Kapillarmikroskopie und rheumatische Erkrankungen: State of the art

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 (scleroderma, 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.

Identification of transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon by nailfold videocapillaroscopy: Comment on the article by Hirschl et al

“…Specific microvascular alterations are recognized by capillaroscopic analysis in several different connective tissue diseases (i.e., dermatomyositis, mixed connective tissue disease [MCTD], and systemic lupus erythematosus) (5,6). In addition, distinct morphologic patterns on nailfold videocapillaroscopy and a significant and gradual increase in these microvascular abnormalities are observed during the progression of SSc and seem to reflect the possible evolution of the pathophysiologic process (7).…”

Assessment of serum vascular endothelial growth factor and nail fold capillaroscopy changes in systemic lupus erythematosus with and without cutaneous manifestations

“…Nail fold capillaroscopy (NFC) is the best method to analyze microvascular abnormalities in autoimmune rheumatic diseases including SLE and is a non‐invasive and easily repeatable technique 8 . Nail fold capillaroscopic abnormalities seem to be related to the disease severity and the presence of specific autoantibodies in the serum of SLE patients 9,10 …”

Nailfold capillaroscopy microscopy - an interdisciplinary appraisal

“…The prediction of a typical scleroderma pattern for the identifi cation of actual connective tissue disease or its subsequent development is high, whereas the negative prediction for a normal microscopic pattern is excellent [36,42,49,64].…”