1575 Manfredi, et al: Capillaroscopy in SSc and DM Personal non-commercial use only. The Journal of Rheumatology Copyright © 2016. All rights reserved. Nailfold Videocapillaroscopy Alterations in Dermatomyositis and Systemic Sclerosis: Toward Identification of a Specific Pattern Andreina Manfredi, Marco Sebastiani, Federica Campomori, Nicolò Pipitone, Dilia Giuggioli, Michele Colaci, Emanuela Praino, and Clodoveo Ferri ABSTRACT. Objective. The term scleroderma pattern typically defines capillary abnormalities of scleroderma spectrum disorders, mainly systemic sclerosis (SSc) and dermatomyositis (DM). Our study aimed to investigate differences in nailfold videocapillaroscopy (NVC) between DM and SSc, with a cross-sectional and longitudinal evaluation. Methods. NVC features of 29 consecutive patients with DM were compared with 90 patients with SSc categorized into the 3 subsets of scleroderma pattern: early, active, and late. Twenty patients with DM and all with SSc were also longitudinally reevaluated after 30 months of followup. Results. At baseline, all SSc groups showed giant capillaries, with significant differences with DM only for early and active pattern. Ramified capillaries were significantly more frequent and severe in DM than in early and active patterns, while DM showed an opposite trend compared with late pattern. Capillary loss was lower in early pattern and higher in active and late, compared with DM. Finally, giant-ramified capillaries were almost exclusive of DM. During followup, NVC showed a different evolution in DM and SSc. In DM we recorded a reduction of giant capillaries, while ramified capil- laries increased both in DM and in early and active SSc pattern. The number of capillaries recovered in DM; conversely, capillary loss slightly worsened in all SSc patterns. Giant-ramified capillaries significantly decreased in patients with DM, remaining rare in patients with SSc. Conclusion. Our study strengthens the specificity of DM and SSc microangiopathy and points out the need for large prospective studies to confirm our results and possibly to revise current terminology by distinguishing between “scleroderma” and “dermatomyositis” patterns. (First Release June 15 2016; J Rheumatol 2016;43:1575–80; doi:10.3899/jrheum.160122) Key Indexing Terms: SYSTEMIC SCLEROSIS DERMATOMYOSITIS MICROANGIOPATHY VIDEOCAPILLAROSCOPY SCLERODERMA PATTERN From the Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena; Rheumatology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia; Rheumatology Unit, University of Bari, Bari, Italy. A. Manfredi, MD, Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena; M. Sebastiani, MD, Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena; F. Campomori, MD, Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena; N. Pipitone, MD, Rheumatology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia; D. Giuggioli, MD, Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena; M. Colaci, MD, Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena; E. Praino, MD, Rheumatology Unit, University of Bari; C. Ferri, MD, Professor, Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena. Dr. Manfredi and Dr. Sebastiani contributed equally to this article. Address correspondence to Dr. A. Manfredi, Rheumatology Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41121 Modena, Italy. E-mail: andreina.manfredi@gmail.com Accepted for publication April 19, 2016. The term scleroderma pattern was first used by Brown and O’Leary in 1925 to define capillary abnormalities in the course of systemic sclerosis (SSc) 1 . It is represented by the association of typical capillaroscopic microvascular alter- ations, namely giant capillaries, microhemorrhages, ramified capillaries, microvascular array disorganization, and capillary loss or avascular areas 2,3,4 . It has since been observed that scleroderma pattern is not specific to SSc, but potentially associated with scleroderma spectrum disorders, including (with some variations according to different authors) SSc, myositis, systemic lupus erythematosus, mixed connective tissue disease, and undifferentiated connective disease 5 . SSc and dermatomyositis (DM) are more frequently associated with this typical microvascular derangement 6 . In the course of SSc, the vascular morphological changes in the nailfold occur very early and they have been widely investigated 5 . In 2000, Cutolo, et al proposed a reclassifi- cation of scleroderma pattern into 3 different subgroups: early, active, and late pattern, characterized by prevalent www.jrheum.org Downloaded on February 22, 2022 from