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DM Nailfold Changes — SCE Rheumatology MCQ

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EasyMyositisDM Nailfold ChangesSCE Rheumatology

A 40-year-old woman with dermatomyositis treated with prednisolone and azathioprine has periungual erythema, dilated nailfold capillaries and ragged, overgrown cuticles. Which interpretation of these findings is most accurate?

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Correct answer: E — A characteristic dermatomyositis-associated microangiopathy that may track disease activity

Periungual erythema, ragged or hypertrophic cuticles and dilated nailfold capillaries are characteristic manifestations of dermatomyositis-associated microangiopathy. Capillaroscopy may additionally show giant or tortuous capillaries, microhaemorrhages, capillary loss and disorganisation. Some abnormalities correlate with cutaneous or global disease activity and may improve during treatment, although they are not independently diagnostic or a perfectly reliable activity measure. These findings are not typical evidence of infection or azathioprine toxicity. Similar capillaroscopic abnormalities, including a scleroderma pattern, can occur in systemic sclerosis, so they are not specific to either condition. Their diagnostic and monitoring relevance means they should not be dismissed as cosmetic.

Reference: Piette Y et al. Standardised interpretation of capillaroscopy in autoimmune idiopathic inflammatory myopathies: a structured review on behalf of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Autoimmunity Reviews. 2022;21(6):103087. https://pubmed.ncbi.nlm.nih.gov/35421608/