Background Primary Raynaud's phenomenon (PRP) represents a benign condition observed in healthy subjects. It is usually due to an exaggerated response to the physiological cold-induced vasospasm .
Objectives To detect by nailfold videocapillaroscopy (NVC) the presence of age-related capillary morphological patterns in a large cohort of subjects with PRP.
Methods 877 subjects affected by PRP (median age 44 years; median disease duration 3 years) performed NVC during their normal clinical screenings and they were divided into three groups (age<35 years, 305 patients; 35< age<55 years, 318 patients; age>55 years, 254 patients). Two fields (3 mm) per finger of both hands were analyzed in the central area of the nailfold, and the qualitative score for several capillaroscopic parameters, usually observed in PRP patients, was evaluated (i.e. number of apical ectasias, irregular ectasias, efferent branch ectasias, microhaemorrhages, tortuosity, as well as subpapillary venous plexus visibility) . The statistical analysis was performed by non-parametric tests.
Results Patients with irregular ectasias, as well as patients with efferent branch ectasias, seem significantly younger than those without (median age 40 vs 48 years, and 36 vs 47, p<0.0001). In particular, irregular ectasias are present in 40% of patients with age<35 years, 37% 35<age<55 years and 23% age>55 years (p<0.0001); efferent branch ectasias are present in 49% of patients with age<35 years, 31% 35<age<55 years and 20% age>55 years (p<0.0001). Furthermore, patients with efferent branch ectasias have a longer disease duration than those without (median 4 vs 3 years, p=0.03). The presence of irregular and efferent branch ectasias would seem to exclude the presence of apical ectasias, in fact 99% of subjects with irregular ectasias do not show apical ectasias, and 87% of subjects with efferent branch ectasias do not show apical ectasias (p<0.0001). Moreover, 78% of patients with efferent branch ectasias show even irregular ectasias (p<0.0001). Patients with microhaemorrhages are significantly younger than those without (median age 42 vs 45 years, p=0.05), and 80% of patients without microhaemorrhages even do not show irregular and efferent branch ectasias (p<0.0001). The subpapillary venous plexus seems more easily visible in subjects with age<35, as well as in those with age>55 years (p<0.0001). A statistically significant negative correlation was found between apical and irregular ectasias (p<0.0001), apical ectasias and efferent branch ectasias (p=0.02), apical ectasias and tortuosity (p=0.0005), microhaemorrhages and tortuosity (p<0.0001), efferent branch ectasias and tortuosity (p=0.02). Finally, a statistically significant positive correlation was found between irregular and efferent branch ectasias (p<0.0001), irregular ectasias and microhaemorrhages (p<0.0001), efferent branch ectasias and microhaemorrhages (p<0.0001).
Conclusions Aspecific abnormalities in nailfold microvasculature could be present in subjects with PRP with a different age distribution. The possible relationship with younger age and local trauma/damage, and/or as related to hypoxic conditions linked to the intensity/duration of the PRP are under further investigation.
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Smith V,Pizzorni C. In Atlas of Capillaroscopy in Rheumatic Diseases. M. Cutolo Ed, Elsevier 2010.
Disclosure of Interest None declared
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