The capillaroscopy is a non-invasive technique at nailfold level, making it possible to assess the characteristics of the nailfold distal capillaries, thanks to a lens and a light that shines on said spot.
The information it provides us with helps to complete the diagnosis of the vasculitic autoimmune process of the patient; it does not permit a diagnosis or specific therapeutic approach on its own.
For its correct visualisation, the patient is recommended:
The capillaroscopy allows us to know the extent of the distal vascularisation, which is very important in systemic sclerosis and other connective pathologies, as well as to rule out systemic involvement in patients with Raynaud's phenomenon with no other associated clinical involvement.
The capillaroscopy of the nail bed is a simple, bloodless, economical method which is very useful for studying Raynaud's phenomenon and other rheumatological conditions. Raynaud's phenomenon can be defined as the change in the colouring of the fingers and/or toes in response to cold or stress. It traditionally progresses through three stages: paleness (vasospasm), cyanosis (due to increased carboxyhemoglobin) and erythema (reactive hiperemia).
Raynaud's phenomenon can be primary (Raynaud's disease) or secondary, associated with a connective tissue disease. Primary Raynaud's phenomenon is responsible for around 60% of all new cases. 15-20% of cases of Raynaud's phenomenon are due to a series of non- immunological processes, such as drugs, occupational diseases, neoplasms, etc. The remaining 15-20% are associated with connective tissue diseases.
Raynaud's is present in over 90% of patients with scleroderma and in 70% of cases it is the first symptom. Although it seems impossible to predict that a patient with Raynaud's will develop scleroderma, the presence of antinuclear antibodies (ANA) indicates a greater risk of onset.
The nail bed capillaroscopy shows morphological alterations at an early stage in some connective tissue diseases of maximum rheumatological interest, particularly capillaroscopy. In these cases, the capillaroscopy traditionally shows the "sclerodermic pattern" characterised by: reduction or absence of capillaries in patches, capillary dilation, and sometimes mega-capillaries and splinter haemorrhages. This "sclerodermic pattern" appears early and when it is observed in patients with Raynaud's phenomenon, even if it is not very obvious, it should lead to the search for sclerodermic manifestations in internal organs, which can be present without causing any symptoms. The combination of Raynaud's phenomenon and a "sclerodermic pattern" in a capillaroscopy can precede and therefore predict the onset of scleroderma.
Ultimately, this is an auxiliary diagnostic technique with great value in rheumatology and vascular disease.
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