Background Presence of ramifications (RM) (capillaries from whose central axis lateral branches emerge) in the nailfold capillaroscopy is generally seen in patients with advanced microvascular damage and is a characteristic feature of scleroderma and dermatomyositis. Nevertheless they are also seen in patients without defined disease, so that it can be an inespecific finding whose potential role in the evolution of the patient is unclear.
Objectives To analyze the risk factors and the prognostic implications associated with the presence of RM in the capillaroscopy. Analyze the risk factors associated with RM in patients who we perform a capillaroscopic in our hospital.
Methods We reviewed all the capillaroscopies performed in our systemic autoimmune diseases outpatient between January 2013 and December 2015. We reviewed the clinic and epidemiological characteristics, capillary pattern, diagnosis and evolution of all the patients and we analyzed their relation with the presence of RM.
Results In this period we performed a capillaroscopy to 226 patients, 48 (21.2%) of which had RM. In the RM group (39 women, 9 men), mean age was 51.38 years, with no significant differences in gender distribution and in age compared to the no-RM group (p 0.394 and 0.694 respectively). 78 of our patients were smokers (34.5%), 61 (27%) had history of arterial hypertension, 71 (31.4%) had hypercholesterolemia and 13 (5.8%) diabetes mellitus, with no differences between both groups (p 0.380, 0.265, 0.501 and 0.867 respectively).
We found 6 patients with digital ulcers, any of them with RM (p 0.197). Patients with idiopathic thromboembolic disease were 5 (2.21%), only 1 with RM (p 0.466). 182 patients (80.5%) presented Raynaud's phenomenon (RP) with a mean duration of 8.59 years, 37 of which had RM (p 0.497). Among patients with RP in which the final diagnosis was primary RP (46, 20.53%) only 3 (6.25%) had RM (p 0.006). Patients that finally were diagnosed with any collagen vascular disease were 135 (59.73%), 37 of wich had RM (p 0.01). In this group 6 patients had systemic lupus erythematosus, 32 systemic sclerosis, 5 antiphospholipid syndrome, 6 Sjögren syndrome, 2 mixed connective tissue disease and 67 undifferentiated connective tissue disease. We found no differences between RM and no-RM groups separately analyzing each of these diagnoses (p 0.426, 0.466, 0.223, 0.191, 0.293 and 0.148 respectively).
With respect capillaroscopic findings we found no correlation with the presence of dilatations (p 0.193), megacapilaries (p 0.418) or hemorrhages (p 0.888) but we did with other suggesting advanced microvascular damage as capillary loss (p 0.018) and presence of tortuosities (p<0.001) and with the sclerodermic capillaroscopic pattern (p 0.003).
Conclusions Presence of RM identifies patients at risk of secondary RP, especially with underlying connective tissue diseases. So, the presence of RM in patients with not clear diagnostic force us to have specially attention with them because they have risk to develop a connective tissue disease in the future.
Disclosure of Interest None declared