Capillaroscopic findings in undifferentiated connective tissue disease with Raynaud’s phenomenon

Abstract

Background: Undifferentiated connective tissue disease (UCTD) is characterized with presence of clinical signs and immunological findings suggestive of connective autoimmune disease, but the criteria for a definite rheumatic disease are not fulfilled. Raynaud’s phenomenon (RP) could be found in approximately 50% of cases with UCTD and about half of patients with UCTD and RP exhibit “scleroderma-like” pattern. The aim of the study: To assess the characteristics of capillaroscopic changes in early UCTD. Patients and methods: Inclusion criterion for the study was newly diagnosed by rheumatologist, early UCTD in patients with RP. 26 patients were included in the study – 24 females and 2 males, mean age 38±14 years (range 19 – 66 years). Capillaroscopic examination was performed in all patients using USB microscope Dino-Lite. Follow-up was perfomed for a period between 1 and 3.5 years. Results and discussion: At the time of the initial diagnosis, “scleroderma-like” pattern, “early” phase (giant capillaries, presence of hemorrhages in some cases, preserved distribution, normal capillary density) was found in 17 patients (65%). More advanced capillaroscopic changes including devascularization and derangement were not observed. In 4 patients nonspecific capillaroscopic findings were present (dilated capillaries, hemorrhages, increased tortuousity, elongated capillaries,) and in 5 cases – normal capillaroscopic picture was found. During the follow-up in one patient the diagnosis was revised to systemic lupus erythematous due to newly appeared clinical, laboratory and immunological findings. The normal capillaroscopic pattern was changed to nonspecific findings in this case. Two patients fulfilled the criteria for prescleroderma during the follow-up without skin and visceral involvement. In the rest patients clinical diagnosis and capillaroscopic findings remained unchanged. Conclusion: In conclusion, “scleroderma” type microangiopathy, “early” phase is a common finding in UCTD with RP, while more advanced microvascular pathology is not usually observed. Stable capillaroscopic pattern during the follow-up correlates with the stable clinical course. Capillaroscopy is a key technique for assessment of RP patients in rheumatology and for early diagnosis of UCTD with peripheral vascular syndrome.