; F.J. Lopez-Longo, MD, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón; J. Martínez-Barrio, MD, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón; J.C. Nieto-González, MD, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón; S. Vichi, MD, Dermatology Clinic, University Hospital of Trieste; M. Confalonieri, MD, Department of Pneumology and Respiratory Intermediate Care Unit, University Hospital of Cattinara; P. Tomietto, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti; R. Bergner, MD, Professor, Medizinische Klinik A, Klinikum der Stadt; A. Sulli, MD, Professor, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital IRCCS Genoa; M. Cutolo, MD, Professor, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital IRCCS Genoa; F. Bonella, MD, Interstitial and Rare Lung Disease Unit, Ruhrlandklinik University Hospital, University of Duisburg-Essen; F. Furini, MD, UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara; C.A. Scirè, MD, Associate Professor, UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara; A. Bortoluzzi, MD, UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara; C. Specker, MD, Professor, Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic; S. Barsotti, MD, Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa; R. Neri, MD, Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa; M. Mosca, MD, Professor, Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa; M. Caproni, MD, Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence; J. Weinmann-Menke, MD, Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg; A. Schwarting, MD, Professor, Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg; V. Smith, MD, Professor, University of Ghent, Ghent University Hospital.
³ From the Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy; ACURA Rheumatology Center, Bad Kreuznach, Germany; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDiVAL, University of Cantabria, Santander, Spain; Rheumatology Division, University Hospital of Frankfurt, Frankfurt, Germany; Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Mexico City, Mexico; Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain; Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Bari, Italy; Rheumatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria (IIS) Princesa, Madrid; Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Universidad Autonoma de Barcelona, on behalf of the GEAS group, Barcelona, Spain; Department of Experimental and Clinical Medicine, and Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence; Unità Operativa Complessa (UOC) Reumatologia, Ospedale San Camillo-Forlanini, Rome; ACURA Centre for Rheumatic Diseases, Baden-Baden, Germany; Rheumatology Department, Città Della Salute e della Scienza, Torino; Division of Rheumatology, University and Institute for Research and Health Care (IRCCS) Policlinico S. Matteo Foundation, Pavia, Italy; Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Dermatology Clinic, University Hospital of Trieste; Department of Pneumology and Respiratory Intermediate Care Unit, University Hospital of Cattinara, Trieste; Rheumatology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy; Medizinische Klinik A, Klinikum der Stadt, Ludwigshafen, Germany; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital IRCCS Genoa, Genoa, Italy; Interstitial and Rare Lung Disease Unit, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany; UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Italy; Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic, Essen, Germany; Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa; Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg, Mainz, Germany; University of Ghent, Ghent University Hospital, Ghent, Belgium. ktriantafyllias@gmail.com.
⁴ M. Sebastiani, MD, Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia; A. Manfredi, MD, Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia; G. Cassone, MD, Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia; K. Triantafyllias, MD, ACURA Rheumatology Center; A. Schwarting, MD, Professor, ACURA Rheumatology Center; M.A. González-Gay, MD, Professor, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDiVAL, University of Cantabria; N. Palmou-Fontana, MD, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDiVAL, University of Cantabria; U. Drott, MD, Rheumatology Division, University Hospital of Frankfurt; C. Delbrück, MD, Rheumatology Division, University Hospital of Frankfurt; J. Rojas-Serrano, MD, Professor, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas; C. Bertolazzi, MD, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas; L. Nuño, MD, Servicio de Reumatología, Hospital Universitario La Paz; M. Giannini, MD, DIM, Rheumatology Unit, University of Bari; F. Iannone, MD, Professor, DIM, Rheumatology Unit, University of Bari; E.F. Vicente, MD, Rheumatology Department, Hospital Universitario de la Princesa, IIS Princesa; S. Castañeda, MD, Professor, Rheumatology Department, Hospital Universitario de la Princesa, IIS Princesa; A. Selva-O'Callaghan, MD, Professor, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Universidad Autonoma de Barcelona, on behalf of the GEAS group; E. Trallero Araguas, MD, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Universidad Autonoma de Barcelona, on behalf of the GEAS group; G. Emmi, MD, Department of Experimental and Clinical Medicine, University of Florence; A. Iuliano, MD, UOC Reumatologia, Ospedale San Camillo-Forlanini; J. Bauhammer, MD, ACURA Centre for Rheumatic Diseases; N. Miehle MD, ACURA Centre for Rheumatic Diseases; S. Parisi, MD, Rheumatology Department, Città Della Salute e della Scienza; L. Cavagna, MD, Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation; V. Codullo, MD, Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation; C. Montecucco, MD, Professor, Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation; F.J. Lopez-Longo, MD, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón; J. Martínez-Barrio, MD, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón; J.C. Nieto-González, MD, Servicio de Reumatología, Hospital General Universitario Gregorio Marañón; S. Vichi, MD, Dermatology Clinic, University Hospital of Trieste; M. Confalonieri, MD, Department of Pneumology and Respiratory Intermediate Care Unit, University Hospital of Cattinara; P. Tomietto, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti; R. Bergner, MD, Professor, Medizinische Klinik A, Klinikum der Stadt; A. Sulli, MD, Professor, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital IRCCS Genoa; M. Cutolo, MD, Professor, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital IRCCS Genoa; F. Bonella, MD, Interstitial and Rare Lung Disease Unit, Ruhrlandklinik University Hospital, University of Duisburg-Essen; F. Furini, MD, UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara; C.A. Scirè, MD, Associate Professor, UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara; A. Bortoluzzi, MD, UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara; C. Specker, MD, Professor, Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic; S. Barsotti, MD, Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa; R. Neri, MD, Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa; M. Mosca, MD, Professor, Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa; M. Caproni, MD, Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence; J. Weinmann-Menke, MD, Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg; A. Schwarting, MD, Professor, Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg; V. Smith, MD, Professor, University of Ghent, Ghent University Hospital. ktriantafyllias@gmail.com.

PMID: 30442823
DOI: 10.3899/jrheum.180355

Abstract

Objective: To describe nailfold videocapillaroscopy (NVC) features of patients with antisynthetase syndrome (AS) and to investigate possible correlations with clinical and serological features of the disease.

Methods: We retrospectively analyzed NVC images of 190 patients with AS [females/males 3.63, mean age 49.7 ± 12.8 yrs, median disease duration 53.7 mos (interquartile range 82), 133 anti-Jo1 and 57 non-anti-Jo1-positive patients]. For each patient, we examined number of capillaries, giant capillaries, microhemorrhages, avascular areas, ramified capillaries, and the presence of systemic sclerosis (SSc)-like pattern. Finally, we correlated NVC features with clinical and serological findings of patients with AS. Concomitantly, a historical cohort of 75 patients with antinuclear antibody-negative primary Raynaud phenomenon (RP) and longterm followup was used as a control group (female/male ratio 4.13/1, mean age 53.9 ± 17.6 yrs) for NVC measures.

Results: NVC abnormalities were observed in 62.1% of AS patients compared with 29.3% of primary RP group (p < 0.001). An SSc-like pattern was detected in 67 patients (35.3%) and it was associated with anti-Jo1 antibodies (p = 0.002) and also with a longer disease duration (p = 0.004). Interestingly, there was no significant correlation between the presence of SSc-like pattern and RP, and only 47% of patients with SSc-like pattern had RP.

Conclusion: NVC abnormalities are commonly observed in AS, independently from the occurrence of RP. The presence of an SSc-like pattern could allow identification of a more defined AS subtype, and prospective studies could confirm the association with clinical and serological features of AS.

Keywords: ANTISYNTHETASE ANTIBODIES; ANTISYNTHETASE SYNDROME; NAILFOLD VIDEOCAPILLAROSCOPY; RAYNAUD PHENOMENON; SYSTEMIC SCLEROSIS PATTERN.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Amino Acyl-tRNA Synthetases / immunology
Antibodies, Antinuclear / blood
Capillaries / diagnostic imaging
Female
Follow-Up Studies
Humans
Male
Microscopic Angioscopy / methods*
Middle Aged
Myositis / diagnostic imaging*
Myositis / immunology*
Nails / blood supply
Raynaud Disease / diagnostic imaging
Raynaud Disease / immunology
Retrospective Studies

Substances

Antibodies, Antinuclear
Jo-1 antibody
Amino Acyl-tRNA Synthetases

Supplementary concepts

Antisynthetase syndrome