Nailfold microscopy in adult-onset dermatomyositis in association with myositis antibodies

• Published in: Archives of Dermatological Research 2024-11, Vol.317 (1), p.34, Article 34
• Main Authors: Flatley, Elizabeth M., Collins, Dina, Lukowiak, Tess M., Miller, Jason H.
• Format: Article
• Language: English
• Subjects: Adult; Antibodies; Autoantibodies - blood; Autoantibodies - immunology; Dermatology; Dermatomyositis; Dermatomyositis - complications; Dermatomyositis - diagnosis; Dermatomyositis - immunology; Dermatomyositis - pathology; Dermoscopy; Hemorrhage; Humans; Inflammatory diseases; Medicine; Medicine & Public Health; Microscopic Angioscopy - methods; Myositis; Nails - blood supply; Nails - diagnostic imaging; Nails - immunology; Nails - pathology; Review; Scleroderma
• ISSN: 1432-069X; 0340-3696; 1432-069X
• DOI: 10.1007/s00403-024-03521-z

Dermatomyositis (DM) is an immune mediated inflammatory disease classically associated with muscular and cutaneous involvement. Existing studies have suggested characteristic nailfold findings may be observed in DM, indicating a potential role for nailfold microscopic examination in the diagnosis of DM. To that end, we performed a systematic review of literature pertaining to nailfold microscopic, capillaroscopic, and dermoscopic findings observed in patients with DM, with a secondary review of the association of nailfold microscopic findings with myositis-specific antibody (MSA) and myositis-associated antibody (MAA) status. Thirty-seven papers, representing 346 patients, met inclusion criteria. The most prevalent nailfold findings were evidence of increased vascular diameter (64.5%, n  = 223) and decreased vascularity (57.5%, n  = 199). Scleroderma-spectrum pattern and microhemorrhage or hemorrhage were both observed in 156 (45.1%) patients. Fifty-one patients had nailfold capillaroscopic findings reported in direct association with antibody positivity and demonstrated a range of nailfold findings, preliminarily suggesting associations between antibody-status and capillaroscopic findings. The results of our study align with existing data indicating the scleroderma-spectrum pattern and the pattern’s composite features are prevalent in patients with DM. Our review further demonstrates a variety of nailfold capillaroscopic findings are found in patients positive for MSAs and MAAs.