Top

Published in:

01-09-2009 | Review

The role of capillaroscopy in differentiation of primary and secondary Raynaud’s phenomenon in rheumatic diseases: a review of the literature and two case reports

Authors: Sevdalina Nikolova Lambova, Ulf Müller-Ladner

Published in: Rheumatology International | Issue 11/2009

Abstract

The purpose of this study is to study and systematize the current knowledge about the role of capillaroscopy in differentiation of primary and secondary Raynaud’s phenomenon (RP) in rheumatic diseases. This method is a review of the literature. Capillaroscopy is of crucial value for diagnosis and differentiation of primary and secondary RP in rheumatic diseases. The appearance of abnormal capillaroscopic pattern inherits high positive predictive value for the development of systemic rheumatic disease. The most specific pattern is found in systemic sclerosis (SSc), so called “scleroderma pattern”, which is characterized by the presence of dilated capillaries, hemorrhages, avascular areas and neoangiogeneis. It is found in more than 90% of patients with overt SSc. Similar changes are found in patients with dermatomyositis, mixed connective tissue disease, undifferentiated connective tissue disease and they are called “scleroderma-like pattern”. Absence of abnormal capillaroscopic findings can be regarded as a diagnostic criterion for primary RP. Inclusion of pathologic capillaroscopic pattern may increase the sensitivity of ACR classification criteria for SSc. In conclusion, capillaroscopy is of crucial importance for the differentiation of primary and secondary RP in rheumatic diseases, and also in differentiation between different forms of connective tissue diseases as well as for their early diagnosis.

Cortes S, Cutolo M (2007) Capillaroscopic patterns in rheumatic diseases. Acta Rheumatol Port 32:29–36

Shore AC (2000) Capillaroscopy and measurement of capillary pressure. Br J Clin Pharmacol 50(6):501–513. doi:10.1046/j.1365-2125.2000.00278.x PubMedCrossRef

Grassi W, De Anglis R (2007) Capillaroscopy: questions and answers. Clin Rheumatol 26:2009–2016. doi:10.1007/s10067-007-0681-3 PubMedCrossRef

Ulf Müller-Ladner (2008) Raynaud’s phenomenon and peripheral ischemic syndromes, 1st edn. UNI-MED Verlag AG, Bremen

Maricq HR, LeRoy EC, D’Angelo WA et al (1980) Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 23(2):183–189. doi:10.1002/art.1780230208 PubMedCrossRef

Bollinger A, Fagrell B (1990) Clinical capillaroscopy—a guide to its use in clinical research and practice. Hogrete&Huber Publishers, Toronto, Ontario, pp 1–158

Bergman R, Sharony L, Schapira D et al (2003) The handheld dermatoscope as a nail-foiled capillaroscopic instrument. Arch Dermatol 139:1027–1030. doi:10.1001/archderm.139.8.1027 PubMedCrossRef

Cutolo M, Grassi W, Matucci Cerinic M (2003) Raynaud’s phenomenon ant the role of capillaroscopy. Arthritis Rheum 48(11):3023–3030. doi:10.1002/art.11310 PubMedCrossRef

Cutolo M, Sulli A, Pizzorni C, Accardo S (2000) Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol 27:155–160PubMed

10.

Cutolo M, Pizzorni C, Tuccio M et al (2004) Nailfold videocapillaroscopic patterns and serum autoantibodies in systemic sclerosis. Rheumatol 43:719–726. doi:10.1093/rheumatology/keh156 CrossRef

11.

Cutolo M, Pizzorni C, Sulli A (2005) Capillaroscopy. Best Pract Res Clin Rheumatol 19(3):437–452. doi:10.1016/j.berh.2005.01.001 PubMedCrossRef

12.

Cutolo M, Sulli A, Secchi ME et al (2007) The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol 21(6):1093–1108. doi:10.1016/j.berh.2007.10.001 PubMedCrossRef

13.

Bredemeier M, Xavier RM, Capobianco KG et al (2004) Nailfold capillary microscopy can suggest pulmonary disease activity in systemic sclerosis. J Rheumatol 31:286–294PubMed

14.

Dolezalova P, Young SP, Bacon PA, Southwood TR (2003) Nailfold capillary microscopy in healthy children and in childhood rheumatic diseases: a prospective single blind observational study. Ann Rheum Dis 62(5):444–449. doi:10.1136/ard.62.5.444 PubMedCrossRef

15.

Kabasakal Y, Elvins DM, Ring EF, McHugh NJ (1996) Quantitative nailfold capillaroscopy findings in a population with connective tissue disease and in normal healthy controls. Ann Rheum Dis 55:507–512. doi:10.1136/ard.55.8.507 PubMedCrossRef

16.

Lee P, Leung FY, Alderdice C, Armstrong SK (1983) Nailfold capillary microscopy in the connective tissue diseases: a semiquantitative assessment. J Rheumatol 10(6):930–938PubMed

17.

Lefford F, Edwards JCW (1986) Nailfold capillary microscopy in connective tissue disease: a quantitative morphological analysis. Ann Rheum Dis 45:741–749. doi:10.1136/ard.45.9.741 PubMedCrossRef

18.

Maricq HR, Harper FE, Khan MM et al (1983) Microvascular abnormalities as possible predictors of disease subsets in Raynaud phenomenon and early connective tissue disease. Clin Exp Rheumatol 1(3):195–205PubMed

19.

Maricq HR (1986) Comparison of quantitative and semiquantitative estimates of nailfold capillary abnormalities in scleroderma spectrum disorders. Microvasc Res 32(2):271–276. doi:10.1016/0026-2862(86)90062-2 PubMedCrossRef

20.

Redisch W (1970) Capillaroscopic observations in rheumatic diseases. Ann Rheum Dis 29:244–253. doi:10.1136/ard.29.3.244 PubMedCrossRef

21.

Anders HJ, Sigl T, Schattenkirchner M (2001) Differentiation between primary and secondary Raynaud’s phenomenon: a prospective study comparing nailfold capillaroscopy using an ophthalmoscope or stereomicroscope. Ann Rheum Dis 60:407–409. doi:10.1136/ard.60.4.407 PubMedCrossRef

22.

Beltran E, Toll A, Pros A et al (2007) Assessment of nailfold capillaroscopy by ×30 digital epiluminescence (dermoscopy) in patients with Raynaud’s phenomenon. Clin Lab Invest 156:892–898

23.

Anderson ME, Allen PD, Moore T et al (2005) Computerized nailfold videocapillaroscopy–a new tool for assessment of Raynaud’s phenomenon. J Rheumatol 32:841–848PubMed

24.

Herrick AL (2008) Diagnosis and management of scleroderma peripheral vascular disease. Rheum Dis Clin North Am 34:89–114. doi:10.1016/j.rdc.2007.11.006 PubMedCrossRef

25.

Ho M, Belch JJF (1998) Raynaud’s phenomenon: State of the Art 1998. Scand J Rheumatol 27:319–322. doi:10.1080/03009749850154311 PubMedCrossRef

26.

Cutolo M, Sulli A, Secchi ME et al (2006) Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement? Rheumatol 45:43–46. doi:10.1093/rheumatology/kel310 CrossRef

27.

Herrick AL, Clark S (1998) Quantifying digital vascular disease in patients with primary Raynaud’s phenomenon and systemic sclerosis. Ann Rheum Dis 57:70–78PubMedCrossRef

28.

Block JA, Sequeira W (2001) Raynaud’s phenomenon. Sem Lancet 357:2042–2048. doi:10.1016/S0140-6736(00)05118-7 CrossRef

29.

Seibold JR, Steen VD (1994) Systemic sclerosis. In: Klippel JH, Dieppe PA (eds) Rheumatology. London, Mosby, pp 6.8–6.11

30.

Steven AO (2001) Raynaud’s phenomenon. In: Sterling JB (ed) Secrets of rheumatology. Binom, Moscow, pp 614–619

31.

Susol E, MacGregor AJ, Barrett JH et al (2000) A two- stage, genome-wide screen for susceptibility loci in primary Raynaud’s phenomenon. Arthritis Rheum 43(7):1641–1646. doi:10.1002/1529-0131(200007)43:7<1641::AID-ANR30>3.0.CO;2-Y PubMedCrossRef

32.

Le Roy EC, Medsger TA Jr (1992) Raynaud’s phenomenon–a proposal for classification. Clin Exp Rheumatol 10:485–488

33.

Bukhari M, Hollis S, Moore T et al (2000) Quantitation of microcirculatory abnormalities in patients with primary Raynaud’s phenomenon and systemic sclerosis by videocapillaroscopy. Rheumatol 39(5):506–512. doi:10.1093/rheumatology/39.5.506 CrossRef

34.

Nagy Z, Czirjac L (2004) Nailfold digital capillaroscopy in 447 patients with connective tissue disease and Raynaud` disease. J Eur Acad Dermatol Venereol 18:62–68. doi:10.1111/j.1468-3083.2004.00853.x PubMedCrossRef

35.

Blockmans D, Beyens G, Verhaeghe R (1996) Predictive value of nailfold capillaroscopy in the diagnosis of connective tissue diseases. Clin Rheumatol 15(2):148–153. doi:10.1007/BF02230332 PubMedCrossRef

36.

Pavlov-Dolijanovic S, Damjanov N, Ostojić P et al (2006) The prognostic value of nailfold capillary changes for the development of connective tissue disease in children and adolescents with primary Raynaud’s phenomenon: a follow-up study of 250 patients. Pediatr Dermatol 23(5):437–442. doi:10.1111/j.1525-1470.2006.00278.x PubMedCrossRef

37.

Ziegler S, Brunner M, Eigenbauer E, Minar E (2003) Long-term outcome of primary Raynaud’s phenomenon and its conversion to connective tissue disease: a 12-year prospective patient analysis. Scand J Rheumatol 32:343–347. doi:10.1080/03009740410005007 PubMedCrossRef

38.

Kirou KA, Crow MK (2000) Raynaud’s phenomenon. In: Paget SA et al (eds) Manual of rheumatology and outpatient orthopedic disorders: diagnosis and therapy, 4th edn. Lippincot Williams & Willkins, Philadelphia, pp 82–87

39.

Ling SM, Wigley FM (1999) Raynaud’s phenomenon in older adults. Diagnostic considerations and management. Drugs Aging 15(3):183–195. doi:10.2165/00002512-199915030-00002 PubMedCrossRef

40.

Sherber NS, Wigley FM, Scher R (2007) Autoimmune disorders: nail signs and therapeutic approaches. Dermatol Ther 20(1):17–30. doi:10.1111/j.1529-8019.2007.00108.x PubMedCrossRef

41.

Silver RM (2005) Systemic sclerosis and scleroderma variants:clinical aspects. In: Koopman WJ et al (eds) Arthritis and allied conditions, 15th edn. Lippincot Williams &Wilkins, Philadelphia, pp 1633–1680

42.

Mulligan-Kehoe MJ, Simons M (2008) Vascular disease in scleroderma: angiogenesis and vascular repair. Rheum Dis Clin North Am 34:73–79. doi:10.1016/j.rdc.2007.12.006 PubMedCrossRef

43.

Caramaschi P, Canestrini S, Martinelli N et al (2007) Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Rheumatol 46(10):1566–1569. doi:10.1093/rheumatology/kem190 CrossRef

44.

Houtman PM, Kallenberg CG, Wouda AA, The TH (1985) Decreased nailfold capillary density in Raynaud’s phenomenon: a reflection of immunologically mediated local and systemic vascular disease? Ann Rheum Dis 44:603–609. doi:10.1136/ard.44.9.603 PubMedCrossRef

45.

Ostojic P, Damjanov N (2006) Different clinical features in patients with limited and diffuse cutaneous systemic sclerosis. Clin Rheumatol 25:453–457. doi:10.1007/s10067-005-0041-0 PubMedCrossRef

46.

Lovy M, MacCarter D, Steigerwald JC (1985) Relationship between nailfold capillary abnormalities and organ involvement in systemic sclerosis. Arthritis Rheum 28(5):496–501. doi:10.1002/art.1780280505 PubMedCrossRef

47.

Masi A, Rodnan GP, Medsger TA et al (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum 23:581–590. doi:10.1002/art.1780230510 CrossRef

48.

Lonzetti LS, Joyal F, Raynauld JP et al (2001) Updating the American College of Rheumatology preliminary classification criteria for systemic sclerosis: addition of severe nailfold capillaroscopy abnormalities markedly increases the sensitivity for limited scleroderma. Arthritis Rheum 44(3):735–736. doi:10.1002/1529-0131(200103)44:3<735::AID-ANR125>3.0.CO;2-F PubMedCrossRef

49.

Walker JG (2007) The development of systemic sclerosis classification criteria. Clin Rheumatol 26:1401–1409. doi:10.1007/s10067-007-0537-x PubMedCrossRef

50.

Hudson M, Taillefer S, Steele R et al (2007) Improving the sensitivity of the American College of Rheumatology classification criteria for systemic sclerosis. Clin Exp Rheumatol 25(5):754–757PubMed

51.

Le Roy EC, Medsger TA Jr (2001) Criteria for the classification of early systemic sclerosis. J Rheumatol 28:573–576

52.

Maricq HR, Valter I (2004) A working classification of scleroderma spectrum disorders: a proposal and the results of testing on a sample of patients. Clin Exp Rheumatol 22(3)(Suppl 33):S5–S13

53.

Nadashkevich O, Davis P, Fritzler MJ (2004) A proposal of criteria for the classification of systemic sclerosis. Med Sci Monit 10(11):CR615–CR621PubMed

54.

Granier F, Priollet P, Housset E (1986) Nailfold capillary microscopy in mixed connectivetissue disease. Comparison with systemic sclerosis and systemic lupus erythematosus. Arthritis Rheum 29(2):189–195. doi:10.1002/art.1780290206 PubMedCrossRef

55.

Furtado RNV, Pucinelli ML, Cristo VV et al (2002) Scleroderma-like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud’s phenomenon in SLE patients. Lupus 11(1):35–41. doi:10.1191/0961203302lu144oa PubMedCrossRef

56.

Groen H, ter Borg EJ, Postma DS et al (1992) Pulmonary function in systemic lupus erythematosus is related to distinct clinical, serologic, and nailfold capillary patterns. Am J Med 93(6):619–627. doi:10.1016/0002-9343(92)90194-G PubMedCrossRef

57.

Ingegnoli F, Zeni S, Meani L et al (2005) Evaluation of nailfold videocapillaroscopic abnormalities in patients with systemic lupus erythematosus. J Clin Rheumatol 11(6):295–298. doi:10.1097/01.rhu.0000191193.93720.95 PubMedCrossRef

58.

Bongard O, Bounameaux H, Miescher PA, De Moerloose P (1995) Association of anticardiolipin antibodies and abnormal nailfold capillaroscopy in patients with systemic lupus erythematosus. Lupus 4(2):142–144. doi:10.1177/096120339500400211 PubMedCrossRef

59.

Riccieri V, Spadaro A, Ceccarelli F et al (2005) Nailfold capillaroscopy changes in systemic lupus erythematosus: correlation with disease activity and autoantibody profile. Lupus 14:521–525. doi:10.1191/0961203305lu2151oa PubMedCrossRef

60.

Asherson RA, Pierangeli SS, Cervera R (2007) Is there a microangiopathic antiphospholipid syndrome? Ann Rheum Dis 66:429–432. doi:10.1136/ard.2006.067033 PubMedCrossRef

61.

Pallis M, Hopkinson N, Powell R (1991) Nailfold capillary density as a possible indicator of pulmonary capillary loss in systemic lupus erythematosus but not in mixed connective tissue disease. J Rheumatol 18(10):1532–1536PubMed

62.

Ganczarczyk ML, Lee Armstrong SK (1988) Nailfold capillary microscopy in polymyositis and dermatomyositis. Arthritis Rheum 31(1):116–119. doi:10.1002/art.1780310116 PubMedCrossRef

63.

Nascif AK, Terreri MT, Len CA et al (2006) Inflammatory myopathies in childhood: correlation between nailfold capillaroscopy findings and clinical and laboratory data. J Pediatr 82:40–45. doi:10.2223/JPED.1435 CrossRef

64.

Smolen JS, Steiner G (1998) Mixed connective tissue disease: to be or not to be? Arthritis Rheum 41(5):768–777. doi:10.1002/1529-0131(199805)41:5<768::AID-ART3>3.0.CO;2-Z PubMedCrossRef

65.

de Holanda Mafaldo Diógenes A, Bonfá E, Fuller R, Correia Caleiro MT (2007) Capillaroscopy is a dynamic process in mixed connective tissue disease. Lupus 16(4):254–258. doi:10.1177/0961203307076517 PubMedCrossRef

66.

Garcia-Carrasco M, Sisó A, Ramos-Casals M et al (2002) Raynaud’s phenomenon in primary Sjogren’s syndrome. Prevalence and clinical characteristics in a series of 320 patients. J Rheumatol 29:726–730PubMed

67.

Tektonidou M, Kaskani E, Skopouli FN, Moutsopoulos HM (1999) Microvascular abnormalities in SjÖgren’s syndrome: nailfold capillaroscopy. Rheumatol 38:826–830. doi:10.1093/rheumatology/38.9.826 CrossRef

68.

Capobianco KG, Xavier RM, Bredemeier M et al (2005) Nailfold capillaroscopic findings in primary Sjögren’s syndrome: clinical and serological correlations. Clin Exp Rheumatol 23(6):789–794PubMed

69.

Aguiar T, Furtado E, Dorigo D et al (2006) Nailfold videocapillaroscopy in primary SjÖgren’s syndrome. Angiology 57(5):593–599. doi:10.1177/0003319706293127 PubMedCrossRef

70.

Carrol GJ, Withers K, Bayliss CE (1981) The prevalence of Raynaud’s syndrome in rheumatoid arthritis. Ann Rheum Dis 40:567–570. doi:10.1136/ard.40.6.567 CrossRef

71.

Grassi W, Blasetti P, Core P, Cervini C (1994) Raynaud’s phenomenon in rheumatoid arthritis. Br J Rheumatol 33:139–141. doi:10.1093/rheumatology/33.2.139 PubMedCrossRef

72.

Saraux A, Allain J, Guedes C et al (1996) Raynaud’s phenomenon in rheumatoid arthritis. Br J Rheumatol 35(8):752–754. doi:10.1093/rheumatology/35.8.752 PubMedCrossRef

73.

Grassi W, Felder M, Thüring-Vollenweider U, Bollinger A (1989) Microvascular dynamics at the nailfold in rheumatoid arthritis. Clin Exp Rheumatol 7(1):47–53PubMed

74.

Bhushan M, Moore T, Herrick AL, Griffiths CE (2000) Nailfold video capillaroscopy in psoriasis. Br J Dermatol 142:1171–1176. doi:10.1046/j.1365-2133.2000.03544.x PubMedCrossRef

75.

Salli L, Raimondi F, Pappalardo A (1999) Periungual capillaroscopy in psoriatic arthritis. Clin Term 150(6):409–412 Abstract

76.

Vaz JL, Dancour MA, Bottino DA, Bouskela E (2004) Nailfold videocapillaroscopy in primary antiphospholipid syndrome. Rheumatol 43:1025–1027. doi:10.1093/rheumatology/keh233 CrossRef

77.

Filaci G, Cutolo M, Basso M et al (2001) Long-term treatment of patients affected by systemic sclerosis with cyclosporin A. Rheumatology 40(12):1431–1432. doi:10.1093/rheumatology/40.12.1431 letterPubMedCrossRef

78.

Hahn M, Klyscz T, Jünger M, Rassner G (1995) Local cold exposure test as therapy control in patients with Raynaud’s phenomenon: comparison between laser Doppler fluxmetry and simultaneous red blood cell velocity measurements in nailfold capillaries. Br J Dermatol 133(5):704–709PubMedCrossRef

79.

Schlez A, Häfner HM, Kittel M et al (2003) Systemic scleroderma patients have improved skin perfusion after the transdermal application of PGE1 ethyl ester. Vasa 32(2):83–86. doi:10.1024/0301-1526.32.2.83 PubMedCrossRef

80.

Combe B, Landewe R, Lukas C et al (2007) EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66:34–45. doi:10.1136/ard.2005.044354 PubMedCrossRef

Title: The role of capillaroscopy in differentiation of primary and secondary Raynaud’s phenomenon in rheumatic diseases: a review of the literature and two case reports
Authors: Sevdalina Nikolova Lambova
Ulf Müller-Ladner
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Rheumatology International / Issue 11/2009
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-009-1019-z

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2009

Antibody against mutated citrullinated vimentin: a new sensitive marker in the diagnosis of rheumatoid arthritis

Management of hepatitis B reactivation in patients with lupus nephritis

Fatal myocarditis in adult-onset Still disease with diffuse intravascular coagulation

HLA-Cw*06 class I region rather than MICA is associated with psoriatic arthritis in Czech population

Adding low dose tacrolimus in rheumatoid arthritis patients with an inadequate response to tumor necrosis factor inhibitor therapies

The use of etanercept in a patient with disseminated tuberculosis

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage