Background The prevalence of Raynaud's phenomenon (RP) has been reported between 3–22%. When associated with systemic autoimmune diseases (SAD), especially systemic sclerosis (SSc), it is the sentinel event of irreversible organic damage. Nailfold videocapillaroscopy (NVC) is a non-invasive and safe procedure that allows in vivo observation of the microcirculation. Between 15–20% of patients who have RP with videocapillaroscopic alterations and certain autoantibodies will develop a SAD over two years. In addition, 90% of individuals with SSc and 85% with mixed connective tissue disease (MCTD) had RP as the first symptom.

Objectives To evaluate the role of NVC in the differential diagnosis of RP, as well as in the early detection of SAD, in a cohort of Colombian patients.

Methods A prospective, longitudinal, analytical study was conducted in subjects with RP, over 18-year-old, not active smokers, without previous connective tissue disease, secondary causes or aggravating factors. Optilia NVC with OptiPix software was used (Optilia Instruments; Sollentuna, Sweden). Qualitative variables are described by means, as well as absolute and relative frequencies; quantitative variables, according to the distribution of data, were reported by means or median, with standard deviation (SD) and interquartile range (IQR), respectively. We are reporting the baseline characteristics of these individuals.

Results Fifty-eight individuals were included; 91.4% were female. The mean age was 40.9 years (SD: 14.1). RP was biphasic in 63.6% of the patients, with a median of 30 episodes per month (IQR: 8–30). In 41 subjects (available data), antinuclear antibodies were positive; the most common patterns were: speckled (41.5%) and centromere (26.8%). The median of erythrosedimentation rate (ESR) was 9 (IQR 4–13). Ten individuals (19.2%) were diagnosed with SAD in the first NVC: Seven patients with limited SSc, two with MCTD, and one with diffuse SSc. The patterns observed in the individuals with SSc were: early (n=3), active (n=3), late (n=2), and minor and unspecific abnormalities in subjects with MCTD (one each). The most frequent NCV alterations in subjects with SAD were: megacapillaries (n=10), microhemorrhages (n=10), avascular zones (n=8), neovascularization (n=6), and capilar disorganization (n=6). In these subjects, the mean capillary diameter was 76.7±33.9 mm; the median of capillary number per mm was 7 (IQR: 6–8).

Conclusions The frequency of systemic autoimmune disease was similar to the published reports in the literature. We highlight the following aspects: 1) The normal erythrosedimentation rate in subjects with a rheumatologic diagnosis, a particular finding when compared to previous data; 2) The important percentage of subjects with a specific diagnosis in the first nailfold capillaroscopy; one possible explanation could be a underdiagnosed disorder; this fact could be possibly demonstrated by the large capillary diameter found.

References

1. Ingegnoli F et al. Arthritis Rheum. 2008; 58 (7): 2174–82.

2. Ingegnoli F et al. Rheumatology 2010; 49 (4): 797–805.

References

Acknowledgements Clinica Universitaria Bolivariana. Universidad Pontificia Bolivariana.

Disclosure of Interest None declared