Article Text

SP0028 How To Differentiate Normal from Abnormal Capillaroscopic Patterns: Role of in Early Diagnosis
  1. V. Smith,
  2. on behalf of the EULAR Study Group on Microcirculation in Rheumatic Diseases
  1. Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium


The difference between a normal capillaroscopy and an “abnormal” capillaroscopy is important in the differential diagnosis between a primary Raynaud's phenomenon (=not linked to any condition) from a secondary RP.

A normal capillaroscopic pattern, by qualitative assessment, is characterized by a homogeneous distribution of hairpin shaped capillaries as a “comb-like structure”, with a density of between 9–14 capillaries per mm. Yet, there exists a wide intra- and inter-individual variety in a normal population (non-specific variations) which will be discussed during the workshop.

An abnormal capillaroscopic image due to systemic sclerosis (SSc) is characterized by (a combination) of specific changes (giants, capillary loss, hemorrhages and abnormal shapes (ramifications)). Depending on their relative prevalence three SSc-patterns are described by Cutolo et al. with a 200 magnification videocapillaroscope: the “early”, “active” and “late” scleroderma pattern. The combination of the presence of a scleroderma pattern on capillaroscopy with the presence of an SSc-specific antibody in a patient with Raynaud's phenomenon allows the “early” diagnosis of SSc. When the patient also has “puffy” fingers he/she meets the VEDOSS criteria for very early diagnosis of SSc.

In patients with connective tissue diseases “other than” SSc and diseases of the scleroderma spectrum there are no “unique” capillary patterns. A variety of capillary abnormalities (change in morphology, dimension, presence of hemorrhages) have been observed. These abnormalities by themselves are not predictive of any defined condition and may be referred to as non-specific abnormalities.

Disclosure of Interest None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.