Capillaroscopy is a safe, non-invasive tool with which the microcirculation, more specifically the capillaries can be easily studied at the nailfold of patients (1, 2). For the clinical rheumatologist this tool may be of value in predicting which patients, with reactivity of the microcirculation, clinically characterised by the Raynaud’s phenomenon, may develop a certain connective tissue disease. In this way long-term follow up of patients with merely Raynaud’s phenomenon at baseline shows that those with both pathognomonic scleroderma-type changes on capillaroscopy and systemic sclerosis (SSc)-specific antibodies are at high chance to develop SSc.(3) On the other hand, at this very moment no studies attest any capillaroscopic alterations to be predictive of other connective tissue diseases.(4)
Next to its predictive role in patients with Raynaud’s phenomenon, capillaroscopy ideally may be also of use as a biomarker in patients with connective tissue diseases. In order to be recognised as a biomarker, capillaroscopy needs to fulfil the following criteria: 1) to attest intra- and inter-observer reliability, 2) to detect changes over time and 3) to be able to predict disease associated complications in connective tissue diseases.
First, reliability of qualitative assessment (= pattern recognition of combination of capillaroscopic parameters) to discern “normal” from “pathognomonically abnormal” capillaroscopic images, due to SSc has been (in)directly attested by all tools being used to perform capillaroscopy. Reliability of separate capillaroscopic parameters has been attested for diameter of capillaries and density of capillaries.
Secondly, changes in capillaroscopic parameters over time have been described both in dermatomyositis and SSc. In dermatomyositis persistance of loss of capillaries over time has been associated with a worse clinical course. In SSc, the progressiveness of obliteration and rarefaction of the microvasculature has been reflected in an augmentation of microangiopathy score and in evolution of qualitatively assessed scleroderma patterns over time.(5) Of note, the follow up of change of capillaroscopic parameters over time starts to finds its way into clinical research.
Third, the ability to predict future complications has been promisingly investigated at this very moment in the field of SSc. In this way baseline capillaroscopic parameters have been associated with future digital trophic lesions and lung involvement. (6-8) Moreover prognostic indici have been proposed which allow prediction on the individual patient level.(6) In parallel, the scleroderma patterns themselves (which are readily obtained in one clinical consultation) may also allow prediction of SSc-related complications.(8) These findings suggest both a possible role for capillaroscopy as outcome measure in clinical trials and biomarker in daily practice. In short, capillaroscopy has an established role to diagnose SSc microangiopathy and emerging data instignate to further explore its role as possible outcome measure and biomarker.
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Pavlov-Dolijanovic S, Damjanov NS, Stojanovic RM, et al. Rheumatology international. 2011. Epub 2011/09/09.
Sulli A, Pizzorni C, Smith V, et al. Arthritis Rheum. 2012;64(3):821-5. Epub 2011/12/01.
Sebastiani M, Manfredi A, Colaci M, et al. Arthritis Rheum. 2009;61(5):688-94. Epub 2009/05/01.
Smith V, De Keyser F, Pizzorni C, et al. Ann Rheum Dis. 2011;70(1):180-3. Epub 2010/10/26.
Smith V, Decuman S, Sulli A, et al. Ann Rheum Dis. 2012. Epub 2012/03/10.
Disclosure of Interest None Declared
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