Serial nailfold capillary microscopy in primary Raynaud's phenomenon and scleroderma

Area of Science:

• Vascular Biology
• Rheumatology
• Dermatology

Background:

• Raynaud's phenomenon (RP) is a condition characterized by exaggerated vasoconstriction of peripheral vessels.
• Nailfold capillary microscopy (NCM) is a non-invasive technique to visualize microvascular changes.

Purpose of the Study:

• To evaluate microvascular alterations in patients with Raynaud's phenomenon using nailfold capillary microscopy.
• To investigate the relationship between nailfold capillary microscopy findings and the spectrum of Raynaud's phenomenon, including scleroderma and CREST syndrome.

Main Methods:

• Cross-sectional and longitudinal evaluation of 84 patients with long-standing Raynaud's phenomenon.
• Classification of patients into five groups: primary familial RP, primary nonfamilial RP, possible scleroderma, scleroderma, and CREST syndrome.
• Nailfold capillary microscopy was used to assess capillary loop morphology and count.

Main Results:

• A progressive decrease in capillary loop number and an increase in widened and giant loops were observed from primary RP to scleroderma/CREST syndrome.
• Longitudinal analysis showed a decrease in total nailfold capillary loops in scleroderma/CREST syndrome patients, but not in primary RP or possible scleroderma.
• These findings support the concept of a disease spectrum in Raynaud's phenomenon.

Conclusions:

• Nailfold capillary microscopy can differentiate stages of Raynaud's phenomenon and associated connective tissue diseases.
• The study suggests a continuum from primary RP to more severe forms like scleroderma and CREST syndrome.
• Microvascular changes observed via NCM are indicative of disease progression in Raynaud's phenomenon.