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Abstract Number: 853

Capillaroscopy Compared With Color Doppler Ultrasound Of Digital Arteries For Distinguishing Primary From Secondary Raynaud’s Phenomenon

Wolfgang A. Schmidt1, Katharina Pagel2, Bernd Schicke3 and Andreas Krause4, 1Med Ctr Rheumatology Berlin Buch, Immanuel Krankenhaus Berlin, Berlin, Germany, 2Medical Ctr Rheumatol Berlin Buch, Immanuel Krankenhaus Berlin, Berlin, Germany, 3Tumorzentrum Berlin, Berlin, Germany, 4Immanuel Krankenhaus Berlin, Berlin, Germany

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: dermatomyositis, nailfold capillaroscopy, Raynaud's phenomenon, systemic sclerosis and ultrasound

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Session Information

Session Title: Imaging of Rheumatic Diseases: Imaging in Vascular and Extra-articular

Session Type: Abstract Submissions (ACR)

Background/Purpose: Raynaud’s phenomenon (RP) is commonly seen in rheumatology practice. Differentiating primary from secondary RP is important for disease management and prognosis. How does capillaroscopy compare to color Doppler ultrasound (US) of the finger arteries for distinguishing primary from secondary RP? How often do these imaging techniques detect abnormalities in nailfold arteries or finger arteries in patients with connective tissue diseases?

Methods: Consecutive patients with RP or with suspected connective tissue disease and healthy controls who presented within a 12-month period in a tertiary rheumatology referral center were examined.

Nailfold capillaroscopy of the 2nd to 5th fingers was done bilaterally with a Nikon Stereoscopic Zoom Microscope SMZ1000 including a camera control unit DS-Us, in search for scleroderma, dermatomyositis and other connective tissue disease patterns as previously described (Cutolo M, et al. Best Pract Res Clin Rheumatol 2008;22:1093-108).

Bilateral color Doppler US of the radial, ulnar, all common palmar and all proper digital arteries was performed after a hot water bath of the hands in search for occlusions and stenoses as previously described (Schmidt WA, et al. J Rheumatol 2008;35:1591-8). An Esaote MyLab Twice US machine, equipped with a 6-18 MHz linear probe, was used.

Capillaroscopy and US images were stored electronically. Both investigators were not aware of the results of the other examination. After diagnostic work-up the results of US and capillaroscopy were compared with the final diagnosis.

Results: Twenty healthy controls and 165 patients were included. Final diagnoses included primary RP (52 patients), systemic sclerosis (49 patients), myositis (15 patients), other connective tissue diseases such as SLE (13 patients), MCTD (12 patients), UCTD (10 patients), Sjögren’s syndrome (4 patients) and vascular diseases such as vasculitis (5 patients), anti-phospholipid syndrome (3 patients), and arteriosclerosis (2 patients). Table 1 shows the results.

Table 1:

Diagnosis

N

Consistent   results of US and capillaroscopy

Only   US positive

Only   capillaroscopy positive

Kappa

Controls

20

100%

0%

0%

N.A.

Primary RP

52

71%

10%

19%

-0.10

Systemic   sclerosis

49

88%

8%

4%

0.81

Myositis

15

67%

7%

27%

0.68

Other   connective tissue diseases

39

80%

5%

15%

0.73

Vascular   disease

10

50%

20%

30%

0.51

Total

185

79%

7%

14%

0.58

The highest rate of abnormalities was found in systemic sclerosis (capillaroscopy, 92%;  US 96%). In myositis (87%; 67%) and other connective tissue diseases (82%; 72%) capillaroscopy more often displayed abnormal results than US. In primary RP, US and capillaroscopy were positive in 10% and 19% respectively. None of these patients showed abnormalities in both US and capillaroscopy.

Conclusion: Although capillaroscopy and US are assessing different anatomical structures, each technique helps distinguish primary from secondary RP. Abnormalities are particularly common in systemic sclerosis. Capillaroscopy is more sensitive in other connective tissue diseases. However, it is more frequently positive also in primary RP. The agreement between US and capillaroscopy is good to moderate.


Disclosure:

W. A. Schmidt,

Actelion Pharmaceuticals US,

2,

Esaote,

2,

GE Healthcare,

2;

K. Pagel,

Actelion Pharmaceuticals US,

2;

B. Schicke,
None;

A. Krause,

Actelion Pharmaceuticals US,

2.

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