Capillaroscopy Findings in Patients and Non-Patients with Raynaud's Syndrome in Connective Tissue Patients Referred to Hazrat Rasoul Akram Hospital in Tehran

Background &

Raynaud's is a common phenomenon that is also seen in connective tissue diseases such as polymyositis, lupus and mixed connective tissue diseases. However, its occurrence is more pronounced in systemic sclerosis. This phenomenon can be so severe that it leads to cyanosis and gangrene of the fingertips in the final stages. In Raynaud's phenomenon, finger discoloration occurs during contact with cold weather during various stages. First, the skin turns white, then cyanotic and blue, and then changes color to red. The primary pathology in Raynaud's phenomenon is spasm of the end vessels of the limbs and involvement in it from the distal part of the limb and fingers to the proximal, which gradually causes skin atrophy. Capillaroscopy is a method used to diagnose Raynaud's phenomenon and can be used to evaluate the functional and morphological changes of microcirculation in connective tissue diseases (CTDs). Examination of nail capillaries can reveal the nature and extent of microvascular pathology in patients Show CTD. This method can clearly show the main capillary changes of the nail, including megcapillary, capillary bleeding and reduced capillary distribution, in diseases such as systemic sclerosis. The aim of this study was to determine the capillaroscopy findings in CTD patients. After the study, data on Raynaud's patients were compared with other patients. In other words, the aim of this study was to determine the microvascular structure, capillary density, loop diameter, microhemorrhage and angiogenesis in patients and non-patients with Raynaud's syndrome.

The case control study was performed on patients who referred to the rheumatology clinic of Rasoul Akram hospital in Tehran from 2017 to 2019. According to ACR criteria, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, dermatomyositis, polymyositis, Sjogren and mixed connective tissue disease were included in the study. Patients were divided into two groups according to Raynaud's disease and the findings of capillaroscopy were compared. Written consent was obtained from all patients stating their consent to enter the project. Information obtained from patients was considered confidential. The results of the study were performed without publishing the names of the patients.

Finally, 96 people (22 male / 74 female) participated in the final analysis after completing the required data. The mean age of patients was 46.22 ± 14.02 years (18-84 years). In total, out of 96 cases, 30 (31.3%) had normal, 17 (17.7%) had nonspecific morphological abnormality (NSMA) and 49 (51%) had Scleroderma Pattern. There was no statistically significant difference in capillaroscopy findings according to gender and age groups. Abnormalities of microvascular structures and capillary density as well as loop diameters were significantly higher in the scleroderma group than in the other groups. In terms of micro hemorrhage and angiogenesis, most of the positive cases were in the scleroderma. Abnormalities of microvascular structures and loop diameters were significantly higher in the Raynaud than in the non-Raynaud patients.

There was a statistically significant difference between the Capillaroscopy results. This difference in microvascular structures and loop diameters was significant between Raynaud's patients and other patients, so that Raynaud's patients had a higher relative frequency of abnormal microvascular structures and abnormal loop diameters. According to some studies, the trend of capillary changes can be highly related to the progression of the disease to diseases of the scleroderma spectrum. Therefore, it seems that the sequence of using Capillaroscopy can be helpful in diagnosing these changes.