Title:The Value of Nailfold Capillaroscopy in the Classification and Differential
Diagnosis of Raynaud’s Phenomenon in Rheumatology
Volume: 20
Issue: 2
Author(s): Sevdalina Nikolova Lambova*
Affiliation:
- Department of Propaedeutics of Internal Diseases "Prof Dr. Anton Mitov", Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Department of Rheumatology, MHAT "Sveti Mina", 4002 Plovdiv, Bulgaria
Keywords:
Capillaroscopy, classification, Raynaud’s phenomenon, undifferentiated connective tissue disease, capillary dilations, microangiopathy.
Abstract: Among instrumental techniques, nailfold capillaroscopy plays a leading role in the assessment
of Raynaud’s phenomenon (RP) patients because it is the only method that provides opportunities
for morphological assessment of capillaroscopic findings in the nailfold area, with proven
diagnostic and prognostic significance in rheumatology. The discussion about updating the classification
of RP in rheumatology is interesting given the current understanding of capillaroscopic
findings in rheumatic diseases and improvements in immunological diagnostics. The presence of
dilation of the “true” capillary diameters in primary RP could be observed. There are some cases of
primary RP where the capillaroscopic pattern is completely normal and there are no dilated capillaries
present, which could be related to the duration and severity of the symptoms. It is possible that
longer duration and greater severity are associated with the appearance of capillary dilations, but
more research is needed to confirm it. Rarely, pathological capillaroscpic features of microangiopathy
could be observed in RP patients in whom clinical, laboratory and immunological findings are
compatible with the diagnosis “primary RP”. These cases should be defined as “suspected secondary
RP” and require closer follow-up for the assessment of symptom evolution. Abnormal “scleroderma”
type capillaroscopic pattern has been established as a new classification criterion for systemic
sclerosis (SSc) in 2013. Similar changes (“scleroderma-like” pattern) could be observed in
other rheumatic diseases, i.e., undifferentiated connective tissue disease (UCTD), systemic lupus
erythematosus, dermatomyositis, rheumatoid arthritis, including without evidence of overlap with
scleroderma. The appearance of such microvascular abnormalities at disease presentation is less
well studied in diseases different from SSc. However, “scleroderma-like” microangiopathy has also
been reported as an initial sign in some systemic rheumatic diseases, such as UCTD and systemic
lupus erythematosus. Thus, interpretation of capillaroscopic findings is performed in overall context,
including clinical findings and laboratory and immunological test results.
