Capillaroscopy and rheumatic disease 4.33/5 (6)

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Definition

Capillaroscopy uses magnification and oil on the nail (nail fold capillaroscopy). Thus, the nail acts as a window and one can observe the capillaries at the nail fold. The same is not possible through the skin which is not transparent.

  • One can detect varicose veins which may be early signs of rheumatic disease in such small blood vessels. Usually, the nails of finger 2-5 on both hands are examined.

Method

Best suited for the examination is an electronic small microscope with a light source (capillary head) that is prohibited by a PC. In order to prevent the blood vessels from contracting (and appearing to be too low in capillary density), the study should be carried out at stable room temperature. Air between the nails and the capillaroscope is removed using a clear oil, peanut oil (note allergy) or cedar oil dripping on. The study is painless and takes a few minutes.

Capillaroscopy is particularly suitable for distinguishing benign, common (primary) Raynaud's phenomenon from underlying Systemic sclerosis (with secondary Raynaud's phenomenon) or other systemic connective tissue disease that exhibits signs of disease in the capillaries. Systemic sclerosis-like pattern (usually less clear) can be seen by:

Medical investigation and findings

Changes in the capillaries are also described by a variety of other conditions. Disease-specific changes do not exist. In systemic sclerosis, almost all have significant changes, while it is more varied by others connective tissue diseases og Vasculitis.

The result can be described by comparison with normal findings:

  • Reduced density of capillaries
  • Avascular areas
  • Dilatations
    • Mega Capillaries
  • Bleeding
  • Agio-neogenesis
  • Branching
  • Distortions
  • Abnormal architecture ("bushy")

Early phase

  • Some megacapillaries
  • Some bleeding
  • Relatively well preserved "architecture"
  • No loss of capillaries (not low density)

Active phase

  • Many megacapillaries
  • Bleeding
  • Moderate loss of capillaries (lower density)
  • Beginning of abnormal architecture without much branching

Late phase

  • Irregular, enlarged capillaries
  • Few or no megacapillaries
  • Little or no bleeding
  • Significantly reduced capillary density
  • Changed architecture with branches / bushy scattered around

Literature


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