The British Journal of Rheumatology, Vol 37, 1272-1278, Copyright © 1998 by British Society for Rheumatology
A von Bierbrauer, P Barth, J Willert, C Baerwald, HD Mennel and JA Schmidt
The aims of the study were to describe and compare the frequency and nature
of histologically detectable microvascular lesions in patients with various
connective tissue diseases (CTD). An electron microscopic examination of
specimens obtained by the technique of capillaroscopically guided nailfold
biopsy was performed in 52 patients with CTD [nine systemic lupus
erythematosus (SLE), eight mixed CTD, 18 scleroderma, 17 undifferentiated
CTD] and 27 controls. The microvascular changes most frequently observed by
electron microscopy were multilayering of the basal lamina (approximately
70% of the CTD patients), an increased amount of perivascular connective
tissue, perivascular oedema formation, and an increased number of
perivascular fibroblasts and mast cells (each in 30-37% of the CTD
patients). In contrast, no particular histopathological feature was found
in > 25% of the controls, multilayering (22.6%) being the most
frequently observed. Comparing the different conditions studied, there were
distinct differences in the frequency and nature of the histologically
observed microvascular changes. In particular, SLE seems to be based on a
separable type of vasculopathy consisting of significantly less frequent
microvascular abnormalities. In conclusion, ultrastructural abnormalities
of the microvascular system are a frequent finding in CTD. Electron
microscopic examination of specimens obtained by capillaroscopically guided
nailfold biopsy is able to disclose histopathological differences between
defined entities. Therefore, this approach may be a useful tool to gain
further insights into potentially separable aetiopathological mechanisms of
the various types of CTD.
ORIGINAL PAPERS
Electron microscopy and capillaroscopically guided nailfold biopsy in connective tissue diseases: detection of ultrastructural changes of the microcirculatory vessels
Department of Internal Medicine, Philipps-University Marburg, Germany.
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