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EF. The outcome of pregnancies before and after the birth of infants with nervous system malformations. Dev Med Child Neurol 1968;15:6-10. 16 Robertson RD, Sarti DA, Brown WJ, Crandall BF. Congenital hydrocephalus in two pregnancies following the birth of a child with a neural tube defect: aetiology and management.

Objectives: Early microvascular damage and dysfunction are clinically mirrored in Raynaud’s phenomenon (RP). Currently, nailfold capillaroscopy (NC) is applied to differentiate between primary RP (PRP) and secondary RP (PRP), associated with connective tissue disease. However, abnormal morphology can also be caused due to age-related changes and cardiovascular disease. Thermography (TG) is a non-invasive technique which enables quantification of cutaneous vascular function. An approach using both NC and TG could improve the differentiation between PRP and SRP. Methods: Thirty RP patients (PRP, n = 21; SRP, n = 9) underwent nailfold capillaroscopy and thermography. Morphologic features were scored and patients were categorized according to the guidelines of EULAR Study group on Microcirculation in Rheumatic Diseases. TG of the hand was performed before, directly and ten minutes after a cold challenge test. Baseline images and rewarming curves were analyzed. Results: Capillary abnormalities with NC were found in all SRP patients (9/9) and in 48% (10/21) of PRP patients. Out of 10 PRP patients with altered capillary morphology, 9 (90%) had a cardiovascular disease. For all patients mean temperature was significantly higher 10 minutes after cold induction than before (p < 0,01). The gradient of the rewarming curve was significantly lower in patients with SRP compared to PRP patients (p = 0.015). Conclusions: Nailfold capillaroscopy and thermography can reliably be used to measure microvascular damage and dysfunction. Additional thermography can assist in differentiating between PRP and SRP, especially in elderly patients or in presence of a cardiovascular disease. Keywords: Raynaud’s phenomenon; Nailfold capillaroscopy; Thermography

BackgroundRaynaud’s phenomenon (RP) is defined as episodic attacks of artery and arteriole vasoconstriction. To differentiate between the benign RP (pRP) and the form associated with connective tissue diseases (sRP) the capillary morphology can be studied using nailfold capillaroscopy (nCS). However, abnormal morphology can also be caused due to age-related changes and has been described in patients with diabetes and cardiovascular disease. In addition, this technique cannot provide functional information.Thermal imaging (thermography; TG) is a non-invasive technique which enables quantification of cutaneous blood vessel function. In veterinary medicine, thermal imaging is applied for various clinical settings. A combined approach using both nCS and TG could improve the differentiation between pRP and sRP.ObjectivesThe aim of this pilot study was to determine which technique (TG versus nCS) allows the best discrimination amongst older patients with pRP and sRP.MethodsThirty patients with RP (pRP, n=21; sRP, n=9) underwent nCS (Olympus SZ51) and TG (Flirr B 620). Nailfold morphologic features were measured and scored on capillary density, giant capillaries, ramification and hemorrages. The patients were divided into three categories: normal, slightly abnormal (slightly enlarged capillaries) and severely abnormal (destruction of capillary structure and hemorrages).TG of the hand was performed before, directly after and 10 min after a cold challenge test with cold manchets of 3°C. Rewarming and reperfusion were monitored and baseline images and rewarming curves were analysed.ResultsCapillary abnormalities with nCS were found in all patients with sRP (9/9) and in 52% (11/21) of patients with pRP. Out of 11 pRP patients with altered capillary morphology, 7 (63%) had a cardiovascular disease.TG demonstrated a lower average temperature at baseline in the pRP group compared to the sRP group (d 1,68°C, p<0,01). In patients with pRP temperature decreased after cold induction (−2.34°C, p=0,01), whereas in sRP patient temperature stayed consistent (+0.07°C, p=0,46) (table 1). In both groups temperature increased ten minutes after cold induction (pRP +2.62°C, p<0,01; sRP +1.57°C, p<0,01).The gradient of the rewarming curve was significantly lower in patients with sRP compared to the pRP group (median 0.16 vs. 0.26 °C/min; p=0.015).Abstract FRI0599 – Table 1Average temperature of the fingers before the immersion in cold water (in °C)Average temperature of the fingers just after the immersion test (in °C)Average temperature of the fingers 10 min after removing the hand from cold water (in °C)Average temperature recovery speed (in °C/min) Primary Raynaud Phenomenon29.4927.1529.770.26Secondary Raynaud Phenomenon31.1731.2432.810.16Capillaroscopy abnormalities25.8025.6027.920.23Secondary Raynaud phenomenon and Capillaroscopy abnormalities27.9928.1531.520.34ConclusionsNailfold capillaroscopy and thermography can reliably be used to measure microvascular damage and dysfunction. TG is better suitable to differentiate between older pat...