Background Nailfold videocapillaroscopy (NVC) analysis can definitely distinguish between primary (PRP) and secondary (SRP) Raynaud’s phenomenon by identifying the “early” scleroderma-pattern of microangiopathy (giant capillaries and microhaemorrhages) (1).
Objectives The aim of the study was to evaluate, in recent SRP patients, who developed the “early” pattern of nailfold microangiopathy (and SRP) the evolution of very early non-specific morphological capillary alterations by a follow up of their previous NVC microvascular status.
Methods After informed consent and Ethical Committee approval, fifty patients with early diagnosis of SRP (mean age 47±16 years; mean SRP duration 7±8 years) based on the new finding of “early” NVC scleroderma-pattern of microangiopathy were evaluated (one year retrospective follow-up), to study the evolution of not specific capillary abnormalities possibly present at previous NVC examinations, in particular capillary ectasias (diameter between 20-50 microns). Two fields per finger (from the 2nd to the 5th finger) of both hands were analyzed and the average semiquantitative scores for the capillaroscopic parameters (i.e. capillary number, ectasias, giant capillaries, microhaemorrhages, ramified capillaries), as previously reported (2-3). The statistical examination was performed by non-parametric tests.
Results All the SRP patients showed two or more giant capillaries, identifying the “early” scleroderma-pattern of microangiopathy at the moment of inclusion. In 74% of patients the “ectasia score” remained the same during one-year follow-up, despite the appearance of giant capillaries, while in 26% of patients the “ectasia score” increased from 1 to 2 (p=0.005). 42% of patients showed a one-point increment of the microhaemorrhage score (from 0 to 1 or from 1 to 2) (p=0.005). At first NVC examination, 9% of patients showed a mild capillary number reduction, which did not change during the subsequent follow-up (score 1); in 16% of cases a not statistically significant reduction of capillary number (score from 0 to 1) was observed at last NVC visit. Capillaries ramifications were not observed at follow-up.
Conclusions The results confirm that the transition from PRP to SRP is characterised by the appearance of giant capillaries, at NVC. However, the very early identification of nailfold capillary ectasias in a subgroup of PRP patients suggests the need for close NVC monitoring of these patients, in order to early detect the onset of giant capillaries and related diseases, such as systemic sclerosis, especially when other clinical features of the disease are not evident.
Cutolo, M. et al. Nature Rev Rheumatol 2010; 6, 578–587.
Cutolo M, et al. Rheumatology 2004; 43: 719-26. 3. Sulli A, et al. Ann Rheum Dis 2008; 67:885-7.
Disclosure of Interest None Declared
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