Background Nailfold capillaroscopy (NCP) is an easy, non-invasive and useful tool for the diagnosis and follow-up of Systemic Sclerosis (SSc) and other systemic rheumatic diseases.
Objectives To present our single center experience with NCP, describing the main reasons for NCP request, and the major abnormalities detected in capillaroscopy.
Methods Retrospective analysis of patients submitted to NCP assessment, from January 2013 to December 2015 in our center. We collected reasons for NCP request, demographic and clinical data, autoimmunity profile and NCP results.
Results A total of 221 NPC, corresponding to 197 patients, 167 females (84.8%) and 30 males (15.2%) aged from 9 to 90 years were reviewed. One hundred and thirty eight (62.4%) patients had no definitive diagnosis, 53 patients (24%) had SSc, 7 (3.2%) had mixed connective tissue disease, 3 (1.4%) had dermatomyositis/polymyositis (DM/PM), and 3 (1.4%) antiphospholipid syndrome (APS).
Raynaud's phenomenon (RP) alone was the most frequent reason for requesting NCP (33% of the cases), and combined with ANA positivity accounted for another 30.8% of the requests. RP was present in 73.3% of the patients, acrocyanosis in 16.3%, livedo reticularis and puffy hands accounted for 8.6% each one. Anti-nuclear antibodies (ANA) were positive in 59.7%, anti-centromere antibodies were present in 21.3%, anti-topoisomerase I and SSA/SSB in 5.1% of the cases.
One hundred and fifty nine (71.9%) NCP were considered abnormal. The most frequent specific disease pattern was the early one (Cuttolo) in 15%. The most frequent findings were: capillary tortuosity in 112 (71.8%) cases, capillary dilatations in 95 (60.9%), and hemorrhages in 85 (54.5%). NCP was abnormal in 79.4% of patients with RP and ANA, 41.2% of them displaying specific findings of rheumatic diseases (Table 1).
In SSc patients the late and the early pattern (Cuttolo) were the most frequent, present in 15 and 13 NCP, respectively. Concerning specific NCP findings capillary dilatations (81%), hemorrhages (73.6%) and megacapillaries (71.7%) were the most frequent (Table 2).
Of the 138 cases without definitive diagnosis, 61. 6% had abnormal NCP, although mostly with non-specific patterns (50%). In 10 (7.2%) patients NCP helped to establish the diagnosis: VEDOSS (Very Early Diagnosis of Systemic Sclerosis) in 6, antiphospholipid syndrome in 3 and DM in one case.
Conclusions In our experience, NCP was helpful for the diagnosis of rheumatic systemic disease. Specific NCP findings were more frequent in patients with RP + ANA positivity, suggesting that this combination is associated with more disease incidence. Patients with isolated RF had less pathologic NCP findings than those with isolated. ANA positivity. The prospective follow up of those patients with abnormal NCP and no definitive diagnosis will help to establish the predictive value of observed alterations.
Cutolo M, Pizzorni C, Sulli A. Capillaroscopy. Best Pract Res Clin Rheumatol. 2005 Jun;19(3):437–52
Disclosure of Interest None declared
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