A Practical Overview of the Role of Capillaroscopy in Rheumatic Diseases
DOI:
https://doi.org/10.12970/2310-9874.2019.07.01Keywords:
Capillaroscopy, connective tissue diseases, Raynaud’s phenomenon.Abstract
Nailfold capillaroscopy is currently the best method to investigate microvascular abnormalities in systemic sclerosis and related conditions, and in other rheumatic conditions in which there is a clinical suspicion of microangiopathy. Although easy to perform, it is essential that the operators have been properly trained about correct method of images acquisition and interpretation. There are some parameters to indicate a normal/healthy capillaroscopic picture, but it is important to consider that there is a great variability in the capillary structure both interindividual and intraindividual. The early differential diagnosis between primary and secondary RP is the best advantage that the technique may offer.
Remarkable capillaroscopic alterations are found in the majority of cases of systemic sclerosis and the so-called “scleroderma spectrum disorders” (dermatomyositis, mixed connective tissue disease, undifferentiated connective tissue disease). Nevertheless, some capillaroscopic changes have been observed in systemic lupus erythematosus, Sjogren’s syndrome, psoriatic and rheumatoid arthritis.
Discussion about controversies on this topic should be encouraged, leading to a progressive development of capillaroscopy as a routine investigation in rheumatology.
References
De Angelis R, Cutolo M, Salaffi F, Restrepo JP, Grassi W. Quantitative and qualitative assessment of one rheumatology trainee's experience with a self-teaching programme in videocapillaroscopy. Clin Exp Rheumatol 2009; 27(4): 651-3.
Grassi W, Del Medico P. Atlas of Capillaroscopy, Edra Medical Publishing & New Media, Milan 2004.
Grassi W, De Angelis R. Capillaroscopy: questions and answers. Clin Rheumatol 2007; 26(12): 2009-16. https://doi.org/10.1007/s10067-007-0681-3
De Angelis R, Grassi W, Cutolo M. A growing need for capillaroscopy in rheumatology. Arthritis Rheum 2009; 61(3): 405-10. https://doi.org/10.1002/art.24274
Ingegnoli F, Gualtierotti R, Lubatti C, et al. Nailfold capillary patterns in healthy subjects: a real issue in capillaroscopy. Microvasc Res 2013; 90: 90-5. https://doi.org/10.1016/j.mvr.2013.07.001
Grassi W, Medico PD, Izzo F, Cervini C. Microvascular involvement in systemic sclerosis: capillaroscopic findings. Semin Arthritis Rheum 2001; 30: 397-402. https://doi.org/10.1053/sarh.2001.20269
Ingegnoli F, Boracchi P, Gualtierotti R, et al. Prognostic model based on nailfold capillaroscopy for identifying Raynaud's phenomenon patients at high risk for the development of a scleroderma spectrum disorder: PRINCE (prognostic index for nailfold capillaroscopic examination). Arthritis Rheum 2008; 58: 2174-82. https://doi.org/10.1002/art.23555
Ingegnoli F, Boracchi P, Gualtierotti R, et al. Improving outcome prediction of systemic sclerosis from isolated Raynaud’s phenomenon: role of autoantibodies and nail-fold capillaroscopy. Rheumatology 2010; 49: 797-805. https://doi.org/10.1093/rheumatology/kep447
Caramaschi P, Canestrini S, Martinelli N, et al. Scleroderma patient nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Rheumatology 2007; 46: 1566-9. https://doi.org/10.1093/rheumatology/kem190
Sebastiani M, Manfredi A, Vukatana G, et al. Predictive role of capillaroscopic skin ulcer risk index in systemic sclerosis: a multicentre validation study. Ann Rheum Dis 2012; 71: 67-70. https://doi.org/10.1136/annrheumdis-2011-200022
De Angelis R, Cutolo M, Gutierrez M, Bertolazzi C, Salaffi F,Grassi W. Different microvascular involvement in dermatomyositis and systemic sclerosis. A preliminary study by a tight videocapillaroscopic assessment. Clin Exp Rheumatol 2012; 30(2 Suppl 71): S67-70.
De Angelis R, Bertolazzi C, Filippucci E, Gutierrez M, Grassi W. Fast microvascular remodelling in a patient with cancer-associated dermatomyositis: capillaroscopic follow-up. Rheumatology (Oxford) 2010; 49(2): 400. https://doi.org/10.1093/rheumatology/kep281
de Holanda Mafaldo Diógenes A, Bonfá E, Fuller R, Correia Caleiro MT. Capillaroscopy is a dynamic process in mixed connective tissue disease. Lupus 2007; 16: 254-8. https://doi.org/10.1177/0961203307076517
De Angelis R, Cerioni A, Del Medico P, Blasetti P. Raynaud’s phenomenon in undifferentiated connective tissue disease (UCTD). Clin Rheumatol 2005; 24 (2): 145-51. https://doi.org/10.1007/s10067-004-0988-2
De Angelis R, Del Medico P, Blasetti P, Cervini C. Raynaud's phenomenon: clinical spectrum of 118 patients. Clin Rheumatol 2003; 22(4-5): 279-84. https://doi.org/10.1007/s10067-003-0726-1
Furtado RN, Pucinelli ML, Cristo VV, Andrade LE, Sato EI. Scleroderma-like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud’s phenomenon in SLE patients. Lupus 2002; 11(1): 35-41. https://doi.org/10.1191/0961203302lu144oa
Corominas H, Ortiz-Santamaría V, Castellví I, et al. Nailfold capillaroscopic findings in primary Sjögren's syndrome with and without Raynaud's phenomenon and/or positive anti-SSA/Ro and anti-SSB/La antibodies. Rheumatol Int 2016; 36 (3): 365-9. https://doi.org/10.1007/s00296-015-3396-9
Baldini C, Mosca M, Della Rossa A, et al. Overlap of ACA-positive systemic sclerosis and Sjögren's syndrome: a distinct clinical entity with mild organ involvement but at high risk of lymphoma. Clin Exp Rheumatol 2013; 31(2): 272-80.
Sag S, Sag MS, Tekeoglu I, Kamanli A, Nas K, Aydın Y. Nailfold videocapillaroscopy results in patients with rheumatoid arthritis. Clin Rheumatol 2017; 36(9): 1969-74. https://doi.org/10.1007/s10067-017-3696-4
De Angelis R, Bugatti L, Del Medico P, Nicolini M, Filosa G. Videocapillaroscopic findings in the microcirculation of the psoriatic plaque. Dermatology 2002; 204(3): 236-9. https://doi.org/10.1159/000057888
De Angelis R, Gasparini S, Bugatti L, Filosa G. Early videocapillaroscopic changes of the psoriatic skin after anti-tumour necrosis factor alpha treatment. Dermatology 2005; 210(3): 241-3. https://doi.org/10.1159/000083519
Jordan S, Maurer B, Toniolo M, Michel B, Distler O. Performance of the new ACR/EULAR classification criteria for systemic sclerosis in clinical practice. Rheumatology (Oxford) 2015; 54: 1454-8. https://doi.org/10.1093/rheumatology/keu53
