Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Perspective

The Value of Nailfold Capillaroscopy in the Classification and Differential Diagnosis of Raynaud’s Phenomenon in Rheumatology

Author(s): Sevdalina Nikolova Lambova*

Volume 20, Issue 2, 2024

Published on: 11 September, 2023

Page: [108 - 114] Pages: 7

DOI: 10.2174/1573397119666230905151903

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.

Keywords: Capillaroscopy, classification, Raynaud’s phenomenon, undifferentiated connective tissue disease, capillary dilations, microangiopathy.

« Previous Next »
[1]
Brown G, O’Leary PA. Skin capillaries in scleroderma. Arch Intern Med 1925; 36(1): 73-88.
[http://dx.doi.org/10.1001/archinte.1925.00120130076008]
[2]
Maricq HR, LeRoy CE. Patterns of finger capillary abnormalities in connective tissue disease by “wide-field” microscopy. Arthritis Rheum 1973; 16(5): 619-28.
[http://dx.doi.org/10.1002/art.1780160506] [PMID: 4742842]
[3]
Maricq HR, LeRoy EC, D’Angelo WA, et al. Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 1980; 23(2): 183-9.
[http://dx.doi.org/10.1002/art.1780230208] [PMID: 7362667]
[4]
Maricq HR, Harper FE, Khan MM, Tan EM, LeRoy EC. Microvascular abnormalities as possible predictors of disease subsets in Raynaud phenomenon and early connective tissue disease. Clin Exp Rheumatol 1983; 1(3): 195-205.
[PMID: 6335855]
[5]
van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: An American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 2013; 65(11): 2737-47.
[http://dx.doi.org/10.1002/art.38098] [PMID: 24122180]
[6]
Ingegnoli F, Herrick AL, Schioppo T, et al. Reporting items for capillaroscopy in clinical research on musculoskeletal diseases: A systematic review and international Delphi consensus. Rheumatology (Oxford) 2021; 60(3): 1410-8.
[http://dx.doi.org/10.1093/rheumatology/keaa457] [PMID: 32984894]
[7]
Smith V, Vanhaecke A, Herrick AL, et al. Fast track algorithm: How to differentiate a “scleroderma pattern” from a “non-scleroderma pattern”. Autoimmun Rev 2019; 18(11): 102394.
[http://dx.doi.org/10.1016/j.autrev.2019.102394] [PMID: 31520797]
[8]
Smith V, Herrick AL, Ingegnoli F, et al. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Autoimmun Rev 2020; 19(3): 102458.
[http://dx.doi.org/10.1016/j.autrev.2020.102458] [PMID: 31927087]
[9]
Lambova S. Capillaroscopy in rheumatology - norm and pathology. (1st ed.), Plovdiv, Bulgaria: Lax Book 2021.
[10]
Belch J, Carlizza A, Carpentier PH, et al. ESVM guidelines – the diagnosis and management of Raynaud’s phenomenon. Vasa 2017; 46(6): 413-23.
[http://dx.doi.org/10.1024/0301-1526/a000661] [PMID: 28895508]
[11]
Valentini G, Pope JE. Undifferentiated connective tissue disease at risk for systemic sclerosis: Which patients might be labeled prescleroderma? Autoimmun Rev 2020; 19(11): 102659.
[http://dx.doi.org/10.1016/j.autrev.2020.102659] [PMID: 32942034]
[12]
Sirufo MM, Ginaldi L, De Martinis M. Raynaud’s phenomenon and the nailfold capillaroscopic findings in a guitar player. QJM 2019; 112(7): 531-3.
[http://dx.doi.org/10.1093/qjmed/hcz095] [PMID: 31028378]
[13]
LeRoy EC, Medsger TA Jr. Raynaud’s phenomenon: A proposal for classification. Clin Exp Rheumatol 1992; 10(5): 485-8.
[PMID: 1458701]
[14]
Maverakis E, Patel F, Kronenberg DG, et al. International consensus criteria for the diagnosis of Raynaud’s phenomenon. J Autoimmun 2014; 48-49: 60-5.
[http://dx.doi.org/10.1016/j.jaut.2014.01.020] [PMID: 24491823]
[15]
Schmidt JA, Caspary L, von Bierbrauer A, et al. Standardisierung der Nagelfalz-Kapillarmikroskopie in der Routinediagnostik. Vasa 1997; 26(1): 5-10.
[http://dx.doi.org/10.1024/0301-1526.35.1.5] [PMID: 9163237]
[16]
Ingegnoli F, Gualtierotti R, Lubatti C, et al. Nailfold capillary patterns in healthy subjects: A real issue in capillaroscopy. Microvasc Res 2013; 90: 90-5.
[http://dx.doi.org/10.1016/j.mvr.2013.07.001] [PMID: 23880032]
[17]
Lambova S, Muller-Ladner U. Nailfold capillaroscopy of fingers and toes - variations of normal. Curr Rheumatol Rev 2017; 13: 28-35.
[18]
Lambova SN, Muller-Ladner U. Capillaroscopic findings in primary fibromyalgia. Curr Rheumatol Rev 2018; 14(1): 36-41.
[http://dx.doi.org/10.2174/1573397113666170607160854] [PMID: 28595537]
[19]
Bukhari M, Herrick AL, Moore T, Manning J, Jayson MIV. Increased nailfold capillary dimensions in primary Raynaud’s phenomenon and systemic sclerosis. Rheumatology (Oxford) 1996; 35(11): 1127-31.
[http://dx.doi.org/10.1093/rheumatology/35.11.1127] [PMID: 8948300]
[20]
Anderson ME, Allen PD, Moore T, Hillier V, Taylor CJ, Herrick AL. Computerized nailfold video capillaroscopy-a new tool for assessment of Raynaud’s phenomenon. J Rheumatol 2005; 32(5): 841-8.
[PMID: 15868619]
[21]
Lambova SN, Müller-Ladner U. Capillaroscopic pattern in systemic lupus erythematosus and undifferentiated connective tissue disease: What we still have to learn? Rheumatol Int 2013; 33(3): 689-95.
[http://dx.doi.org/10.1007/s00296-012-2434-0] [PMID: 22527142]
[22]
Lambova SN, Müller-Ladner U. Inhomogeneity of capillaroscopic findings in systemic sclerosis. Int J Rheum Dis 2020; 23(2): 207-15.
[http://dx.doi.org/10.1111/1756-185X.13760] [PMID: 31808306]
[23]
Cutolo M, Sulli A, Pizzorni C, Accardo S. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol 2000; 27(1): 155-60.
[PMID: 10648032]
[24]
van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: An American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72(11): 1747-55.
[http://dx.doi.org/10.1136/annrheumdis-2013-204424] [PMID: 24092682]
[25]
Lambova SN. Scleroderma-like pattern in various rheumatic diseases. J Rheumatol 2020; 47(6): 942-1-.
[http://dx.doi.org/10.3899/jrheum.200020] [PMID: 32295850]
[26]
van Roon AM, Huisman CC, van Roon AM, et al. Abnormal nailfold capillaroscopy is common in patients with connective tissue disease and associated with abnormal pulmonary function tests. J Rheumatol 2019; 46(9): 1109-16.
[http://dx.doi.org/10.3899/jrheum.180615] [PMID: 30554151]
[27]
Schonenberg-Meinema D, Bergkamp SC, Nassar-Sheikh Rashid A, et al. Nailfold capillary abnormalities in childhood-onset systemic lupus erythematosus: A cross-sectional study compared with healthy controls. Lupus 2021; 30(5): 818-27.
[http://dx.doi.org/10.1177/0961203321998750] [PMID: 33657918]
[28]
Schonenberg-Meinema D, Bergkamp SC, Nassar-Sheikh Rashid A, et al. Nailfold capillary scleroderma pattern may be associated with disease damage in childhood-onset systemic lupus erythematosus: Important lessons from longitudinal follow-up. Lupus Sci Med 2022; 9(1): e000572.
[http://dx.doi.org/10.1136/lupus-2021-000572] [PMID: 35140136]
[29]
Spencer-Green G. Outcomes in primary Raynaud phenomenon: A meta-analysis of the frequency, rates, and predictors of transition to secondary diseases. Arch Intern Med 1998; 158(6): 595-600.
[http://dx.doi.org/10.1001/archinte.158.6.595] [PMID: 9521223]

Rights & Permissions Print Cite
Article Metrics
31
2
World Hemophilia Day
© 2024 Bentham Science Publishers | Privacy Policy