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Kapillarmikroskopie und rheumatische Erkrankungen: State of the art

Capillaroscopy and rheumatic diseases: state of the art

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Zusammenfassung

Die Nagelbett-Kapillarmikroskopie stellt die derzeit beste Methode zur Analyse von Mikrozirkulationsstörungen bei rheumatischen Erkrankungen dar.

Das Raynaud-Phänomen (RP) als häufigstes klinisches Erscheinungsbild einer mikrovaskulären Beteiligung ist pathognomonisch für bestimmte rheumatische Erkrankungen. Unter normalen Bedingungen oder beim primären RP (auszuschließen durch Kälteexpositionstest) zeigt das kapillarmikroskopische Bild ein reguläres Muster der Kapillarschlingen im Nagelbett. Im Gegensatz dazu sollte man bei Patienten mit einem sekundären RP sowie Veränderungen des kapillarmikroskopischen Bildes eine bisher nicht diagnostizierte Kollagenose in Betracht ziehen. Eine veränderte Gefäßarchitektur, Riesenkapillaren, Hämorrhagien und Kapillarverlust sowie avaskuläre Areale sind typische Veränderungen, die bei mehr als 95% der Patienten mit Sklerodermie auftreten. Der Ausdruck „Sklerodermiemuster“ beinhaltet daher alle kapillarmikroskopisch sichtbaren Veränderungen, die typisch für eine mikrovaskuläre Beteiligung einer Sklerodermie sind. Im Gegensatz hierzu werden die kapillarmikroskopisch sichtbaren Veränderungen bei Dermatomyositis (DM) und bei der undifferenzierten Kollagenose allgemein als „Sklerodermie-artige Muster“ bezeichnet. Besonders in frühen Stadien der Erkrankung kann die periphere Mikroangiopathie sehr gut mittels Nagelbett-Kapillarmikroskopie oder besser noch Nagelbett-Videokapillarmikroskopie erkannt und untersucht werden. Eine frühzeitig mögliche Differenzialdiagnose zwischen primärem oder sekundärem RP ist hierbei der größte Vorteil dieser Untersuchung.

Zudem zeigen sich interessante kapillarmikroskopische Veränderungen auch beim systemischen Lupus erythematodes (SLE), beim Antiphospholipidsyndrom sowie beim Sjögren-Syndrom.

Um die Nagelbett-Kapillarmikroskopie weiter zu standardisieren, sind allerdings zusätzliche epidemiologische und klinische Studien nötig.

Abstract

Nailfold capillaroscopy (NVC) represents the best method for analyzing microvascular abnormalities in rheumatic diseases.

Raynaud’s phenomenon (RP) represents the most frequent clinical aspect of microvascular involvement and is a key feature of several such diseases. Under normal conditions or in primary RP (exclusion by the cold-exposure test), the normal nailfold capillaroscopic pattern shows a regular disposition of the capillary loops within the nail bed. However, in subjects suffering from secondary RP, one or more alterations in the capillaroscopic findings should alert the physician to search for an underlying connective tissue disease. Architectural disorganization, giant capillaries, hemorrhages, loss of capillaries and avascular areas characterize more than 95% of patients with overt systemic sclerosis (sclerodema, SSc). Therefore, the term “scleroderma pattern”, includes all capillaroscopic changes typical of the microvascular involvement in SSc. The capillaroscopic aspects observed in dermatomyositis and in undifferentiated connective tissue disease are generally reported as “scleroderma-like patterns”. This peripheral microangiopathy can be effectively detected early in the course of the disease and studied in detail by nailfold capillaroscopy or, better, with NVC.

In addition, early differential diagnosis between primary and secondary RP is the greatest advantage NVC has to offer. In addition, interesting capillaroscopic changes have been observed in systemic lupus erythematosus, antiphospholipid syndrome and Sjögren’s syndrome. However, further epidemiological and clinical studies are needed to better standardize NVC patterns.

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Authors and Affiliations

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

    M. Cutolo, A. Sulli, M. E. Secchi & C. Pizzorni

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  1. M. Cutolo
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  2. A. Sulli
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  3. M. E. Secchi
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  4. C. Pizzorni
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Correspondence to M. Cutolo.

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Übersetzung: Lothar Thöne, Heidelberg

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Cutolo, M., Sulli, A., Secchi, M.E. et al. Kapillarmikroskopie und rheumatische Erkrankungen: State of the art. Z. Rheumatol. 65, 290–296 (2006). https://doi.org/10.1007/s00393-006-0071-2

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  • DOI: https://doi.org/10.1007/s00393-006-0071-2

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