Trophic disturbance in nail growth

Yesterday one of my long term patients (a woman aged 76) showed up for a routine visit. We diagnosed a p-ANCA associated vasculitis in 2002. Histologic work-up of the skin showed vaculitis with lots eosinophiles. Lab tests 2002: p-ANCA 1:2560, ESR 61/>100 mm, CRP 73 mg/l.
She also complained about some new lines on her nails. One could see a trophic disturbance in nail growth.

She has been in remission for long time, still takes methotrexate. Last p-ANCA has been 54.8 RU/ml. CRP 12.9 mg/l, ESR 49 mm. Complement C3 and C4 normal.


Capillary microscopy: elongated capillaries, “avascular” segments, signs post bleeding.

It looks like the term remission won’t stand the test, but otherwise she’s doing fine, so I most probably won’t change therapy.


Did someone see such trophic changes before? My guess is, that a short termed flare 6-8 weeks ago caused the nail changes.