Background/Purpose:

Capillaroscopy is as a useful diagnostic tool in various connective tissue diseases characterized by microangiopathy and vasculitis. Different pathological patterns especially for systemic sclerosis are described and validated. However, the morphologic pattern of healthy individuals (“normal”) has been disregarded. The normal pattern with its high negative prediction for the development of systemic sclerosis in individuals with Raynauds phenomenon is important for the everyday clinical use and for predictive trials.

Methods:

“Rheuma-Truck” was a mobile rheumatology office located in different city centers of Germany offering a screening for rheumatic diseases including questionnaires, lab-tests and imaging. We performed 200x magnification nailfold capillaroscopy of the 3^rd to 5^th finger of both hands in visitors without known prediagnosed rheumatic disease. The pictures were evaluated by experts based on the morphological findings. Documented morphologies were hairpin shaped capillaries (HC), tortuous capillaries (TC), ramification, elongation, calibre variations, bulging. Descriptive statistics for mentioned morphologies were obtained as the mean value ± standard deviation (SD), minimum (min), maximum (max), percentiles. Furthermore a possible impact of age, gender, and smoking was evaluated.

Results:

9771 pictures of 748 visitors were evaluated. The mean age of the examined individuals (75% female, 25% male) was 53,6 years. HC was the most documented morphology (mean 76% ± 23%, min 0%, median 80%, max 100%) followed by TC (mean 21% ± 23%, min 0%, median 20%, max 100%). Only 30% of the examined normal fingers showed 100% HC but 97% exclusively HC and TC. Ramification (2,9% ± 8,2%, min 0%, median 0%, max 100%); elongation (1,8% ± 6,4 %, min 0%, median 0%, max 60%); calibre variations (0,8% ± 4,5%, min 0%, median 0%, max 80%) and bulging (0,3% ± 3,0%, min 0%, median 0%, max 60%) are rare. Giant capillaries were seen in 0,07% of the fingers.

Conclusion:

HC dominate the normal pattern but TC are frequently seen in “normal” with significant (p<0,001) increasing probability in age and male. There is no significance for the age or gender after adding the results for HC and TC, suggesting a physiologic alteration without prediction for connective tissue diseases. Hence “normal” is defined (2 SD range of the mean) as 80-100% HC and/or TC, <10% calibre variations, <6% bulging, <19% ramifications, <15% elongation and no giant capillaries. This definition should be used as a reference in future trials and clinical use to enlarge the prediction for healthy individuals.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/going-back-to-basics-redefining-the-normal-pattern-in-nailfold-capillaroscopy-in-a-large-healthy-population-results-of-the-german-rheuma-truck-cohort/