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Purpose: To analyze the nailfold capillaroscopic findings, and evaluate their predicitive value in Raynaud phenomenon and systemic sclerosis (SSc) patients, in a rheumatology university clinical setting.
Methods: All patients sent to the Rheumatology Department to perform a capillaroscopy between jan/01 and apr/06 were reviewed. Those with a definite diagnosis or without a definite diagnosis, but with at least two years of follow-up were included. In each case, capillaroscopy was performed in 8 fingers, with a 20-40x microscopy by the same observer (PEC). The following findings were considered pathologic: global or local evident capillary loss (>20%); hemorrhages (2 o more in at least 2 different fingers); and enlarged capillaries (2 or more with double caliber in at least 2 different fingers). No specific capillary measurements were made in any case. Mean capillaroscopy time was 5 minutes. Complete history and physical exam, blood cell count, biochemistry and ANA were performed in every patient. Descriptive statistical, univariate and multivariate logistic regression with OR with 95% confidence interval were used.
Results: 300 patient, 61 (20%) men, and 239 (80%) women, with 49±18 years were included. Capillaroscopy was performed because of Raynaud in 189 (63%) patients, SSc evaluation in 82 (27%), ischemic ulcers in 8 (3%), hand edema in 6 (2%) and other reason in 15 (5%). Capillaroscopy was normal in 197 (66%) patients and abnormal in 103 (34%). Final diagnosis was primary Raynaud in 72 (25%), Buerger’s disease in 5 (2%), acrocyanosis in 14 (5%), inflammatory myopathy in 9 (3%), SSc in 116 (39%) and others in 64 (21%). From the 189 patients studied because of Raynaud, this was normal in 158 and abnormal in 31. Final diagnosis was primary Raynaud in 165 (87%) cases, SSc in 34 (18%), acrocyanosis in 14 (8%), LES in 14 (8%), inflammatory myopathy in 4 (2%), Buerger in 1 (1%), and others in 47 (25%) (22 other connective tissue diseases, 5 carpal tunnel syndrome, 10 fibrotic conditions). By both univariate and multivariate logistic regression, the possibility of having SSc with a normal capillaroscopy was very low (OR 0.03; 95%CI 0.1-0.8; p<0.0001), and SSc diagnosis was associated with the presence of sclerodactily (OR=10.8; 95%CI 4.5-25.9; p<0.0001) and ANA (OR=21.9; 95%CI 6.3-77.2; p<0.0001). The abnormality in the capillaroscopy was associated with the presence of sclerodactily (p<0.0001), ANA (p<0.0001) and SSc diagnosis (p<0.0001)
Conclusions: Nailfold capillaroscopy performed in a routine clinical setting, without any special measurement, is a simple and useful technique for patients with Raynaud’s phenomenon and may help to identify those patients with SSc diagnosis.
Methods: All patients sent to the Rheumatology Department to perform a capillaroscopy between jan/01 and apr/06 were reviewed. Those with a definite diagnosis or without a definite diagnosis, but with at least two years of follow-up were included. In each case, capillaroscopy was performed in 8 fingers, with a 20-40x microscopy by the same observer (PEC). The following findings were considered pathologic: global or local evident capillary loss (>20%); hemorrhages (2 o more in at least 2 different fingers); and enlarged capillaries (2 or more with double caliber in at least 2 different fingers). No specific capillary measurements were made in any case. Mean capillaroscopy time was 5 minutes. Complete history and physical exam, blood cell count, biochemistry and ANA were performed in every patient. Descriptive statistical, univariate and multivariate logistic regression with OR with 95% confidence interval were used.
Results: 300 patient, 61 (20%) men, and 239 (80%) women, with 49±18 years were included. Capillaroscopy was performed because of Raynaud in 189 (63%) patients, SSc evaluation in 82 (27%), ischemic ulcers in 8 (3%), hand edema in 6 (2%) and other reason in 15 (5%). Capillaroscopy was normal in 197 (66%) patients and abnormal in 103 (34%). Final diagnosis was primary Raynaud in 72 (25%), Buerger’s disease in 5 (2%), acrocyanosis in 14 (5%), inflammatory myopathy in 9 (3%), SSc in 116 (39%) and others in 64 (21%). From the 189 patients studied because of Raynaud, this was normal in 158 and abnormal in 31. Final diagnosis was primary Raynaud in 165 (87%) cases, SSc in 34 (18%), acrocyanosis in 14 (8%), LES in 14 (8%), inflammatory myopathy in 4 (2%), Buerger in 1 (1%), and others in 47 (25%) (22 other connective tissue diseases, 5 carpal tunnel syndrome, 10 fibrotic conditions). By both univariate and multivariate logistic regression, the possibility of having SSc with a normal capillaroscopy was very low (OR 0.03; 95%CI 0.1-0.8; p<0.0001), and SSc diagnosis was associated with the presence of sclerodactily (OR=10.8; 95%CI 4.5-25.9; p<0.0001) and ANA (OR=21.9; 95%CI 6.3-77.2; p<0.0001). The abnormality in the capillaroscopy was associated with the presence of sclerodactily (p<0.0001), ANA (p<0.0001) and SSc diagnosis (p<0.0001)
Conclusions: Nailfold capillaroscopy performed in a routine clinical setting, without any special measurement, is a simple and useful technique for patients with Raynaud’s phenomenon and may help to identify those patients with SSc diagnosis.
A. Movasat, None; B. Joven, None; R. Almodovar, None; P. Carreira, None.