Distinct Nailfold Videocapillaroscopy Findings in Patients With Anti‐Aminoacyl‐ <scp>tRNA</scp> Synthetase Antibodies

We investigated nailfold videocapillaroscopy (NVC) findings in antisynthetase syndrome (ASyS) and compared patterns among six anti-aminoacyl-tRNA synthetase (anti-ARS) antibody (Ab) subtypes. In this retrospective study of 66 Japanese patients positive for anti-Jo-1, EJ, PL-7, PL-12, KS, or OJ Abs, seven NVC abnormalities were assessed: enlarged capillaries, reduced capillaries, hemorrhages, capillary ramifications, disorganization of the vascular array, loss of capillaries, and giant capillaries. Enlarged capillaries, reduced capillaries, and hemorrhages were common overall; in contrast, patients with anti-KS Abs exhibited significantly fewer abnormalities, particularly hemorrhages (25% vs. 75%-100% in other groups; p < 0.05). Capillary ramifications, disorganization, and capillary loss were rare across all subtypes. Although ASyS patients may present with similar clinical manifestations, NVC findings vary among anti-ARS Ab subtypes; anti-KS Ab identifies a subset with milder microvascular involvement. Recognizing anti-ARS Ab specificity may help interpretation of vascular heterogeneity in ASyS.