The capillaroscopy is a method to early diagnose the symptoms of capillary spasm in the vibration. Beside of usual microscope M- 70 A of Soviet Union, any microscope can be used to illuminate and take the photograph of the capillary of finger transnail skin fold.
Microscopic Angioscopy ; Fingers

OBJECTIVE: To evaluate the usefulness of power Doppler ultrasonography (PDU) in diagnosing Raynaud's phenomenon (RP) and in differentiating primary RP from secondary RP comparing with nailfold capillaroscopy (NFC). METHODS: Microvascularity in the nailfold and finger tip of ten healthy controls and 36 patients with primary RP (n=16) or secondary RP (systemic sclerosis, n=20) was evaluated using PDU before and after cold challenge, respectively. Also, NFC was performed in all persons. The results of PDU were compared with the findings of NFC. RESULTS: According to the change of microvascularities before and after cold challenge, the findings of PDU are classified into 3 patterns such as normal, primary RP, and secondary RP. PDU yielded a correct classification in 87.5% of the persons analyzed (normal=100%, primary RP=87.5%, secondary RP=75%) and confirmed presence of RP in all patients with clinically diagnosed RP. There was good correlation between PDU and NFC examination for differentiating primary RP from secondary RP (Kappa=0.611, p<0.01). CONCLUSION: The PDU technique is a useful and reliable method to diagnose RP and to discriminate between primary RP and secondary RP and the results of PDU is well correlated with those of NFC examination.
Classification ; Fingers ; Humans ; Microscopic Angioscopy* ; Sclerosis ; Ultrasonography, Doppler*

Nailfold capillaroscopy (NFC) is a non-invasive morphological study that routinely used to differentiate between a primary and secondary Raynaud's phenomenon (RP). Secondary RP is a manifestation of an underlying rheumatic disease that occurs in 80-95% of patients with systemic sclerosis (SSc), 75% of patients with mixed connective tissue disease and in 20-25% of patients with systemic lupus erythematosus or rheumatoid arthritis. These RP frequently precedes the underlying disease by many years. The well-established roles of NFC are the early diagnosis of SSc, and potential for predicting clinical complication, as like digital ulcers. The following review will present a technique about how to perform NFC and optimal assessment with emphasis on its possible role as a reliable diagnostic tool.
Arthritis, Rheumatoid ; Early Diagnosis ; Humans ; Lupus Erythematosus, Systemic ; Microscopic Angioscopy* ; Mixed Connective Tissue Disease ; Rheumatic Diseases* ; Scleroderma, Systemic ; Treatment Outcome* ; Ulcer

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

OBJECTIVE: To evaluate the correlation between nailfold capillaroscopic (NC) findings and the presence of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients. METHODS: We retrospectively involved 71 SSc patients, 45 patients with ILD. NC was performed in all the patients according to the standard method. The NC findings were semi-quantitatively scored, including enlarged and giant capillaries, hemorrhages, loss of capillaries, avascular areas, ramified/bushy capillaries and disorganization of the vascular array. The demographic and clinical data collected were gender, age, presence/absence of Raynaud phenomenon (RP), duration of RP, serological acute phase reactants and antibodies, presence of ILD (also evaluated the CT score for ILD) and pulmonary function parameters. RESULTS: Among the 71 patients, the frequency of the women was 91.5%, the mean age was (52.59±12.77) years, and disease duration was (3.00±6.00) years. NC changes of the scleroderma pattern were observed in 90.1% patients. There were 45 patients with ILD and 26 patients without ILD. The patients with ILD had significantly higher loss of capillaries score [0.50 (1.03) vs. 0.00 (0.43), P=0.003], avascular area score [0.75 (1.24) vs. 0.25 (0.83), P=0.006] and ramified/bushy capillaries score [0.33 (0.88) vs. 0.13 (0.25), P=0.006] compared with those without ILD. Moreover, ramified/bushy capillaries score together with diffused SSc were independent risk factors for the presence of ILD. And the score of giant capillaries were significantly lower in the patients with more severe ILD group [0.25 (0.94) vs. 0.00 (0.28), for the mild and severe ILD groups respectively, P=0.019]. There was no statistically significant difference between the two groups with respect to the scores of enlarged capillaries, hemorrhages, or disorganization of the vascular array. CONCLUSION Capillary deletion and severe deformity in NC were associated with the presence of ILD in SSc patients. And patients with less giant capillaries had more severe ILD involvement. These indicated that NC maybe a useful tool to evaluate ILD in SSc.
Adult ; Aged ; Capillaries ; Female ; Hemorrhage ; Humans ; Lung Diseases, Interstitial/complications* ; Male ; Microscopic Angioscopy ; Middle Aged ; Nail Diseases/complications* ; Nails ; Raynaud Disease ; Scleroderma, Systemic/complications*

Raynaud's phenomenon (RP) is a reversible vasospasm that is aggravated by cold or emotional stress. Before confirming RP, it is essential to consider other possible causes including compressive neuropathy, sensori-neuropathy, thyroid disease, hematologic conditions and offending drugs. RP is typically characterized by the three-step color change that turns pallor (white), cyanosis (blue), and then erythema (red) of reperfusion. Once RP is diagnosed, it is important to determine whether it is primary or secondary RP. To distinguish primary from the secondary RP, the specialized tests performing in clinical practice are antinuclear antibody (ANA) and nailfold capillary microscopy (NFC). The combination of ANA and NFC is most helpful for discriminating secondary RP due to autoimmune rheumatic disease. Thereby, normal findings of NFC in primary RP distinguished from secondary RP should be understood. Patients with primary RP usually improves with symptomatic treatment focused on lifestyle modification and patient education, but those with secondary RP should be treated together with associated disease or causes.
Antibodies, Antinuclear ; Capillaries ; Cyanosis ; Erythema ; Humans ; Life Style ; Microscopic Angioscopy ; Microscopy ; Pallor ; Patient Education as Topic ; Reperfusion ; Rheumatic Diseases ; Stress, Psychological ; Thyroid Diseases

BACKGROUND/AIMS: Nailfold capillaroscopy (NFC) has been used to examine morphological and functional microcirculation changes in connective tissue diseases. It has been demonstrated that NFC patterns reflect abnormal microvascular dynamics, which may play a role in fibromyalgia (FM) syndrome. The aim of this study was to determine NFC patterns in FM, and their association with clinical features of FM. METHODS: A total of 67 patients with FM, and 30 age- and sex-matched healthy controls, were included. Nailfold capillary patterns were quantitatively analyzed using computerized NFC. The parameters of interest were as follows: number of capillaries within the central 3 mm, deletion score, apical limb width, capillary width, and capillary dimension. Capillary dimension was determined by calculating the number of capillaries using the Adobe Photoshop version 7.0. RESULTS: FM patients had a lower number of capillaries and higher deletion scores on NFC compared to healthy controls (17.3 +/- 1.7 vs. 21.8 +/- 2.9, p < 0.05; 2.2 +/- 0.9 vs. 0.7 +/- 0.6, p < 0.05, respectively). Both apical limb width (microm) and capillary width (microm) were significantly decreased in FM patients (1.1 +/- 0.2 vs. 3.7 +/- 0.6; 5.4 +/- 0.5 vs. 7.5 +/- 1.4, respectively), indicating that FM patients have abnormally decreased digital capillary diameter and density. Interestingly, there was no difference in capillary dimension between the two groups, suggesting that the length or tortuosity of capillaries in FM patients is increased to compensate for diminished microcirculation. CONCLUSIONS: FM patients had altered capillary density and diameter in the digits. Diminished microcirculation on NFC may alter capillary density and increase tortuosity.
Adult ; Capillaries/*pathology/physiopathology ; Case-Control Studies ; Female ; Fibromyalgia/*diagnosis/pathology/physiopathology ; Humans ; Image Interpretation, Computer-Assisted ; Male ; Microcirculation ; *Microscopic Angioscopy ; Nails/*blood supply ; Predictive Value of Tests ; Regional Blood Flow

BACKGROUND: Since the endothelin-1 may be implicated in the pathogenesis of peripheral vascular diseases associated with connective tissue diseases (CTDs), we examined the plasma endothelin-1 level in association with quantitative nailfold capillaroscopy in patients with CTDs. METHODS: We investigated 79 patients with connective tissue diseases (54 systemic lupus erythematosus (SLE), 18 systemic sclerosis (SSc), 4 mixed connective tissue disease, 3 polymyositis/dermatomyositis). Plasma samples were obtained and endothelin-1 levels were measured by sandwich enzyme-linked immunosorbent assay. The presence and duration of Raynaud phenomenon as well as nailfold capillaroscopy were evaluated in each patient. To examine the quantitative nailfold capillaroscopy, we measured the length of apical limb width, capillary width and capillary length. RESULTS: According to the presence or absence of Raynaud phenomenon, there was no statistically increased plasma endothelin-1 level between two groups (2.433 +/- 2.259 pg/mL n=33, vs. 1.905 +/- 1.371 pg/mL n=46, p=non specific). All the SSc patients had Raynaud phenomenon and according to the presence of abnormal capillaroscopic findings, there were increased level of endothelin-1 in abnormal capillaroscopy group compared to normal capillaroscopy group (3.940 +/- 3.335 pg/mL (n=12), vs 1.573 1.006 pg/mL (n=6), p<0.05). As compared quantitative examination of nailfold capillaroscopy with plasma endothelin-1 level, in SSc patients the endothelin-1 level correlated well with the length of apical limb width (r(s)=0.577 p<0.05). In SLE patients the endotheliln-1 level correlated well with the length of apical limb width and capillary width (r(s)=0.425 p<0.01, rs=0.278 p<0.05, respectively). CONCLUSION: Our data demonstrate that the presence of abnormal capillaroscopic findings reflect increased plasma endothelin-1 level in patients with connective tissue diseases, and quantitative analysis of nailfold capillaroscopy can be useful to predict the disease activity with the evidence of increased plasma endothelin-1.
Capillaries ; Connective Tissue Diseases* ; Connective Tissue* ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Extremities ; Humans ; Lupus Erythematosus, Systemic ; Microscopic Angioscopy ; Mixed Connective Tissue Disease ; Peripheral Vascular Diseases ; Plasma* ; Raynaud Disease ; Scleroderma, Systemic

Systemic sclerosis is a connective tissue disease characterized by alterations in microvascular structure and function. In these patients, numerous studies have demonstrated a relationship between capillary morphology and peripheral blood perfusion. Nailfold videocapillaroscopy reveals the peripheral microvascular morphology and thus allows classification and scoring of capillary abnormalities with respect to different microangiopathy patterns (early, active, and late). Laser Doppler flowmetry and laser speckle contrast analysis can be used to estimate cutaneous blood flow through microvessels and to assess and quantify blood perfusion at peripheral sites. These two methods are also used to identify changes in digital blood perfusion after the infusion of vasodilators.
Blood Flow Velocity ; Humans ; *Laser-Doppler Flowmetry ; *Microcirculation ; Microscopic Angioscopy/*methods ; Microvessels/*pathology/*physiopathology ; Nails ; Predictive Value of Tests ; Regional Blood Flow ; Scleroderma, Systemic/*diagnosis/pathology/physiopathology ; Skin/*blood supply ; Vasodilator Agents/diagnostic use ; *Video Recording