Background Nailfold capillaroscopy is the only method for morphological assessment of nutritional capillaries. Due to specific changes observed the method is diagnostic for systemic sclerosis. It plays a crucial role in differentiation of primary from secondary Raynaud's phenomenon in connective tissue disease. As definite signs for microangiopathy are considered giant capillaries, diffuse haemorrhages and avascular areas, which could not be found at the capillaroscopic examination of fingers in healthy subjects. However, minor changes such as presence of single dilated capillaries, single haemorrhages, tortuous capillaries could be observed at capillaroscopic examination of the fingers in healthy people. The literature data about capillaroscopic findings of toes in healthy individuals and connective tissue diseases are scarce. In an own study in patients with systemic sclerosis, we have observed the classic pathological capillaroscopic changes also at the toes although in a lower proportions of patients (p<0.05).
Objectives To evaluate capillaroscopic findings of the toes in healthy subjects.
Methods 22 healthy individuals were included in the study. Capillaroscopic examination of toes and fingers was performed with videocapillaroscope Videocap 3.0 (DS Medica). Exclusion criteria were history of vasospasm, any concomitant known diseases, taking any medications, arterial hypertension in first degree relatives, obesity (body mass index above >25kg/m2), presence of chronic arterial or venous insufficiency, manual work.
Results The mean diameter of the arterial (0.012±0.002 mm) and venous limb (0.017±0.002 mm). at the toes did not differ significantly as compared of the respective values of the fingers (0.013±0.002 mm for the arterial limb, p=0.46 and 0.018±0.002 mm for the venous limb, p=0.25). The mean capillary length of the toes was shorter 0.165±0.096 mm as compared with hands 0.220±0.079 mm but the difference was not statistically significant (p=0.37). Mean capillary density of the toes was 10.818±1.139 capillaries/mm and at the fingers - 10.318±0.716 capillaries/mm respectively. Dilated capillaries of the toes were observed in 2 cases vs 4 with dilated capillaries (p<0.05) of the fingers. Presence of tortuous capillaries (>10%) was found significantly more often at the toes (12/22) as compared with fingers (6/22, χ2=6.769, p<0.05). There was no difference in the frequency of elongated capillary loops at the toes vs fingers but shorter capillaries were observed significantly more often at the toes (11/22) vs fingers (1/22, χ2=14.666, p<0.05). The subpapillary plexus was visible in 12 cases (54.54%) both at fingers at toes but not simultaneously among these in 5 cases it was observed simultaneously at fingers and toes.
Conclusions Capillaroscopic examination of the toes shows some differences as compared to those of fingers such as greater number of shorter capillaries and increased tortuosity, which might be related with the increased capillary pressure due to gravity among other factors. The major capillaroscopic parameters such as capillary diameters and capillary density does not differ significantly. Moreover, we have previously reported presence of specific microvascular pattern at the toes in systemic sclerosis. Thus, it is an optional additional site for examination when microvascular assessment is indicated.
Disclosure of Interest None declared
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