J Rheum Dis.  2015 Apr;22(2):69-75. 10.4078/jrd.2015.22.2.69.

The Efficacy of Nailfold Capillaroscopy in Patients with Raynaud's Phenomenon

• Kim HS

• KMID: 2222908
• DOI: http://doi.org/10.4078/jrd.2015.22.2.69

Abstract

Raynaud's phenomenon (RP) is characterized by reversible digital vasospasm triggered by exposure to cold or emotional stress. It manifests with unique 'triphasic' (pallor, cyanosis, erythema) or 'biphasic' (white, blue) color change. Clinically, RP is classified as primary RP, which does not have an underlying associated cause with a relatively benign course, and secondary RP, which predates various cause such as systemic connective tissue disease (CTD). Therefore, RP must be differentiated for detection of emerging CTD such as systemic sclerosis (SSc), systemic lupus erythematosus, and mixed conective tissue disease, ect. Nailfold capillaroscopy (NFC) is a non-invasive morphological study used routinely with antinuclear antibodies for parallel of secondary RP. A recent study showed NFC to be the best predictor of transition from a primary RP to secondary RP. The well-established role of NFC for early diagnosis of SSc, and potential for monitoring disease progression and predictive clinical complication makes NFC an important tool in research and clinical practice. In this paper, I present a recent update with emphasis on its possible role as a reliable diagnostic tool and biomarker in secondary RP.

Keyword

Raynaud phenomenon; Nailfold capillaroscopy; Biomarker

MeSH Terms

Antibodies, Antinuclear
Connective Tissue Diseases
Cyanosis
Disease Progression
Early Diagnosis
Humans
Lupus Erythematosus, Systemic
Microscopic Angioscopy*
Raynaud Disease
Scleroderma, Systemic
Stress, Psychological
Antibodies, Antinuclear

Figure

• 

  Figure 1. Three-step approach to diagnosis of primary Raynaud's phenomenon (RP). If 3 or more criteria met from step 3, then the patient has RP. Cited from the article of Maverakis et al. (J Autoimmun 2014;48-49:60-5) [12].

• 

  Figure 2. The examples of nailfold capillaroscopic finding in healthy subjects (×200) [15,28]. (A) For counting the total number of capillaries in 1 mm, we should check the number of the loop that exceeded a half line of mean capillary length. The capillary number is 9/mm. (B, C) It shows ‘perfect normal patterns' with ＞5 U-shaped loops/mm. Increasing subvenous capillary plexus can be visible in normal persons. (D) It shows ‘within normal pattern' mainly compatible criteria with 2∼5 U-shaped loops/mm and ≤2 tortuous loops/mm.

• 

  Figure 3. The example of nailfold capillaroscopic finding in systemic sclerosis (SSc) (×200) [9,15]. (A, B) It shows that almost capillaries are dilated and large number of megacapillaries in the early phase of SSc. (C) Typically many giant capillaries and micro-hemorrages are noted in the active phase of SSc. (D) At the late phase of SSc, avascular areas are observed along with bushy capillaries.

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