Differentiation between primary and secondary Raynaud's phenomenon: a prospective study comparing nailfold capillaroscopy using an ophthalmoscope or stereomicroscope.
BACKGROUND
Nailfold capillary microscopy is a routine procedure in the investigation of patients with Raynaud's phenomenon (RP). As a standard method, nailfold capillary morphology is inspected with a stereomicroscope to look for capillary abnormalities such as giant loops, avascular areas, and bushy capillaries, which have all been found to be associated with certain connective tissue diseases.


OBJECTIVE
To investigate prospectively whether nailfold capillary inspection using an ophthalmoscope is of equivalent diagnostic value to standard nailfold capillary microscopy.


METHODS
All the fingers of 26 patients with RP were examined in a blinded fashion and compared with the final diagnosis one month later.


RESULTS
All giant loops, large avascular areas, and bushy capillaries were identified by both methods. The correlation for moderate avascular areas and crossed capillaries was 0.93 and 0.955 respectively. The correlation for minor abnormalities that do not contribute to the differentiation between primary and secondary RP was 0.837 and 0.861 respectively. All patients were classified identically by the two methods.


CONCLUSIONS
For the evaluation of patients with RP, nailfold capillary morphology can reliably be assessed with an ophthalmoscope.
Division of Rheumatology, Medizinische Poliklinik, Ludwig-Maximilians Universität Munich, Germany. hjanders@clinbio.med.uni-muenchen.de
H J
HJ
Anders
T
T
Sigl
M
M
Schattenkirchner
D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D020678:Microscopic Angioscopy / Q000295:instrumentation*; D008875:Middle Aged; D009260:Nail Diseases / Q000473:pathology*; D019721:Ophthalmoscopes; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011928:Raynaud Disease / Q000175:diagnosis* / Q000209:etiology