The specificity of capillaroscopic pattern in connective  autoimmune diseases. A comparison with microvascular  changes in diseases of social importance: arterial hypertension  and diabetes mellitus.
Capillaroscopy is a method with substantial value for diagnosis and differentiation of primary and secondary Raynaud's phenomenon in rheumatic diseases. The most specific finding is in systemic sclerosis--the so-called "scleroderma pattern." which is characterized by the presence of dilated capillaries, hemorrhages, avascular areas, and neoangiogenesis. Similar changes are found in patients with dermatomyositis, overlap syndromes, and others and are termed "scleroderma-like pattern." For the development of these patterns, the most specific finding in the early phase is appearance of dilated capillaries. Capillaroscopic changes in connective autoimmune diseases are specific and differ significantly from those of that can be found in other diseases. Diseases of social importance such as diabetes mellitus and arterial hypertension often present as comorbidity in patients with rheumatic diseases. In diabetes mellitus, the capillaroscopic examination does not show dilated capillaries until the advanced stages of the disease. In the late stages of connective tissue disease, a loss of capillaries is typical. In addition, in diabetes mellitus, the diabetic stiff-hand syndrome and sclerodactyly are common complications, which have to be differentiated from similar signs in rheumatic diseases, and capillaroscopic examination appears to be useful in these situations. In arterial hypertension, a reduced capillary density in different body regions has been observed in patients with established disease as well as in preclinical stages. Analogous phenomenon of reduction in the nail-fold area has also been observed in a group of patients with essential hypertension, none of whom previously received hypertensive drugs.
Clinic of Rheumatology, Medical University, 4002 Plovdiv, Bulgaria. sevdalina_n@abv.bg
Sevdalina Nikolova
SN
Lambova
Ulf
U
Müller-Ladner
D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis*; D002196:Capillaries / Q000473:pathology*; D003240:Connective Tissue Diseases / Q000150:complications / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D020678:Microscopic Angioscopy / Q000379:methods*; D011928:Raynaud Disease / Q000175:diagnosis / Q000209:etiology; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis