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Ma Z, Mulder DJ, Gniadecki R, Cohen Tervaert JW, Osman M. Methods of Assessing Nailfold Capillaroscopy Compared to Video Capillaroscopy in Patients with Systemic Sclerosis-A Critical Review of the Literature. Diagnostics (Basel) 2023; 13:2204. [PMID: 37443598 DOI: 10.3390/diagnostics13132204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Nailfolds of patients with systemic sclerosis (SSc) provide an opportunity to directly visualize microvascular remodeling in SSc. Nailfold video capillaroscopy (NVC) remains the gold standard for assessing nailfold capillaroscopy (NFC). However, access to NVC is limited by expense and expertise. This review aims to synthesize current research on other NFC devices compared to NVC. METHODS The literature search included the primary research of adult patients with SSc as defined by the 2013 ACR/EULAR criteria. Methods of assessing NFC included stereomicroscopy/wide-field microscopy, ophthalmoscopy, dermatoscopy, smartphone devices, and digital USB microscopy. Primary outcomes included both qualitative (normal vs. abnormal nailfolds, overall pattern recognition, presence/absence of giant capillaries, hemorrhages, and abnormal morphology) and quantitative (capillary density and dimension) measures. RESULTS The search yielded 471 studies, of which 9 were included. Five studies compared NVC to dermatoscopy, two compared it to widefield/stereomicroscopy, one to smartphone attachments, and one to USB microscopy. In dermatoscopy studies, NVC had a higher percentage of images that were interpretable (63-77% vs. 100%), classifiable (70% vs. 84%), or gradable (70% vs. 79.3%) across three studies. Dermatoscopy had a lower sensitivity (60.2% vs. 81.6%) and higher specificity (92.5% vs. 84.6%) compared to NVC. One stereomicroscopy study found a significant difference between methods in capillary density in limited cutaneous SSc, while another found correlations in all parameters between stereomicroscopy and NVC. One smartphone lens had good agreement with NVC on abnormal capillary morphology and density. USB microscopy was able to differentiate between SSc and healthy controls using mean capillary width but not by capillary density. DISCUSSION A dermatoscope may serve as a more portable and affordable screening tool to identify a normal "scleroderma pattern", and images that need further corroboration by NVC. NFC parameters reported are heterogenous and the standardization of these parameters is important, especially in non-gold-standard devices.
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Affiliation(s)
- Zechen Ma
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Douwe Johannes Mulder
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Mohammed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada
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Smith V, Ickinger C, Hysa E, Snow M, Frech T, Sulli A, Cutolo M. Nailfold capillaroscopy. Best Pract Res Clin Rheumatol 2023; 37:101849. [PMID: 37419757 DOI: 10.1016/j.berh.2023.101849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
Nailfold capillaroscopy is a safe and well-established method for the assessment of structural alterations of the microcirculation. It is a crucial tool in the investigation and monitoring of patients presenting with Raynaud's phenomenon. Detection of the characteristic "scleroderma pattern" on capillaroscopy may indicate an underlying rheumatic disease, particularly systemic sclerosis (SSc). Herein, we highlight the practical aspects of videocapillaroscopy, including image acquisition and analysis, with mention of dermoscopy. Special emphasis is placed on standardized use of terminology to describe capillary characteristics. Systematic evaluation of images in discerning the normal from the abnormal using the validated European Alliance of Associations for Rheumatology (EULAR) Study Group consensus reporting framework is paramount. In addition to the relevance of capillaroscopy in the (very) early diagnosis of SSc, its emerging predictive value (especially capillary loss) for new organ involvement and disease progression is underscored. We further provide capillaroscopic findings in selected other rheumatic diseases.
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Affiliation(s)
- Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium.
| | - Claudia Ickinger
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
| | - Marcus Snow
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tracy Frech
- Internal Medicine, Vanderbilt University Medical Center and Tennessee Valley Healthcare System Nashville, TN, USA
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
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Miziołek B, Pieczyrak R, Polak K, Frątczak A, Jedlecka A, Grosicka A, Bergler-Czop B. Role of short courses on nailfold capillaroscopy in obtaining abilities for the identification of microvasculopathy in patients with Raynaud's phenomenon. Skin Res Technol 2023; 29:e13223. [PMID: 36385255 PMCID: PMC9838766 DOI: 10.1111/srt.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION An early distinction between "normal" and "abnormal" capillaroscopic pattern during the first visit to a dermatologist has a crucial significance for a diagnostic management of Raynaud's phenomenon (RP). There exists a question about the level of expertise sufficient to evaluate the microcirculation. AIM To evaluate the utility of short courses on NFC among dermatologists and medical students in obtaining sufficient abilities for the identification of microvasculopathy in patients with RP using videocapillaroscope and handheld dermoscope. METHODS Both groups participated in 1-h course on NFC. Before the course, participants were asked to classify 20 videocapillaroscopic and 10 dermoscopic capillaroscopic pictures into "normal" or "abnormal" pattern. Each picture was displayed on a separate slide MS PowerPoint for 10 s. The evaluation was repeated soon after the course. RESULTS A total of 36 dermatologists and 49 medical students were enrolled. The rate of properly classified dermoscopic and videodermoscopic pictures increased after the course in both groups, but students improved the accuracy of classification on dermoscopic pictures to the greater extent than dermatologists. The rate of correctly recognized pictures with "abnormal" pattern was significantly greater than ones with "normal" pattern at the baseline and after the course, independently of imagining tool. CONCLUSIONS Short courses on NFC may improve the classification of capillaroscopic images, even in medical staff with no previous experience in NFC. The recognition of capillaroscopic abnormalities seems to be easier than obtaining the confidence that evaluated picture has "normal pattern."
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Affiliation(s)
- Bartosz Miziołek
- Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Robert Pieczyrak
- Department of Internal Medicine, Rheumatology and Clinical Immunology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Karina Polak
- Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Frątczak
- Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Jedlecka
- Students' Scientific Association at the Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anida Grosicka
- Department of Internal Medicine, Rheumatology and Clinical Immunology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Beata Bergler-Czop
- Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Abstract
PURPOSE OF REVIEW Vascular assessment in systemic sclerosis (SSc) is included in classification criteria for this disease, thus routinely used in the evaluation of patients in which this diagnosis is being considered. In this review, imaging techniques for assessment of vascular involvement in SSc hands and skin are discussed. RECENT FINDINGS Longitudinal use of imaging techniques has important implications for understanding the progressive vasculopathy and fibrotic transition in SSc. Nailfold and oral capillaroscopy as well as laser speckle contrast analysis are established techniques for vascular functional assessment, but longitudinal use is challenged by equipment costs and clinical time constraints. Ultrasound techniques are well described but require technical training. Advances in mobile infrared thermography and optical coherence tomography could potentially provide a point-of-care, quantitative outcome measure in clinical trials and practice. SUMMARY The equipment cost, technical training, data standardization, and invasiveness of vascular assessment techniques that quantify morphological (microangiopathy) and functional (blood flow reduction) are critical for implementation into SSc clinical trials and practice to understand progressive vasculopathy, such as wound development.
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Affiliation(s)
- Tracy M. Frech
- Vanderbilt University Medical Center, Department of Medicine, Division of Rheumatology and Immunology, Nashville, Tennessee, USA
- Veterans Affair Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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Smith V, Herrick AL, Ingegnoli F, Damjanov N, De Angelis R, Denton CP, Distler O, Espejo K, Foeldvari I, Frech T, Garro B, Gutierrez M, Gyger G, Hachulla E, Hesselstrand R, Iagnocco A, Kayser C, Melsens K, Müller-Ladner U, Paolino S, Pizzorni C, Radic M, Riccieri V, Snow M, Stevens W, Sulli A, van Laar JM, Vonk MC, Vanhaecke A, Cutolo M. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev 2020; 19:102458. [DOI: 10.1016/j.autrev.2020.102458] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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Karbalaie A, Emrani Z, Fatemi A, Etehadtavakol M, Erlandsson BE. Practical issues in assessing nailfold capillaroscopic images: a summary. Clin Rheumatol 2019; 38:2343-2354. [PMID: 31278512 DOI: 10.1007/s10067-019-04644-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 11/30/2022]
Abstract
Nailfold capillaroscopy (NC) is a highly sensitive, safe, and non-invasive technique to assess involvement rate of microvascularity in dermatomyositis and systemic sclerosis. A large number of studies have focused on NC pattern description, classification, and scoring system validation, but minimal information has been published on the accuracy and precision of the measurement. The objective of this review article is to identify different factors affecting the reliability and validity of the assessment in NC. Several factors can affect the reliability of the examination, e.g., physiological artifacts, the nailfold imaging instrument, human factors, and the assessment rules and standards. It is impossible to avoid all artifacts, e.g., skin transparency, physically injured fingers, and skin pigmentation. However, minimization of the impact of some of these artifacts by considering some protocols before the examination and by using specialized tools, training, guidelines, and software can help to reduce errors in the measurement and assessment of NC images. Establishing guidelines and instructions for automatic characterization and measurement based on machine learning techniques also may reduce ambiguities and the assessment time.
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Affiliation(s)
- Abdolamir Karbalaie
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Zahra Emrani
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alimohammad Fatemi
- Rheumatology Section, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Etehadtavakol
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Björn-Erik Erlandsson
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
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Herrick AL. Evidence-based management of Raynaud's phenomenon. Ther Adv Musculoskelet Dis 2017; 9:317-329. [PMID: 29201156 PMCID: PMC5700788 DOI: 10.1177/1759720x17740074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022] Open
Abstract
Raynaud's phenomenon (RP) is relevant to the rheumatologist because it may signify an underlying connective tissue disease and also because it can be very challenging to treat, especially when it has progressed to digital ulceration or critical ischaemia. This review article discusses diagnosis (does this patient have an underlying connective tissue disease?), including the role for nailfold capillaroscopy, and treatment. Management of 'uncomplicated' RP is first described and then treatment of RP complicated by progression to digital ulceration or critical ischaemia, highlighting recent advances (including phosphodiesterase type 5 inhibition, and endothelin 1 receptor antagonism) and the evidence base underpinning these. Possible future therapies are briefly discussed.
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Affiliation(s)
- Ariane L. Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester UK, M13 9PT and NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester, UK
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Cutolo M, Damjanov N, Ruaro B, Zekovic A, Smith V. Imaging of connective tissue diseases: Beyond visceral organ imaging? Best Pract Res Clin Rheumatol 2016; 30:670-687. [DOI: 10.1016/j.berh.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
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Smith V, Thevissen K, Trombetta AC, Pizzorni C, Ruaro B, Piette Y, Paolino S, De Keyser F, Sulli A, Melsens K, Cutolo M. Nailfold Capillaroscopy and Clinical Applications in Systemic Sclerosis. Microcirculation 2016; 23:364-72. [DOI: 10.1111/micc.12281] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Vanessa Smith
- Department of Internal Medicine; Ghent University; Ghent Belgium
- Department of Rheumatology; Ghent University Hospital; Ghent Belgium
| | - Kristof Thevissen
- Department of Rheumatology; Ghent University Hospital; Ghent Belgium
| | - Amelia C. Trombetta
- Research Laboratory and Academic Division of Clinical Rheumatology; Department of Internal Medicine; University of Genova; Genova Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology; Department of Internal Medicine; University of Genova; Genova Italy
| | - Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology; Department of Internal Medicine; University of Genova; Genova Italy
| | - Yves Piette
- Department of Rheumatology; Ghent University Hospital; Ghent Belgium
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology; Department of Internal Medicine; University of Genova; Genova Italy
| | - Filip De Keyser
- Department of Internal Medicine; Ghent University; Ghent Belgium
- Department of Rheumatology; Ghent University Hospital; Ghent Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology; Department of Internal Medicine; University of Genova; Genova Italy
| | - Karin Melsens
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology; Department of Internal Medicine; University of Genova; Genova Italy
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Smith V, Beeckman S, Herrick AL, Decuman S, Deschepper E, De Keyser F, Distler O, Foeldvari I, Ingegnoli F, Müller-Ladner U, Riccieri V, Riemekasten G, Sulli A, Voskuyl A, Cutolo M. An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases. Rheumatology (Oxford) 2016; 55:883-90. [PMID: 26843483 DOI: 10.1093/rheumatology/kev441] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To propose simple capillaroscopic definitions for interpretation of capillaroscopic morphologies and to assess inter-rater reliability. METHODS The simple definitions proposed were: normal--hairpin, tortuous or crossing; abnormal--not hairpin, not tortuous and not crossing; not evaluable--whenever rater undecided between normal and abnormal. Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4) and not evaluable (0.2) capillaries, 90 single capillaries were presented to three groups of raters: experienced independent raters, n = 5; attendees of the sixth EULAR capillaroscopy course, n = 34; novices after a 1-h course, n = 11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients. RESULTS Mean kappa based on 90 capillaries was 0.47 (95% CI: 0.39, 0.54) for expert raters, 0.40 (95% CI: 0.36, 0.44) for attendees and 0.46 (95% CI: 0.41, 0.52) for novices, with overall agreements of 67% (95% CI: 63, 71), 63% (95% CI: 60, 65) and 67% (95% CI: 63, 70), respectively. Comparing only normal vs the combined groups of abnormal and not evaluable capillaries did increase the kappa: 0.51 (95% CI: 0.37 ,: 0.65), 0.53 (95% CI: 0.49, 0.58) and 0.55 (95% CI: 0.49, 0.62). On the condition that the capillaries were classifiable, the mean kappa was 0.62 (95% CI: 0.50, 0.74) for expert raters (n = 65), 0.76 (95% CI: 0.69, 0.83) for attendees (n = 20) and 0.81 (95% CI: 0.74, 0.89) for novices (n = 44). CONCLUSION This multicentre, international study showed moderate reliability of simple capillaroscopic definitions for describing morphology of capillaries by rheumatologists with varying levels of expertise. Novices were capable of distinguishing normal from abnormal capillaries by means of a 1-h training session. In future studies, the class not evaluable may be obsolete.
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Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium,
| | - Sam Beeckman
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Saskia Decuman
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence, Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest, An der Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Francesca Ingegnoli
- Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Milano, Italy
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, University Sapienza Rome, Rome, Italy
| | | | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy and
| | - Alexandre Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy and
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Fueyo-Casado A, Campos-Muñoz L, Pedraz-Muñoz J, Conde-Taboada A, López-Bran E. Nail fold dermoscopy as screening in suspected connective tissue diseases. Lupus 2015; 25:110-1. [PMID: 26385223 DOI: 10.1177/0961203315605369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022]
Affiliation(s)
- A Fueyo-Casado
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - L Campos-Muñoz
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - J Pedraz-Muñoz
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - A Conde-Taboada
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - E López-Bran
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
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Hughes M, Moore T, O’Leary N, Tracey A, Ennis H, Dinsdale G, Murray A, Roberts C, Herrick AL. A study comparing videocapillaroscopy and dermoscopy in the assessment of nailfold capillaries in patients with systemic sclerosis–spectrum disorders. Rheumatology (Oxford) 2015; 54:1435-42. [DOI: 10.1093/rheumatology/keu533] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Indexed: 11/13/2022] Open
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Abstract
Use of dermoscopy has been proven to increase diagnostic accuracy for melanoma. It is frequently used by dermatologists and other healthcare providers during skin cancer screening and in the evaluation of concerning skin lesions. Studies have shown that it is useful in the diagnosis of many nononcologic cutaneous diseases as well as in the monitoring of disease progression and treatment response. Furthermore, dermoscopy has the potential to aid in pathology specimen sectioning, translational research and medical technology development. Its broad applications and ease of use will make it an increasingly influential tool in healthcare. In this article, we review the established uses of dermoscopy by different healthcare providers and its potential future applications.
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Affiliation(s)
- Xinyuan Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Senet P, Fichel F, Baudot N, Gaitz JP, Tribout L, Frances C. La capillaroscopie péri-unguéale en dermatologie. Ann Dermatol Venereol 2014; 141:429-37. [DOI: 10.1016/j.annder.2014.04.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/11/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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Mazzotti NG, Bredemeier M, Brenol CV, Xavier RM, Cestari TF. Assessment of nailfold capillaroscopy in systemic sclerosis by different optical magnification methods. Clin Exp Dermatol 2013; 39:135-41. [PMID: 24330076 DOI: 10.1111/ced.12254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) is characterized by target-organ fibrosis and microvascular dysfunction, which can be assessed using nailfold capillaroscopy. Dermoscopy is a useful and easily performed method for diagnosing skin lesions. AIM To compare conventional capillaroscopy, using the gold-standard method (conventional stereomicroscope nailfold capillaroscopy; SNFC), with polarized light noncontact dermoscopy (PNCD) and nonpolarized light contact dermoscopy (NPCD), and to evaluate their accuracy in diagnosing characteristic SSc-related alterations. METHODS The study enrolled 45 patients with SSc. Capillaroscopy images and photographs were taken with three devices, SNFC, NPCD and PNCD, and these images were randomly analysed by a blinded observer. RESULTS The scleroderma pattern was found in 83% of patients. PNCD and NPCD were highly sensitive in identifying the presence of focal capillary loss (96.4% and 100%, respectively), haemorrhage (96.2% and 92%, respectively), and scleroderma (91.9%, 94.6%), and showed high specificity for haemorrhage and enlarged loops. The intra-observer kappa values for detection of the scleroderma pattern by SNFC images, NPCD and PNCD were moderate to good: (κ = 0.71 (95% CI 0.44-0.95), κ = 0.60 (95% CI 0.35-0.83) and κ = 0.60 (95% CI 0.32-0.86), respectively. Evaluation of haemorrhage presence gave high kappa values for all methods: κ = 0.77 (95% CI 0.57-0.95), κ = 0.90 (95% CI 0.76-1.00) and κ = 0.95 (95% CI 0.85-1.00), respectively. CONCLUSIONS Both polarized and nonpolarized dermoscopy are reliable methods for valuation of nailfold capillaroscopy in patients with SSc. They are easy to perform, with good rates of accuracy and results that are comparable with traditional capillaroscopy.
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Affiliation(s)
- N G Mazzotti
- Department of Dermatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
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Ingegnoli F, Gualtierotti R, Lubatti C, Bertolazzi C, Gutierrez M, Boracchi P, Fornili M, De Angelis R. Nailfold capillary patterns in healthy subjects: a real issue in capillaroscopy. Microvasc Res 2013; 90:90-5. [PMID: 23880032 DOI: 10.1016/j.mvr.2013.07.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/10/2013] [Accepted: 07/04/2013] [Indexed: 12/22/2022]
Abstract
Nailfold capillaroscopy has been extensively applied in a broad spectrum of pathologic conditions, but very few data have been published in healthy individuals. The aim of this study was to describe the nailfold capillary findings on a large series of healthy subjects using the video-capillaroscopy technique. Nailfold capillaries were studied based on their morphology, dimensions and density. Then, to evaluate jointly the association between different capillary findings in groups of subjects which were homogeneous for their characteristics, cluster analysis was performed. The results (median) of capillary measurements were as follows: loop length 207μm, external diameter 39μm, internal diameter 17μm, apical diameter 17μm, and intercapillary distance 143μm. Based on the cluster analysis three major "normal" morphologic capillaroscopic patterns were depicted: 1) the "normal" pattern mainly with 2 to 5 U-shaped loops/mm and ≤2 tortuous loops/mm; 2) the "perfect normal" pattern with ≥5 U-shaped loops/mm and 3) the "unusual normal" with at least 1 meandering or bushy loop, or at least 1 microhemorrhage, or with >4 crossed loops/mm. Regarding the loop measurements, the majority of subjects had a median of 7capillaries/mm with a median length of 198μm.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy
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Jung P, Trautinger F. Capillaroscopy. J Dtsch Dermatol Ges 2013; 11:731-6. [PMID: 23738531 DOI: 10.1111/ddg.12137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/23/2013] [Indexed: 11/28/2022]
Abstract
Microscopy of the nailfold capillaries has found increasing use in dermatology, rheumatology and angiology particularly as an important tool to distinguish between primary and secondary Raynaud disease. The best evidence is available in systemic sclerosis where specific capillaroscopic patterns have a high positive predictive value for the development of the disease. Conversely, a regular capillary pattern rules out systemic sclerosis with high degree of probability. PRINCE (prognostic index for nailfold capillaroscopic examination) was developed to identify patients at high risk of developing systemic sclerosis. CSURI (capillaroscopic skin ulcer risk index) should predict the risk of developing digital ulcers in patients with systemic sclerosis with high specificity and sensitivity. As a consequence of recent results a pathologic capillary pattern was integrated by the EULAR Scleroderma Trials and Research Group (EUSTAR) in the diagnostic algorithm of the VEDOSS-Project (very early diagnosis of systemic sclerosis). Capillary patterns may correlate with visceral involvement and capillaroscopy thus has the potential as a screening tool to enable early diagnosis of organ involvement in systemic sclerosis.
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Affiliation(s)
- Peter Jung
- Department of Dermatology, State Hospital St. Pölten, Austria.
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Cutolo M, Smith V. State of the art on nailfold capillaroscopy: a reliable diagnostic tool and putative biomarker in rheumatology? Rheumatology (Oxford) 2013; 52:1933-40. [DOI: 10.1093/rheumatology/ket153] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Impact of Hallmark Autoantibody Reactivity on Early Diagnosis in Scleroderma. Clin Rev Allergy Immunol 2012; 43:249-55. [DOI: 10.1007/s12016-012-8331-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Capillaroscopy and autoantibodies in patients with Raynaud's phenomenon. COR ET VASA 2011. [DOI: 10.33678/cor.2011.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Herrick AL, Cutolo M. Clinical implications from capillaroscopic analysis in patients with Raynaud's phenomenon and systemic sclerosis. ACTA ACUST UNITED AC 2010; 62:2595-604. [PMID: 20506306 DOI: 10.1002/art.27543] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ariane L Herrick
- University of Manchester, Manchester Academic Health Science Centre, Salford Royal National Health Service Foundation Trust, Salford, UK
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In Brief. Nat Rev Rheumatol 2010. [DOI: 10.1038/nrrheum.2010.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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