Evaluation of Capillaroscopy Findings in Patients Presenting with Raynaud's Phenomenon (RP): A Retrospective Study

Öz

Raynaud's phenomenon (RP) is a discoloration of the fingers due to abnormal vasoconstriction in the digital arteries and cutaneous arterioles in response to cold or emotional stress. The study included patients who presented to a tertiary rheumatology clinic with RP between September 2022 and April 2023 and underwent nailfold capillaroscopy (NFC). Of the included patients, 34 (57.6%) were diagnosed with inflammatory rheumatic disease (IRD) and 25 (42.4%) with primary RP. When analysing antibodies, the most common antibody was antinuclear antibody (ANA) (n=39, 66.1%), and most of them were positive with a low titer (n=22, 37.3%). When comparing patients with and without IRD, the capillary density of ≥7 per 1 millimetre was sufficient in all patients in the group without IRD. There was a decrease in capillary density (<7) in 13 (38.24%) patients in the IRD group. When the sizes of capillaries were evaluated, a significant difference was found between the groups in terms of giant capillaries (>50 μm) (p=0.005). In the IRD group, 14 (41.18%) patients had a scleroderma (SCL) pattern and 20 (58.82%) had a non-SCL pattern. In the non-IRD group, all but two patients had a non-SCL pattern. Age, ANA positivity, high ANA titer, presence of giant capillaries and SCL pattern had a positive significant discriminatory effect (p<0.05) in distinguishing between patients with and without IRD. NFC assessment is an important tool in the diagnosis of IRDs such as systemic sclerosis. Advanced age, SCL pattern, giant capillaries and ANA positivity should be warning signs of secondary RP.

Anahtar Kelimeler

• inflammatory rheumatic disease
• capillaroscopy
• raynoud phenomenon
• systemic sclerosis

Raynaud Fenomeni (RF) ile Başvuran Hastaların Kapilleroskopi Bulgularının Değerlendirilmesi: Retrospektif Çalışma Raynaud Fenomeni (RF) ve Kapilleroskopi

Öz

Raynaud fenomeni (RF), soğuğa veya duygusal strese karşı dijital arterlerde ve kutanöz arteriyollerdeki anormal vazokonstriksiyona bağlı olarak gelişen parmaklardaki renk değişikliğidir. Çalışmaya Eylül 2022-Nisan 2023 tarihleri arasında üçüncü basamak bir romatoloji polikliniğine RF ile başvurup tırnak kıvrımı kapilleroskopisi (TKK) yapılan hastalar dahil edildi. Dahil edilen hastaların 34 (%57,6)’üne inflamatuvar romatizmal hastalık (İRH) tanısı konulduğu, 25 (%42,4)’inin ise primer RF olarak kabul edildiği belirlendi. Antikorlar değerlendirildiğinde, en sık saptanan anti-nükleer antikor (ANA) (n=39, %66,1) olup, çoğunluğu düşük titrede pozitifti (n=22, %37,3). İRH saptanan ve saptanmayan hastalar karşılaştırıldığında, İRH olmayan gruptaki hastaların tamamında kapiller dansite her 1 milimetrelik alanda ≥7 olup yeterliydi. İRH grubundaki hastaların 13’ünde kapiller dansitede azalma (<7) mevcuttu. Kapillerlerin boyutları değerlendirildiğinde, gruplar arasında dev kapiller (>50 μm) açısından anlamlı farklılık saptandı (p=0,005). İRH grubundaki hastaların 14’ünde SCL paterni, 20 (%58,82)’sinde ise non-SCL paterni saptanmıştı. İRH olmayan gruptaki hastaların sadece ikisi hariç tamamında non-SCL paterni saptanmıştı. Yaş, ANA pozitifliği, yüksek titre ANA pozitifliği, dev kapiller görülmesi ve SCL paterninin İRH olan ve olmayan hastaları ayırmada pozitif anlamlı ayırıcı (p<0,05) etkisi gözlenmiştir. TKK değerlendirmesi, sistemik skleroz gibi İRD'lerin tanısında önemli bir araçtır. İleri yaş, SCL paterni, dev kapiller ve ANA pozitifliği sekonder RF açısından uyarıcı olmalıdır.

Anahtar Kelimeler

• inflamatuvar romatizmal hastalık
• kapilleroskopi
• raynoud fenomeni
• sistemik skleroz

Kaynakça

1. 1. Amaral, M. C., Paula, F. S., Caetano, J., Ames, P. R. J. & Alves, J. D. Re-evaluation of nailfold capillaroscopy in discriminating primary from secondary Raynaud’s phenomenon and in predicting systemic sclerosis: a randomised observational prospective cohort study. Expert Rev. Clin. Immunol. 20, 665–672 (2024).
2. 2. Di Donato, S. et al. Clinically relevant differences between primary Raynaud’s phenomenon and secondary to connective tissue disease. Semin. Arthritis Rheum. 68, 152521 (2024).
3. 3. Brunner-Ziegler, S. et al. Capillaroscopic differences between primary Raynaud phenomenon and healthy controls indicate potential microangiopathic involvement in benign vasospasms. Vasc. Med. (United Kingdom) 29, 200–207 (2024).
4. 4. Lambova, S. N. & Müller-Ladner, U. The role of capillaroscopy in differentiation of primary and secondary Raynaud’s phenomenon in rheumatic diseases: A review of the literature and two case reports. Rheumatol. Int. 29, 1263–1271 (2009).
5. 5. Ture, H. Y., Lee, N. Y., Kim, N. R. & Nam, E. J. Raynaud’s Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment. Vasc. Spec. Int. 40, (2024).
6. 6. Ciaffi, J. et al. Nailfold capillaroscopy in common non-rheumatic conditions: A systematic review and applications for clinical practice. Microvasc. Res. 131, (2020).
7. 7. Van Den Hoogen, F. et al. 2013 classification criteria for systemic sclerosis: An American college of rheumatology/European league against rheumatism collaborative initiative. Ann. Rheum. Dis. 72, 1747–1755 (2013).
8. 8. Komai, M. et al. Nailfold Capillaroscopy: A Comprehensive Review on Its Usefulness in Both Clinical Diagnosis and Improving Unhealthy Dietary Lifestyles. Nutrients 16, (2024).

9. 9. Smith, V. et al. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Autoimmun. Rev. 19, 102458 (2020).
10. 10. Bernardino, V., Rodrigues, A., Lladó, A. & Panarra, A. Nailfold capillaroscopy and autoimmune connective tissue diseases in patients from a Portuguese nailfold capillaroscopy clinic. Rheumatol. Int. 40, 295–301 (2020).
11. 11. Corominas, H. et al. Nailfold capillaroscopic findings in primary Sjögren’s syndrome with and without Raynaud’s phenomenon and/or positive anti-SSA/Ro and anti-SSB/La antibodies. Rheumatol. Int. 36, 365–369 (2016).
12. 12. Capobianco, K. G., Xavier, R. M., Bredemeier, M., Restelli, V. G. & Brenol, J. C. T. Nailfold capillaroscopic findings in primary Sjögren’s syndrome: Clinical and serological correlations. Clin. Exp. Rheumatol. 23, 789–794 (2005).
13. 13. Cutolo, M. et al. Nailfold videocapillaroscopic patterns and serum autoantibodies in systemic sclerosis. Rheumatology 43, 719–726 (2004).
14. 14. Shenavandeh, S., Ajri, M. & Hamidi, S. Causes of Raynaud’s phenomenon and the predictive laboratory and capillaroscopy features for the evolution to a definite connective tissue disease. Rheumatol. (United Kingdom) 61, 1975–1985 (2022).
15. 15. Roberts-Thomson, P. J., Patterson, K. A. & Walker, J. G. Clinical utility of nailfold capillaroscopy. Intern. Med. J. 53, 671–679 (2023).
16. 16. Roberts-Thomson, P. J. et al. Diagnostic utility of nailfold capillaroscopy. APLAR J. Rheumatol. 10, 275–279 (2007).
17. 17. Pavlov-Dolijanovic, S., Damjanov, N. S., Stojanovic, R. M., Vujasinovic Stupar, N. Z. & Stanisavljevic, D. M. Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: A follow-up study of 3,029 patients with primary Raynaud’s phenomenon. Rheumatol. Int. 32, 3039–3045 (2012).
18. 18. Szabo, N. et al. Functional and morphological evaluation of hand microcirculation with nailfold capillaroscopy and laser Doppler imaging in Raynaud’s and Sjögren’s syndrome and poly/dermatomyositis. Scand. J. Rheumatol. 37, 23–29 (2008).