Capillaroscopic pattern in paraneoplastic Raynaud's phenomenon.

Area of Science:

• Rheumatology
• Dermatology
• Oncology

Background:

• Paraneoplastic Raynaud's phenomenon (RP) secondary to rheumatic conditions lacks systematic capillaroscopic investigation.
• Severe secondary RP can be a manifestation of underlying paraneoplastic syndromes.

Observation:

• Three cases of paraneoplastic syndromes with severe secondary RP are presented.
• Case 1: Psoriatic arthritis with lung cancer showed an 'early' scleroderma pattern.
• Case 2 & 3: Dermatomyositis with lung/thyroid cancer exhibited a 'scleroderma-like' pattern with microvascular changes.

Findings:

• Capillaroscopic findings in paraneoplastic RP associated with scleroderma-like syndrome and dermatomyositis are indistinguishable from idiopathic rheumatic diseases.
• Microvascular changes observed include dilated/giant capillaries, hemorrhages, disarrangement, and neoangiogenesis.

Implications:

• Nailfold capillaroscopy alone may not differentiate paraneoplastic RP from idiopathic rheumatic diseases.
• Further research is needed to establish specific capillaroscopic markers for paraneoplastic syndromes.
• Early detection of underlying malignancy is crucial in patients presenting with severe secondary RP and rheumatic symptoms.