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Background Raynaud’s phenomenon (RP) is defined as episodic attacks of artery and arteriole vasoconstriction. To differentiate between the benign RP (pRP) and the form associated with connective tissue diseases (sRP) the capillary morphology can be studied using nailfold capillaroscopy (nCS). However, abnormal morphology can also be caused due to age-related changes and has been described in patients with diabetes and cardiovascular disease. In addition, this technique cannot provide functional information. Thermal imaging (thermography; TG) is a non-invasive technique which enables quantification of cutaneous blood vessel function. In veterinary medicine, thermal imaging is applied for various clinical settings. A combined approach using both nCS and TG could improve the differentiation between pRP and sRP. Objectives The aim of this pilot study was to determine which technique (TG versus nCS) allows the best discrimination amongst older patients with pRP and sRP. Methods Thirty patients with RP (pRP, n=21; sRP, n=9) underwent nCS (Olympus SZ51) and TG (Flirr B 620). Nailfold morphologic features were measured and scored on capillary density, giant capillaries, ramification and hemorrages. The patients were divided into three categories: normal, slightly abnormal (slightly enlarged capillaries) and severely abnormal (destruction of capillary structure and hemorrages). TG of the hand was performed before, directly after and 10 min after a cold challenge test with cold manchets of 3°C. Rewarming and reperfusion were monitored and baseline images and rewarming curves were analysed. Results Capillary abnormalities with nCS were found in all patients with sRP (9/9) and in 52% (11/21) of patients with pRP. Out of 11 pRP patients with altered capillary morphology, 7 (63%) had a cardiovascular disease. TG demonstrated a lower average temperature at baseline in the pRP group compared to the sRP group (d 1,68°C, p The gradient of the rewarming curve was significantly lower in patients with sRP compared to the pRP group (median 0.16 vs. 0.26 °C/min; p=0.015). Conclusions Nailfold capillaroscopy and thermography can reliably be used to measure microvascular damage and dysfunction. TG is better suitable to differentiate between older patients with pRP and sRP. Furthermore, in presence of cardiovascular disease, TG appears to be a more reliable technique than nCS for differentiating between patients with pRP and sRP. Disclosure of Interest None declared |
