title: Capillaroscopic pattern at the toes of systemic sclerosis patients: does it "tell" more than those of fingers?
abstract: OBJECTIVE
  The aim of the study was to compare nail fold capillaroscopic findings of the fingers with those of the toes in patients with systemic sclerosis (SSc).
  
  
  METHODS
  Thirty-six patients with SSc were included in the study: 30 patients had limited SSc, 5 patients had diffuse SSc, and 1 patient had an overlap syndrome. Of these 36 patients, 30 were women and 6 were men (mean [SD] age, 56 [14] years). The severity of the Raynaud phenomenon (RP), the presence of digital ulcers, and skin scores at the fingers and feet were assessed. Nail fold capillaroscopy was performed with a videocapillaroscope (Videocap 3.0; DS Medica).
  
  
  RESULTS
  All 36 patients (100%) reported about symptoms of RP in the hands and 34 (94.4%) reported episodes of RP in the feet; the difference is not significant (P > 0.05). In most patients with RP symptoms of both hands and feet, the symptoms were more severe at the hands (82%, 28/34). Digital ulcers of the fingers were found in 36% (13/36) of the case and those of the toes were found in 8.3% (3/36) of the cases. Nail fold capillaroscopy of the hands showed the classic "scleroderma"-type capillaroscopic pattern in 97.2% (35/36) of the patients. In the toes, a scleroderma-type capillaroscopic pattern was found only in 66.7% (24/36) of patients (P < 0.05). With respect to distinct differences, in the toes, the dilated capillaries were found in 72.2% (26/36) of the cases, giant capillaries in 30.6% (11/36) of the cases, hemorrhages in 8.3% (3/36) of the cases, avascular areas in 41.7% (15/36) of the cases, and neoangiogenesis in 22.1% (8/36) of the cases. This difference in frequency of the findings regarding the toes and the fingers of patients with SSc was statistically significant for all parameters.
  
  
  CONCLUSIONS
  Capillaroscopy of the toes of SSc also shows patterns characteristic of SSc. However, these patterns differ from the respective patterns of the fingers, which is probably related to less-severe RP and lower skin score at the feet.
authors.affiliation: Department for Propedeutics of Internal Medicine, Clinic of Rheumatology, Medical University - Plovdiv, Bulgaria. ssevdalina_n@abv.bg
authors.forename: Sevdalina
authors.initials: S
authors.lastname: Lambova
authors.forename: Walter
authors.initials: W
authors.lastname: Hermann
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller-Ladner
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009262:Nails / Q000098:blood supply; D009389:Neovascularization, Pathologic / Q000453:epidemiology; D011928:Raynaud Disease / Q000453:epidemiology; D012039:Regional Blood Flow / Q000502:physiology; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D012720:Severity of Illness Index; D014034:Toes / Q000098:blood supply*