Possibilities of nailfold capillaroscopy in the differential diagnosis of immuno-inflammatory and rheumatological diseases

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Abstract


This article considers capillaroscopic changes in the patients with systemic sclerosis compared to the patients with a group of rheumatological diseases (rheumatoid arthritis, polymyositis, osteoarthritis) and the patients with idiopathic pulmonary hypertension. All the patients diagnosed with systemic sclerosis according to nailfold capillaroscopy had a characteristic combination of capillary disorders (Raynaud’s syndrome): the expansion of all three segments of the capillary loop, the “loss” of capillaries, and the destruction of the nail fold. In the comparison groups, the capillaroscopic picture was represented by single pathological changes that did not add up to the pathognomonic scleroderma patterns, with the exception of the groups with dermato/polymyositis, where 2 patients had significant Raynaud’s syndrome. There were also significant differences in the density of the capillaries in the patients with systemic sclerosis in comparison with the other groups.


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About the authors

Ilya N. Penin

Almazov National Medical Research Centre; Leningrad Regional Clinical Hospital

Author for correspondence.
Email: md_pin@mail.ru
SPIN-code: 7904-5650

Russian Federation, Saint-Petersburg

Rheumatologist

A. L. Maslyanskiy

Almazov National Medical Research Centre

Email: esc_4@mail.ru
ORCID iD: 0000-0003-2427-4148
SPIN-code: 5698-7797

Russian Federation, Saint Petersburg

Senior Researcher of Rheumatology Department, Almazov National Medical Research Centre

A. O. Konradi

Almazov National Medical Research Centre; ITMO University

Email: konradi@almazovcentre.ru
ORCID iD: 0000-0001-8169-7812
SPIN-code: 2298-8269

Russian Federation, Saint Petersburg

MD, Professor, Corresponding Member Russian Academy of Sciences, Deputy General Director for Science, Head of the Research Department of Hypertension

Vadim I. Mazurov

North-Western State Medical University named after I.I. Mechnikov

Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051
SPIN-code: 6823-5482

Russian Federation, Saint-Petersburg

D. Sci. (Med.), Prof., RAS academician,  Head of the research institute of Rheumatology, head of Department of Therapy, Rheumatology, Examination of Temporary Disability and Quality of Medical Care named after E.E.Eichwald 

References

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  2. Bollinger A, Jäger K, Roten A, et al. Diffusion, pericapillary distribution and clearance of Na-fluorescein in the human nailfold. Pflugers Arch. 1979;382(2):137-143. https://doi.org/10.1007/bf00584215.
  3. Bukhari M, Herrick AL, Mooreet T, al. Increased nailfold capillary dimensions in primary Raynaud’s phenomenon and systemic sclerosis. Br J Rheumatol. 1996;35(11):1127-1131. https://doi.org/10.1093/rheumatology/35.11.1127.
  4. Grassi W, Core P, Carlino G, et al. Labial capillary microscopy in systemic sclerosis. Ann Rheum Dis. 1993;52(8): 564-569. https://doi.org/10.1136/ard.52.8.564.
  5. Cutolo M, Sulli A, Pizzorni C, Accardo S. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000;27(1):155-160.
  6. Smith V, Pizzorni C, De Keyser F, et al. Reliability of the qualitative and semiquantitative nailfold videocapillaroscopy assessment in a systemic sclerosis cohort: A two-centre study. Ann Rheum Dis. 2010;69(6):1092-1096. https://doi.org/10.1136/ard.2009.115568.

Supplementary files

Supplementary Files Action
1.
Fig. 1. Normal structure of capillaroscopic pattern. Homogeneous structure of the capillaries, their parallelism. Capillary density is more than 7 capillaries per 1 mm2

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2.
Fig. 2. “Early” pattern. The capillaries with dilated ascending and descending loops, marked loss of parallelism. Capillary density is normal: more than 7 capillaries per 1 mm2

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3.
Fig. 3. “Active” pattern. The dilated capillaries with a more than three-fold increase in the diameter (giant capillaries). Non-parallelism is more expressed than in the “early” pattern. Capillary density is less than 7 capillaries per 1 mm2

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4.
Fig. 4. “Late” pattern. A rapid decrease in density of the capillaries, complete destruction of the capillary structure, the signs of neoangiogenesis

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5.
Fig. 5. Semi-quantitative assessment of capillaroscopic changes

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6.
Fig. 6. Pathological changes of the capillary bed in the group of patients with idiopathic pulmonary hypertension

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7.
Fig. 7. Pathological changes of the capillary bed in the group of patients with osteoarthritis

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8.
Fig. 8. Pathological changes of the capillary bed in the group of patients with rheumatoid arthritis

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9.
Fig. 9. Pathological changes of the capillary bed in the group of patients with dermato/polymyositis

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10.
Fig. 10. Comparison of capillary density in different groups ( — mean; — mean error; — mean deviation, p — relative to the group with systemic scleroderma). The patient groups: 1 — with systemic scleroderma; 2 — with idiopathic pulmonary hypertension; 3 — control group; 4 — with osteoarthritis; 5 — with rheumatoid arthritis; 6 — with dermato/polymyositis

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Copyright (c) 2020 Penin I.N., Maslyanskiy A.L., Konradi A.O., Mazurov V.I.

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