Skip to main content

Advertisement

SpringerLink
Log in

Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: a follow-up study of 3,029 patients with primary Raynaud’s phenomenon

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

To assess the prognostic value of scleroderma pattern of nailfold capillary changes for the development of connective tissue diseases (CTD) in subjects with primary Raynaud’s phenomenon (RP). The study included 3,029 consecutive patients with primary RP who had been followed at 6-month intervals during the mean of 4.8 years. The pathological features of nailfold capillaroscopy were recorded in all patients who had neither clinical nor serological signs of a CTD. In patients who developed CTD, capillary changes obtained 6 months prior to diagnosis were analyzed. A possible relationship between capillary changes and the presence of associated CTD was assessed. At the end of follow-up, 1,660 (54,8%) patients have still the primary RP, 246 (8,1%) had suspected secondary RP, and 1,123 (37,1%) patients developed CTD (363 undifferentiated CTD, 263 systemic sclerosis, 143 systemic lupus erythematosus, 106 rheumatoid arthritis, 102 Sjögren’s syndrome, 61 overlap syndrome, 30 vasculitides, 24 mixed CTD, 19 polymyositis, 7 dermatomyositis, and 5 primary antiphospholipid syndrome). Scleroderma pattern were significantly associated with the development of systemic sclerosis [P = .00001, sensitivity 94%, specificity 92%, positive predictive value 52%, negative predictive value 99%, and odds ratio 163 (95% CI, 97,9–271,5)], as well as dermatomyositis (P = .0004), overlap syndrome with signs of systemic sclerosis (P = .0001), and mixed connective tissue disease (P = .007). Capillary microscopy is effective method for differentiation between primary and secondary RP and useful tool for the prediction of scleroderma spectrum disorders in RP patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wigley FM (2002) Raynaud’s phenomenon. N Engl J Med 347:1001–1008

    Article  PubMed  Google Scholar 

  2. Maricq HR, Weinberg AB, LeRoy EC (1982) Early detection of scleroderma-spectrum disorders by in vivo capillary microscopy: a prospective study of patients with Raynaud’s phenomenon. J Rheumatol 9:289–291

    PubMed  CAS  Google Scholar 

  3. Kallenberg CG, Pastoor GW, Wouda AA (1982) Antinuclear antibodies in patients with Raynaud’s phenomenon: clinical significance of anticentromere antibodies. Ann Rheum Dis 41:382–387

    Article  PubMed  CAS  Google Scholar 

  4. Porter JM, Bardana EJ Jr, Baur GM, Wesche DH, Andrasch RH, Rosch J (1976) The clinical significance of Raynaud’s syndrome. Surgery 80:756–764

    PubMed  CAS  Google Scholar 

  5. Zufferey P, Depairon M, Chamot AM, Monti M (1992) Prognostic significance of nailfold capillary microscopy in patients with Raynaud’s phenomenon and scleroderma pattern abnormalities: a six-years follow-up study. Clin Rheumatol 11:536–541

    Article  PubMed  CAS  Google Scholar 

  6. Spencer-Green G (1998) Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates, and predictors of transition to secondary diseases. Arch Intern Med 158:595–600

    Article  PubMed  CAS  Google Scholar 

  7. Cutolo M, Grassi W, Matucci Cerinic M (2003) Raynaud’s phenomenon and the role of capillaroscopy. Arthr Rheum 48:3023–3030

    Article  Google Scholar 

  8. Maricq HR, Spencer-Green G, LeRoy EC (1976) Skin capillary abnormalities as indicators of organ involvement in scleroderma (systemic sclerosis), Raynaud syndrome and dermatomyositis. Am J Med 61:862–870

    Article  PubMed  CAS  Google Scholar 

  9. Maricq HR, LeRoy EC, D’Angelo WA et al (1980) Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthr Rheum 23:183–189

    Article  CAS  Google Scholar 

  10. Houtman PM, Kallenberg CGM, Wouda AA, The TH (1985) Decreased nailfold capillary density in Raynaud phenomenon: a reflection of immunologically mediated local and systemic vascular disease. Ann Rheum Dis 44:603–609

    Article  PubMed  CAS  Google Scholar 

  11. Meli M, Gityelmann G, Koppensteiner R, Amann-Vesti BR (2006) Predictive value of nailfold capillaroscopy in patients with Raynaud’s phenomenon. Clin Rheumatol 25:153–158

    Article  PubMed  Google Scholar 

  12. LeRoy EC, Medsger TA Jr (1992) Raynaud’s phenomenon: a proposal for classification. Clin Exp Rheumatol 10:485–488

    PubMed  CAS  Google Scholar 

  13. Maricq HR (1981) Widefield capillary microscopy: technique and rating scale for abnormalities seen in scleroderma and related disorders. Arthr Rheum 24:1159–1164

    Article  CAS  Google Scholar 

  14. Damjanov N, Pavlov S, Radosavljevic V, Ostojic P, Curcic A (1998) Prognostic significance of capillaroscopic findings in subjects with Raynaud phenomenon. Acta Rheumatol Belgradensia 28:12–17

    Google Scholar 

  15. LeRoy EC, Black C, Fleischmajer R et al (1988) Scleroderma (systemic sclerosis): classification, subset and pathogenesis. J Rheumatol 15:202–205

    PubMed  CAS  Google Scholar 

  16. Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthr Rheum 25:1271–1277

    Article  CAS  Google Scholar 

  17. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 31:315–324

    Article  CAS  Google Scholar 

  18. Alarcon-Segovia D, Cardiel MH (1989) Comparison between 3 diagnostic criteria for mixed connective tissue disease. Study of 593 patients. J Rheumatol 16:328–334

    PubMed  CAS  Google Scholar 

  19. Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (second of two parts). N Engl J Med 292:403–407

    Article  PubMed  CAS  Google Scholar 

  20. Vitali C, Bombardieri S, Jonsson R et al (2002) Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-Europe Consensus Group. Ann Rheum Dis 61:554–558

    Article  PubMed  CAS  Google Scholar 

  21. Mosca M, Neri R, Bombardieri S (1999) Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria. Clin Exp Rheum 17:615–620

    CAS  Google Scholar 

  22. Wilson WA, Gharavi AE, Koike T et al (1999) International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthr Rheum 42:1309–1311

    Article  CAS  Google Scholar 

  23. Campbell G (1994) Advances in statistical methodology for the evaluation of diagnosis and laboratory test. Stat Med 13:499–508

    Article  PubMed  CAS  Google Scholar 

  24. Cervini C, Grassi W (1996) Raynaud’s phenomenon. Rheumatol Eur 25:111–113

    Google Scholar 

  25. Maricq HR, Weinrich MC, Keli JE, LeRoy EC (1986) Prevalence of Raynaud’s phenomenon in the general population. J Chron Dis 39:423–427

    Article  PubMed  CAS  Google Scholar 

  26. Harper FE, Maricq HR, Turner RE, Lidman RW, LeRoy EC (1982) A prospective study of Raynaud phenomenon and early connective tissue disease. A five-year report. Am J Med 72:883–888

    Article  PubMed  CAS  Google Scholar 

  27. Nagy Z, Czirják L (2004) Nailfold digital capillaroscopy in 447 patients with connective tissue disease and Raynaud’s disease. JEADV 18:62–68

    PubMed  CAS  Google Scholar 

  28. Kabasakal Y, Elvins DM, Ring EF, McHugh NJ (1996) Quantitative nailfold capillaroscopy findings in a population with connective tissue disease and in normal healthy controls. Ann Rheum Dis 55:507–512

    Article  PubMed  CAS  Google Scholar 

  29. Furtado RNV, Pucinelli ML, Cristo VV, Andrade LE, Sato EI (2002) Scleroderma like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud’s phenomenon in SEL patients. Lupus 11:35–41

    Article  PubMed  CAS  Google Scholar 

  30. Nakano M, Ohuchi Y, Hasegawa H, Kuroda T, Ito S, Gejyo F (2000) Clinical significance of anticentromere antibodies in patients with systemic lupus erythematosus. J Rheumatol 27:1403–1407

    PubMed  CAS  Google Scholar 

  31. Fritzler MJ, Kinsella TD (1980) The CREST syndrome: a distinct serologic entirety with anticentromere antibodies. Am J Med 69:520–526

    Article  PubMed  CAS  Google Scholar 

  32. Ferri C, Bernini L, Cecchetti R et al (1991) Cutaneous and serologic subset of systemic sclerosis. J Rheumatol 18:1826–1832

    PubMed  CAS  Google Scholar 

  33. Sarkozi J, Bookman AM, Lee P, Keystone EC, Fritzler MJ (1987) Significance of anticentromere antibody in idiopathic Raynaud’s syndrome. Am J Med 83:893–898

    Article  PubMed  CAS  Google Scholar 

  34. Lambova SN, Müller-Ladner U (2009) The role of capillaroscopy in differentiation of primary and secondary Raynaud’s phenomenon in rheumatic diseases: a review of the literature and two case reports. Rheumatol Int 29:1263–1271

    Article  PubMed  Google Scholar 

  35. Ingegnolli F, Zeni S, Meani L, Soldi A, Lurati A, Fantini F (2005) Evaluation of nailfold videocapillaroscopic abnormalities in patients with systemic lupus erythematosus. J Clin Rheumatol 11:295–298

    Article  Google Scholar 

  36. Bongard O, Bounameaux H, Miescher PA, deMoerloose P (1995) Association of anticardiolipin antibodies and abnormal nailfold capillaroscopy in patients with systemic lupus erythematosus. Lupus 4:142–144

    Article  PubMed  CAS  Google Scholar 

  37. Jouanny P, Schmidt C, Feldmann L, Schmitt J (1994) Focus on a quick reading of nailfold capillaroscopy. J Mal Vasc 19:206–209

    PubMed  CAS  Google Scholar 

  38. Fitzgerald O, Hess EV, O’Connor GT, Spencer-Green G (1988) Prospective study of the evolution of Raynaud’s phenomenon. Am J Med 84:718–726

    Article  PubMed  CAS  Google Scholar 

  39. Luggen M, Belhorn L, Evans T, Fitzgerald O, Spencer-Green G (1995) The evolution of Raynaud’s phenomenon: a longterm prospective study. J Rheumatol 22:2226–2232

    PubMed  CAS  Google Scholar 

  40. Tektonidou M, Kaskani E, Skopouli FN, Moutsopoulos HM (1999) Microvascular abnormalities in Sjögren’s syndrome: nailfold capillaroscopy. Rheumatology 38:826–830

    Article  PubMed  CAS  Google Scholar 

  41. Redisch W (1970) Capillaroscopic observations in rheumatic diseases. Ann Rheum Dis 29:244–253

    Article  PubMed  CAS  Google Scholar 

  42. Zimmerman C, Steiner G, Skriner K, Hassfeld W, Petera P, Smolen JS (1998) The concurrence of rheumatoid arthritis and limited systemic sclerosis. Clinical and serological characteristics of an overlap syndrome. Arthr Rheum 41:1938–1945

    Article  Google Scholar 

  43. Ohtsuka T, Tamura T, Yamakage A, Yamazaki S (1998) The predictive value of quantitative nailfold capillary microscopy in patients with undifferentiated connective tissue disease. Br J Dermatol 139:622–629

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We are indebted to Ministry of science of Republic of Serbia. This study was supported by research grant number 17541 for 2011–2014, issued by the Ministry of science of Republic of Serbia. We thank Prof Dr Pavle Milenkovic for helpful comments on the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute of Rheumatology, Belgrade, Serbia

    Slavica Pavlov-Dolijanovic

  2. Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Serbia, Belgrade, Serbia

    Nemanja S. Damjanov, Roksanda M. Stojanovic & Nada Z. Vujasinovic Stupar

  3. Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia, Belgrade, Serbia

    Dejana M. Stanisavljevic

Authors
  1. Slavica Pavlov-Dolijanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nemanja S. Damjanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roksanda M. Stojanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nada Z. Vujasinovic Stupar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dejana M. Stanisavljevic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Slavica Pavlov-Dolijanovic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pavlov-Dolijanovic, S., Damjanov, N.S., Stojanovic, R.M. et al. Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: a follow-up study of 3,029 patients with primary Raynaud’s phenomenon. Rheumatol Int 32, 3039–3045 (2012). https://doi.org/10.1007/s00296-011-2109-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-011-2109-2

Keywords

Search

Navigation