NAILFOLD CAPILLARY MICROSCOPY IN PATIENTS WITH ANTICARDIOLIPIN ANTIBODIES - A CASE-CONTROL STUDY

Background and Design: This case-control study was undertaken to deter mine whether anticardiolipin antibodies (ACA) are responsible for part icular abnormalities in nailfold capillary microscopy (NCM). Cases com prised 33 consecutive patients positive for ACA (24 women and 7 men). Controls comprised the same number of ACA-negative patients, with the same sex ratio, the same diagnosis and the most similar duration of di sease possible. Clinical data, serum samples and NCM recordings were o btained from all patients and controls. Results: In each group, 22 pat ients had connective-tissue-related disorders and 11 various other dis eases. In ACA-positive patients,the mean IgG ACA titre was 39 +/- 58 I gG phospholipid units. Cases and controls displayed various cutaneous manifestations. In ACA-positive patients, there were Raynaud's phenome non (54%), cutaneous vasculitis (24%), scleroderma changes (18%), phot osensitivity (9%), a history of digital gangrene (6%), malar rash (6%) , acrocyanosis (6%), chilblains (3%), livedo reticularis (3%) and purp ura (3%). Cases and controls exhibited numerous NCM abnormalities. In ACA-positive patients, they included haemorrhages (54%), oedema (24%), bushy capillaries (21%), distorded capillaries (18%), capillary bed d isorganization (12%), capillary rarefaction (9%), giant capillaries (6 %) and 'desert areas' (3%). There were no correlations between the ACA titres on the one hand and the number of cutaneous manifestations or NCM abnormalities on the other. Conclusions: ACA-positive patients fre quently exhibit clinical skin lesions and abnormal NCM. In this study, these lesions and NCM abnormalities resembled those of the matched AC A-negative controls.