Usefulness of Nailfold capillary microscopy in the diagnosis of Raynaud’s phenomenon
Keywords:
Scleroderma, Systemic Sclerosis, Nailfold capillary microscopy, Primary Raynaud’s Phenomenon, Secondary Raynaud’s PhenomenonAbstract
Nailfold capillary microscopy (NCM) is an easy and non-invasive
exam that allows the observation of capillaries.
Raynaud’s Phenomenon (RP) can be the manifestation of an
underlying systemic illness so, it would be useful to have an easy
exam making it simpler to distinguish primary from secondary.
The aims of this study were: to evaluate which capillaroscopic
changes are more frequent in RP; to analyse the informative
value of the different criteria and determine the validity of NCM
for the diagnosis of RP.
The clinical files of patients observed by NCM due to RP were
evaluated. According to capillaroscopic criteria they were classified in three groups: primary RP, secondary RP due to a probable
Connective Tissue Disease (CTD) and secondary RP to Systemic
Sclerosis (SS).
According to the final clinical diagnosis made in later consultations (medium follow-up 2,3 years), patients were also placed
into three groups (primary RP, DCT and SS).
The sample comprised 286 individuals: 40 with SS pattern,
111 with probable CTD and 135 with primary RP.
Differences of the alterations among the 3 groups were very
significant. In primary RP we observed more stasis (38,5%), and
edema (35,6%), in CTD, serious dystrophies (89,2%) and in SS
edema and blurred capillary outlines in all patients.
Tests for sensitivity, specificity and predictive values were high
as well as statistical index among the various pathologies (Cohen K = 0.87).
We concluded that NCM criteria are an important help to
differentiate the etiology of RF.
The high sensitivity, specificity, predictive value and statistical
agreement levels make it possible to recommend NCM as the
first step exam for the evaluation of patients with RP.
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