Skip to main content
SpringerLink
Log in

Nailfold video-capillaroscopy in systemic sclerosis

Die Video-Kapillarmikroskopie der Nagelfalz bei systemischer Sklerose

  • CONTRIBUTION TO THE MAIN TOPIC
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Summary

The Raynaud’s phenomenon (RP) is the most common and significant clinical condition supporting microvascular analysis as soon as possible. Microvascular involvement is a key feature of RP, and several rheumatic diseases are characterized by the presence of the RP. Nailfold capillary microscopy shows an impressive cost/effectiveness ratio: it is simple, noninvasive and inexpensive.

Well-recognized videocapillaroscopic patterns (NVC) have been described mainly in scleroderma (SSc) patients complaining of a secondary RP. The peripheral microvascular damage in SSc is characterized by increasing structural alterations of the capillaries (giant capillaries and microhemorrhages) with progressive decrease of their density. The detection of the scleroderma NCV allows early differentiation between primary RP (functional, not disease associated), and secondary RP (disease associated). Other major NVC patterns have been described in the field of rheumatic diseases. Interestingly, correlations are evident between the NCV and the clinical symptoms, severity of the disease and the laboratory findings. Further clinical and epidemiological studies, as well as a standardized and computerized quantitation of the observed damages are required.

Zusammenfassung

Das Raynaud-Phänomen (RP) ist die häufigste und klinisch relevanteste Störung, die eine möglichst frühzeitige mikrovaskuläre Diagnostik erfordert. Die mikrovaskuläre Beteiligung ist eines der zentralen Merkmale des RP und mehrere Erkrankungen des rheumatischen Formenkreises sind durch das Auftreten eines RP gekennzeichnet. Die Kapillarmikroskopie der Nagelfalz weist ein eindrucksvolles Kosten-Nutzen-Verhältnis auf: Sie ist einfach durchführbar, nicht invasiv und preiswert.

Spezifische Videokapillaroskopie-Muster wurden im Wesentlichen für Patienten mit Sklerodermie und sekundärem RP beschrieben. Die periphere Schädigung der Mikrovaskulatur ist bei der Sklerodermie durch zunehmende strukturelle Veränderungen der Kapillaren (Riesenkapillaren und Mikroblutungen) mit fortschreitender Dichtereduktion gekennzeichnet. Der Befund eines für die Sklerodermie typischen Videokapillaroskopie-Musters erlaubt die frühe Unterscheidung zwischen einem primären RP (funktionell, nicht mit einer Erkrankung einhergehend) und einem sekundären RP (mit einer Erkrankung einhergehend). Für andere rheumatische Erkrankungen wurden weitere wichtige Muster beschrieben. Interessanterweise besteht eine Korrelation zwischen dem Videokapillaroskopie-Muster und klinischen Symptomen, Schweregrad der Erkrankung und Laborbefunden. Weitere klinische und epidemiologische Studien sowie eine standardisierte und computergestützte Quantifizierung der beobachteten Läsionen sind erforderlich.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cutolo M, Grassi W, Matucci Cerinic M (2003) Raynaud’s phenomenon and the role of capillaroscopy. Arthritis Rheum 48(11):3023–3030

    Google Scholar 

  2. Maricq HR, LeRoy EC (1973) Patterns of finger capillary abnormalities in connective tissue disease by wide-field microscopy. Arthritis Rheum 16:619–628

    Google Scholar 

  3. Maricq HR, Downey JA, LeRoy EC (1976) Standstill nailfold capillary blood flow during cooling in scleroderma and Raynaud’s syndrome. Blood Vessels 13:338–349

    Google Scholar 

  4. Cutolo M, Sulli A, Pizzorni C, Accardo S (2000) Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol 27:155–160

    Google Scholar 

  5. Bergman R, Sharony L, Schapira D et al (2003) The handheld dermatoscope as a nail-fold capillaroscopic instrument. Arch Dermatol 139:1027–1030

    Google Scholar 

  6. Silman A, Holligan S, Brennan P, Maddison P (1990) Prevalence of symptoms of Raynaud’’s phenomenonin general practice. BMJ 301:590–592

    Google Scholar 

  7. Maricq HR, Carpentier PH, Weinrich MC et al (1997) Geographic variation in prevalence of Raynaud’s phenomenon: a 5 region comparison. J Rheumatol 24:879–889

    Google Scholar 

  8. Le Roy EC, Medsger TA Jr (1992) Raynaud’s phenomenon: a proposal for classification. Clin Exp Rheumatol 10:485–488

    Google Scholar 

  9. Planchon B, Pistorius MA, Beurrier P, De Faucal P (1994) Primary Raynaud’s phenomenon: age of onset and pathogenesis in a prospective study of 424 patients. Angiology 45:677–686

    Google Scholar 

  10. Kallenberg CG (1990) Early detection of connective tissue disease in patients with Raynaud’s phenomenon. Rheum Dis Clin North Am 16:11–30

    Google Scholar 

  11. Spencer-Green G (1998) Outcomes in primary Raynaud’s phenomenon a meta-analysis and the frequency, rates, and predictors of transition to secondary disease. Arch Intern Med 158:595–600

    Article  CAS  PubMed  Google Scholar 

  12. Zuffery P, Depairon M, Chamot AM, Monti M (1992) Prognostic significance of nailfold capillary microscopy in patients with Raynaud’s phenomenon and scleroderma-pattern abnormalities: a six-year follow-up study. Clin Rheumatol 11:536–541

    Google Scholar 

  13. Colwell JA, Halusshka PV, Sarji KE et al (1979) Vascular disease in diabetes. Pathophysiological mechanisms and therapy. Arch Intern Med 139:225–230

    Google Scholar 

  14. Maricq HR (1981) Widefield capillary microscopy: technique and rating scale for abnormalities seen in scleroderma and related disorders. Arthritis Rheum 24:1159–1165

    CAS  PubMed  Google Scholar 

  15. Maricq HR, Harper FE, Khan MM et al (1983) Microvascular abnormalities as possible predictors of disease subset in Raynaud’s phenomenon and early connective tissue disease. Clin Exp Rheumatol 1:195–205

    CAS  PubMed  Google Scholar 

  16. Maricq HR (1981) Widefield capillary microscopy: technique and rating scale for abnormalities seen in scleroderma and related disorders. Arthritis Rheum 24:1159–1165

    CAS  PubMed  Google Scholar 

  17. Ryan TJ (1980) Microcirculation in psoriasis: blood vessels, lymphatics and tissue fluid. Pharmacol Ther 10:27–64

    Google Scholar 

  18. Houtman PM, Kallenberg CGM, Fidler V, Wouda AA (1986) Diagnostic significance of nailfold capillary patterns in patients with RP: an analysis of patterns discriminating patients with and without connective tissue disease. J Rheumatol 13:556–563

    Google Scholar 

  19. Jayson MIV (1984) The microcirculation in systemic sclerosis. Clin Exp Rheumatol 2:85–91

    Google Scholar 

  20. Chen ZY, Silver RM, Ainsworth SK et al (1984) Association between fluorescent antinuclear antibodies, capillary patterns, and clinical features in scleroderma spectrum disorders. Am J Med 77:812–822

    Google Scholar 

  21. Bombardieri S, Medsger TA Jr, Silman AJ, Valentini G (2003) The assessment of the patient with systemic sclerosis. Introduction. Clin Exp Rheumatol 21(3 Suppl 22.9):S2–S4

    Google Scholar 

  22. Blann AD, Illinworth K, Jayson MIV (1993) Mechanisms of endothelial damage in systemic sclerosis and Raynaud’s phenomenon. J Rheumatol 20:1325–1330

    Google Scholar 

  23. Carpentier PH, Maricq HR (1990) Microvasculature in Systemic Sclerosis. Rheum Dis Clin North Am 16:75–91

    Google Scholar 

  24. Maricq HR, Le Roy EC, D’Angelo WA et al (1980) Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 23:183–189

    Google Scholar 

  25. Blockmans D, Beyens G, Verhaeghe R (1996) Predictive value of nailfold capillaroscopy in the diagnosis of connective tissue disease. Clin Rheumatol 15:148–153

    Google Scholar 

  26. Von Bierbrauer AF, Mennel HD, Schmidt JA, Von Wichert P (1996) Intravital microscopy and capillaroscopically guided nailfold biopsy in scleroderma. Ann Rheum Dis 55:305–310

    Google Scholar 

  27. Chandran G, Smith M, Ahern MJ, Roberts-Thomson PJ (1995) A study of scleroderma in South Australia: prevalence, subset characteristics and nailfold capillaroscopy. Aust N Z J Med 25:688–694

    Google Scholar 

  28. Mannarino E, Pasqualini L, Fedeli F et al (1994) Nailfold capillaroscopy in the screening and diagnosis of Raynaud’s phenomenon. Angiology 45:37–42

    Google Scholar 

  29. Andrade LEC, Gabriel AJr, Assad RL, et al (1990) Panoramic nailfold capillaroscopy: a new reading method and normal range. Semin Arthritis Rheum 20:21–31

    Article  CAS  PubMed  Google Scholar 

  30. Kabasakal Y, Elvins DM, Ring EFJ, McHugh NJ (1996) Quantitative nailfold capillaroscopy findings in a population with connective tissue disease and in normal healthy controls. Ann Rheum Dis 55:507–512

    CAS  PubMed  Google Scholar 

  31. Bollinger A, Fagrell B (1990) Collagen vascular disease and related disorders. In Clinical capillaroscopy. Hogrefe & Huber Publ, pp 121–143

  32. Nobili F, Cutolo M, Sulli A et al (1997) Impaired quantitative cerebral blood flow in scleroderma patients. J Neurol Sci 152:63–71

    Google Scholar 

  33. Sulli A, Savarino V, Cutolo M (2000) Lack of correlation between gastric Helicobacter pylori infection and primary or secondary Raynaud’s phenomenon in patients with systemic sclerosis. J Rheumatol 27:1820–1821

    Google Scholar 

  34. Cutolo M, Nobili F, Sulli A et al (2000) Evidence of cerebral hypoperfusion in scleroderma patients. Rheumatology 39:1366–1373

    Google Scholar 

  35. Filaci G, Cutolo M, Basso M et al (2001) Long-term treatment of patients affected by systemic sclerosis with cyclosporin A. Rheumatology 40:259–260

    Google Scholar 

  36. Distler O, Del Rosso A, Giacomelli R et al (2002) Angiogenic and angiostatic factors in systemic sclerosis: increased levels of vascular endothelial growth factor are a feature of the earliest disease stages and are associated with the absence of fingertip ulcers. Arthritis Res 4:R11

    Google Scholar 

  37. Anderson ME, Moore TL, Lunt M, Herrick AL (2004) Digital iontophoresis of vasoactive substances as measured by laser Doppler imaging—a non-invasive technique by which to measure microvascular dysfunction in Raynaud’s phenomenon. Rheumatology (Oxford) 43:986–991

    Google Scholar 

  38. Maricq HR, Valter I (2004) A working classification of scleroderma spectrum disorders: a proposal and the results of testing on a sample of patients. Clin Exp Rheumatol 22(3 Suppl 33):S5–S13

    Google Scholar 

  39. Cutolo M, Pizzorni C, Craviotto C, Sulli A (2003) The videocapillaroscopic patterns in scleroderma. Ann Rheum Dis 62:SP0092

    Google Scholar 

  40. Cutolo M, Sulli A (2004) Raynaud’s phenomenon and scleroderma: Ann Rheum Dis 63.SP0022

Download references

Author information

Authors and Affiliations

  1. Full Professor of Rheumatology Director Department of Internal Medicine, University of Genova, Viale Benedetto xv,6, 16132, Genova, Italy

    M. Cutolo

  2. Research Laboratory and Division of Rheumatology Department of Internal Medicine, University of Genova, Viale Benedetto xv,6, 16132, Genova, Italy

    C. Pizzorni (Clinical Training Fellow) &  A. Sulli (Assistant Professor)

Authors
  1. M. Cutolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Pizzorni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Sulli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Cutolo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cutolo, M., Pizzorni, C. & Sulli, A. Nailfold video-capillaroscopy in systemic sclerosis. Z Rheumatol 63, 457–462 (2004). https://doi.org/10.1007/s00393-004-0673-5

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-004-0673-5

Key words

Schlüsselwörter

Search

Navigation