Clinical Rheumatology

, Volume 15, Issue 2, pp 148–153 | Cite as

Predictive value of nailfold capillaroscopy in the diagnosis of connective tissue diseases

  • D. Blockmans
  • G. Beyens
  • R. Verhaeghe


We revised the clinical files of 326 patients who underwent nailfold capillaroscopy. These patients could be subdivided into 4 groups : I : patients with clinical suspicion of connective tissue disease, II : patients with isolated Raynaud's phenomenon, III : patients with existing connective tissue disease, IV : patients with acrocyanosis, chronic pernio or related disorders. The presence of megacapillaries was noted. The sensitivity of their presence for the various categories of connective tissue disease was as follows : systemic sclerosis (n=11) : 100 %, CREST (n=15) : 73 %, MCTD (n=9) : 56 %, dermatomyositis (n=7) : 86 %. Nineteen patients with megacapillaries had no final diagnosis of connective tissue disease (specificity 93.3 %). The positive predictive value of the presence of megacapillaries for a scleroderma spectrum disorder (SSD) was 63.5 % and the negative predictive value of a normal capillaroscopy 96.7 %. We conclude that nailfold capillaroscopy can be advised to rule out SSD's.

Key words

Capillaroscopy Scleroderma Megacapillaries 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Redisch, W., Messina E.J., Hughes, G., McEwen, C. Capillaroscopic observations in rheumatic diseases. Ann Rheum Dis 1970, 29, 244–253.PubMedGoogle Scholar
  2. 2.
    Brown, O'Leary. Skin capillaries in scleroderma. Arch Intern Med 1926, 36, 73–88.Google Scholar
  3. 3.
    Maricq, H.R., Spencer-Green, G., Leroy, E.C. Skin capillary abnormalities as indicators of organ involvement in scleroderma (systemic sclerosis), Raynaud's syndrome and dermatomyositis. Am J Med 1976, 61, 862–870.CrossRefPubMedGoogle Scholar
  4. 4.
    Maricq, H.R., Leroy, E.C., D'Angelo, W.A. et al. Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 1980, 23, 183–189.PubMedGoogle Scholar
  5. 5.
    Maricq, H.R., Maize, J.C. Nailfold capillary abnormalities. Clin Rheum Dis 1982, 8, 455–478.PubMedGoogle Scholar
  6. 6.
    Maricq, H.R. Widefield capillary microscopy. Technique and rating scale for abnormalities seen in scleroderma and related disorders. Arthritis Rheum 1981, 24, 1159–1165.PubMedGoogle Scholar
  7. 7.
    Carpentier, P., Jeannoel, P., Bost, M., Franco, A. La capillaroscopie périunguale en pratique pédiatrique. Pédiatrie 1988, 43, 165–169.Google Scholar
  8. 8.
    Silver, R.M., Maricq, H.R. Childhood dermatomyositis: serial microvascular studies. Pediatrics 1989, 83, 278–283.PubMedGoogle Scholar
  9. 9.
    Spencer-Green, G., Crowe, W.E., Levinson, J.E. Nailfold capillary abnormalities and clinical outcome in childhood dermatomyositis. Arthritis Rheum 1982, 25, 954–958.PubMedGoogle Scholar
  10. 10.
    Ganczarczyk, M.L., Lee, P., Armstrong, S.K. Nailfold capillary microscopy in polymyositis and dermatomyositis. Arthritis Rheum 1988, 31, 116–119.PubMedGoogle Scholar
  11. 11.
    Granier, F., Vayssairat, M., Priollet, P., Housset, E. Nailfold capillary microscopy in mixed connective tissue disease. Arthritis Rheum 1986, 29, 189–195.PubMedGoogle Scholar
  12. 12.
    Chen, Z., Silver, R.M., Ainsworth, S.K., Dobson, R.L., Rust, P., Maricq, H.R. Association between fluorescent antinuclear antibodies, capillary patterns, and clinical features in scleroderma spectrum disorders. Am J Med 1984, 77, 812–822.CrossRefPubMedGoogle Scholar
  13. 13.
    Houtman, P.M., Kallenberg, C.G.M., Fidler, V., Wouda, A.A. Diagnostic significance of nailfold capillary patterns in patients with Raynaud's phenomenon. An analysis of patterns discriminating patients with and without connective tissue disease. J Rheum 1986, 13, 556–563.PubMedGoogle Scholar
  14. 14.
    Rouen, L.R., Terry, E.N., Doft, B.H., Clauss, R.H., Redisch, W. Classification and measurement of surface microvessels in man. Microvasc Res 1972, 4, 285–292.CrossRefPubMedGoogle Scholar
  15. 15.
    Andrade, L.E.C., Gabriel, A., Assad, R.L., Ferrari, A.J.L., Atra, E. Panoramic nailfold capillaroscopy: a new reading method and normal range. Semin Arthritis Rheum 1990, 20, 21–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Lefford, F., Edwards, J.C.W. Nailfold capillary microscopy in connective tissue disease: a quantitative morphological analysis. Ann Rheum Dis 1986, 45, 741–749.PubMedGoogle Scholar
  17. 17.
    Bernard, P., Arnaud, M., Tabaraud, F. et al. Intérêt de la capillaroscopie péri-unguéale dans la polyarthrite rheumatoide. Etude critique d'une série de 52 cas et revue de la littérature. Rev Rhum 1987, 54, 413–416.PubMedGoogle Scholar
  18. 18.
    Drevet, J.G., Carpentier, P.H., Lelong, C., Juvin, R., Franco, A., Phelip, X. La capillaroscopie périunguéale dans la polyarthrite rheumatoide. Etude prospective de 80 cas. Rev Rhum 1986, 53, 367–371.PubMedGoogle Scholar
  19. 19.
    Zaric, D., Worm, A.M., Stahl, D., Clemmensen, O.J. Capillary microscopy of the nailfold in psoriatic and rheumatoid arthritis. Scand J Rheumatol 1981, 10, 249–252.PubMedGoogle Scholar
  20. 20.
    Kenik, J.G., Maricq, H.R., Bole, G.G. Blind evaluation of the diagnostic specificity of nailfold capillary microscopy in the connective tissue diseases. Arthritis Rheum 1981, 24, 885–891.PubMedGoogle Scholar
  21. 21.
    Priollet, P., Vayssairat, M., Housset, E. How to classify Raynaud's phenomenon. Long-term follow-up study of 73 cases. Am J Med 1987, 83, 494–498.CrossRefPubMedGoogle Scholar
  22. 22.
    Priollet, P., Yeni, P., Vayssairat, M., Segond, P., Tallon, F., Housset, E. Bilan étiologique minimum des phénomènes de Raynaud. Cent deux cas. Presse Méd 1985, 14, 1999–2003.Google Scholar
  23. 23.
    Fitzgerald, O., Hess, E.V., O'Connor, G.T., Spencer-Green, G. Prospective study of the evolution of Raynaud's phenomenon. Am J Med 1988, 84, 718–726.CrossRefPubMedGoogle Scholar
  24. 24.
    Harper, F.E., Maricq, H.R., Turner, R.E., Lidman, R.W., Leroy, E.C. A prospective study of Raynaud's phenomenon and early connective tissue disease. Am J Med 1982, 72, 883–888.CrossRefPubMedGoogle Scholar
  25. 25.
    Maricq, H.R., Weinberger, A.B., Leroy, E.C. Early detection of scleroderma-spectrum disorders by in vivo capillary microscopy: a prospective study of patients with Raynaud's phenomenon. J Rheumatol 1982, 9, 289–291.PubMedGoogle Scholar
  26. 26.
    Blockmans, D., Vermylen, J., Bobbaers, H. Nailfold capillaroscopy in connective tissue disorders and in Raynaud's phenomenon. Acta Clinica Belgica 1993, 48, 30–41.PubMedGoogle Scholar
  27. 27.
    Tan, E.M., Cohen, A.S., Fries, J.F. et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982, 25, 1271–1277.PubMedGoogle Scholar
  28. 28.
    Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Committee: Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980, 23, 581–590.Google Scholar
  29. 29.
    Kahn, M.F., Appelboom, T. Syndrome de Sharp et connectivites mixtes. In: Les Maladies Systémiques. Médecine-Science. Eds.: Kahn, M.F., Peltier, A.P., Meyer, O., Piette, J.C. Flammarion, Paris 1991, pp. 545–556.Google Scholar
  30. 30.
    Maricq, H.R. Comparison of quantitative and semiquantitative estimates of nailfold capillary abnormalities in scleroderma spectrum disorders. Microvasc Res 1986, 32, 271–276.CrossRefPubMedGoogle Scholar
  31. 31.
    Maire, R., Schnewlin, G., Bollinger, A. Videomikroskopische Untersuchungen von Teleangiektasien bei Morbus Osler und Sklerodermie. Schweiz Med Wschr 1986, 116, 335–338.PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 1996

Authors and Affiliations

  • D. Blockmans
    • 1
  • G. Beyens
    • 2
  • R. Verhaeghe
    • 2
  1. 1.From the Department of General Internal MedicineUZ GasthuisbergLeuvenBelgium
  2. 2.Department of Vascular DisordersUZ GasthuisbergLeuvenBelgium

Personalised recommendations