الفهرس 
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Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting 0.04% - 0.1% of general population. It can cause physical disability that results from bone erosions and joint destruction.
Rheumatoid arthritis (RA) is a complex autoimmune and progressive inflammatory disease that involves the joints and leads to their destruction. The prevalence of rheumatoid arthritis is 0.5%–1.0% in the general population worldwide.
Differential diagnosis between PsA and RA may be quite difficult in psoriatic arthritis patients with mild or with no cutaneous manifestations (PsA sine psoriasis) since both of them may present with symmetrical articular involvement.
Nailfold Capillaroscopy (NC) is a quick, cheap, non-invasive diagnostic method used for studying nailfold capillaries. The morphological changes in microcirculation have been widely demonstrated in PsA and RA patients. Impairment of capillary permeability and changes in the connections between endothelium and extracellular matrix characterize these damages, leading to abnormal structure and shape of the capillaries in the dermal papillae.
The aim of this study was to determine the nailfold capillary microscopic changes in both psoriatic arthritis and rheumatoid arthritis patients and their correlation with disease activity.
This study was conducted on two groups of patients. The first group included 20 psoriatic arthritis patients diagnosed according to CASPAR criteria. The second group included 20 RA patients diagnosed according to the 2010 ACR/ EULAR classification criteria for RA. All patients were recruited from Rheumatology outpatient clinic and inpatients in the department of Internal Medicine-Rheumatology division at Ain Shams university hospital.
All patients were subjected to full medical history taking, full clinical examination including musculoskeletal examination with assessment of disease activity using DAS28 score. Also, laboratory and nailfold capillaroscopic assessment were done to all patients.
To assess the changes and differences in the capillaroscopic findings in both PsA and RA, we compared the nail fold capillaroscopy findings including: density, width, length, arterial diameter, shape, distribution of capillaries besides presence of hemorrhage, avascular areas and subpapillary venous plexus in both PsA and RA patients.
Regarding the characteristic different changes in the capillary microscopic findings in our PsA and RA patients, the capillaroscopy pattern in patients with rheumatoid arthritis did not demonstrate specific alterations in the microcirculation, and the findings were within normal [the capillaries were hairpin in shape and organized with normal mean density (9.55±1 /mm), their mean width was (22.95±4.3um), hemorrhages were present in (10%) of RA patients]. While, in the PsA patients tortuous capillaries were found in 100%, disorganized capillaries in (35%), hemorrhages were found in (65%) with low mean capillary density (8.65±1.39 /mm), and dilated capillaries as their mean width was (28.35±7.76um).
Assessment of the correlation between the capillaroscopic findings and the disease activity in both groups of our studied patients, the current study showed that, as regards the parameters of the disease activity in our PsA patients, there was a statistically significant negative correlation between the number of tender joints and the density of capillaries (P=0.042) while, there was a significant positive correlation with the width of capillaries (P=0.047). Moreover, there was a statistically significant positive relation between number of tender joints and disorganization of capillaries (P=0.035). A statistically significant negative correlation was found between CRP titre as an inflammatory marker of disease activity and arterial diameter of capillaries (P=0.045). While in our RA patients, we did not find statistically significant correlation or relation between parameters of the disease activity” ESR, CRP,..” and nailfold capillaroscopy findings.
In conclusion, the difference in nailfold capillaroscopy findings found in PsA and RA patients supports the usefulness of nail fold capillaroscopy in assisting the differential diagnosis between both diseases. As regards the assessment of disease activity, our results didn’t support the usefulness of nailfold capillaroscopy in assessing the disease activity in RA patients. While in PsA patients we found some changes in nailfold capillaroscopy findings as capillary width and density which was correlated with some parameters of disease activity (CRP titre and the number of tender joints) but we did not find statistically significant correlation between capillary microscopic findings and DAS28 score to support this conclusion. This may be due to the small sample size in our study.