ASSESSMENT OF NAILFOLD CAPILLAROSCOPY BY DIGITAL EPILUMINESCENCE (DERMOSCOPY) IN PATIENTS WITH RAYNAUD PHENOMENON

Background: Dermoscopy is a useful tool for dermatologists to study melanocytic lesions. Recently, its possible usefulness in the assessment of capillary nailfold morphologic changes (capillaroscopy) has been advocated.Objectives: To assess the practical utility of digital epiluminescence microscopy as a capillaroscopic instrument in patients with primary and secondary Raynaud's phenomenon (RP). To compare the sensitivity and specificity rates obtained by epiluminescence microscopy with those previously reported with conventional capillaroscopic devices.Methods: 56 consecutive patients with primary (5 patients) or secondary (51 patients) RP (11 males and 45 females) were included in the study. A control group of 10 healthy subjects was also evaluated. 26 patients (46.4%) suffered from systemic sclerosis (SS), 12 (21.4%) from pre-systemic sclerosis (Pre-SS), 1 (1.8%) from dermatopolymyositis-SS, 1 (1,8%) from mixed connective tissue disease (MCTD), 2 (3,6%) from Sjögren syndrome, 2 (3,6%) from an overlap syndrome, 1 (1,8%) from rheumatoid arthritis (RA), and 6 (10,6%) from other connective tissue diseases. Capillary nail fold changes were studied using a digital epiluminescence device (magnification x 30). Following a systematized protocol, capillary nailfold morphology, density and distribution were evaluated. Several capillaroscopic patterns were identifed (normal, sclerodermic, non-specific, non-diagnostic) as previously defined. A possible relationship between capillary nailfold changes and the intensity of RP or the presence of associated autoimmune diseases was assessed.Results: The sclerodermic pattern showed a sensitivity rate of 76.9% and a specificity rate of 90.9% in SS. A typical capillaroscopic SS pattern was observed in 73,3% of limited SS and in 81,8% of diffuse SS. Patients suffering from Sjögren syndrome and dermatopolymyositis-SS showed a non-specific capillaroscopic pathologic pattern. All patients with primary RP presented a normal capillaroscopic pattern. A normal capilaroscopy was also observed in 11/12 patients with pre-SS. In one out of two patients presenting severe sclerodactity and in all patients showing hand edema (3/56), capillaroscopic changes could not be evaluated. Avascular areas correlated significantly with severe RP (p< 0,002), bone resorption (p< 0,007) and diffuse SS (p<0,008).Conclusion: Digital epiluminescence seems to be a useful and reliable technique in the evaluation of capillary nailfold morphological changes. This technical variation allows the identification of specific capillaroscopic patterns associated with connective tissue diseases. It also permits to differentiate primary RP from secondary RP. The results obtained with this technique are similar to those previously reported using standard capillaroscopy devices.Citation: Ann Rheum Dis, volume 65, supplement II, year 2006, page 383Session: Scleroderma and related syndromes