Presentation: Predictive Value of Nailfold Capillaroscopic Findings in Patients with Raynaud Phenomenon (2007)

10 Predictive Value of Nailfold Capillaroscopic Findings in Patients with Raynaud Phenomenon

PURPOSE: To analyze the predictive value of nailfold capillaroscopic findings in patients with Raynaud’s phenomenon in a routine clinical setting
PATIENTS AND METHODS: All patients sent to the rheumatology department for a capillaroscopy between 2000 and 2006 were reviewed. Only patients with a definite diagnosis or more than 2 years of follow-up were included. Capillaroscopy was done in 8 fingers, with a 20-40x microscopy, by the same observer (PEC). The following findings were considered abnormal: local or global capillary loss (>20%), hemorrhages (2 or more in at least 2 fingers), dilated loops (2 or more loops with at least double caliber in at least 2 fingers). Special measurements were not done, and mean capillaroscopy time was 5 min. In every patient, clinical history, specific questionnaires for connective tissue disease (CTD), vascular risks, physical exam, and blood tests including autoimmunity were done. Univariate and multivariate logistic regression were used.
RESULTS: The study included 477 (95m, 382f) patients, aged 48±18 years. Causes for capillaroscopy were Raynaud in 337(70%) cases, SSc evaluation in 86(18%), ischemic ulcers in 9(2%), hand edema in 8(2%) and others in 37(8%). Capillaroscopy was normal in 338(71%) patients and abnormal in 139(29%). Final diagnosis was primary Raynaud in 157(33%), SSc in 137(29%), RA-SS in 38(8%), SLE in 23(5%), acrocyanosis in 15(3%), inflammatory myopathy in 13(3%), Buerger’s disease in 9(2%), MCTD in9 (2%) and others in 73(15%). In the 337 patients studied for Raynaud, capillaroscopy was normal in 278(82%) and abnormal in 59(18%). Final diagnosis was primary Raynaud in 146(46%), SSc in 49(15%), RA-SS in 34(10%), SLE in 21(6%), acrocyanosis in 9(3%), inflammatory myopathy in 8(2%), Buerger’s disease in 3(1%) and others in 42(12%) (14 carpal tunnel syndrome, 11 atherosclerosis). Within the group of patients studied for Raynaud, univariate logistic regression showed that the possibility of developing SSc or other CTD with a normal capillaroscopy, is very low (OR=0.03; 95%CI 0.02-0.07; OR=0.2; 95%CI 0.08-0.5; respectively, p< 0,001). SSc diagnosis was associated with higher age (OR=1.02; 95%CI 1.01-1.04, p=0.005), high blood pressure (OR=2.8; 95%CI 1.5-5.5, p=0.002), ANA (OR=26.4; 95%CI 10-69; p< 0.001), a-Scl70 (p<0.001), a-centromere (p<0.001) and sclerodactily (p<0.001). Multivariate analysis confirmed high blood pressure, abnormal capillaroscopy, calcinosis, sclerodactily and ANA, as independent risk factors for SSc diagnosis. When only patients with CTD were selected, an abnormal capillaroscopy and ANA continue being predictors for SSc diagnosis.
CONCLUSIONS: Capillaroscopy, done in a routine clinical setting, without any special measurement, is a simple and useful tool for the study of patients with Raynaud phenomenon. Together with ANA, this inexpensive technique is able to predict SSc diagnosis, even within the group of patients with other CTD.

 A. Movasat, None; B. Joven, None; P. Carreira, None.