Antitopoisomerase antibody positivity predates nailfold capillaroscopy abnormalities in scleroderma. Postulated classification of ‘prescleroderma’

$48.00 plus tax (Refund Policy)

Download / Buy Article:

Abstract:

Abstract

In a patient with early topoisomerase antibody-positive scleroderma, antinuclear antibody positivity was fortuitously observed to predate nailfold capillaroscopy changes. Using this case as a template, the prediagnostic phase of the presumed multifactorial disease may be divided into 5 temporal phases – phase 1 representing conception and intrauterine environment, phase 2 representing the extrauterine environment predating environmental exposure; phase 3 representing the early post-environmental exposure interval with no detectable perturbed body status; phase 4 representing the post-environmental exposure interval characterized by autoantibody production and microvascular changes, and phase 5, the symptomatic clinical prediagnostic interval (Raynaud's, skin, musculoskeletal, gastrointestinal, cardiorespiratory) prompting scleroderma diagnosis. Temporal classification of prescleroderma aids in both the understanding and definition of scleroderma ‘onset’. If altered nailfold capillaries and autoantibodies develop at comparable rates, and if the findings from this case – that autoantibody changes precede microvascular changes – are truly representative of the preclinical disease phase, then these findings argue that the evolution of the disease is from within the vessel outwards, rather than vice versa.

Keywords: autoantibody; nailfold capillaroscopy; prediagnostic staging; scleroderma

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2010.02381.x

Affiliations: 1: Rheumatology Department 2: Sydney, New South Wales, Australia 3: Vascular Medicine, St Vincent's Hospital 4: Rheumatology Department, Westmead Hospital

Publication date: February 1, 2011

Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more