Capillaroscopy: a useful tool in the early diagnosis of connective tissue disease and nonscleroderma spectrum disorders.

BACKGROUND Detection of early capillaroscopic alterations in the preclinical phase may prove useful in patients with non-scleroderma connective tissue disease (CTD). We aimed to verify whether certain capillaroscopic alterations, alone or in combination, might be predictive of CTD. METHODS We retrospectively collected data on patients with Raynaud's phenomenon who underwent capillaroscopy conducted by highly expert examiners with a degree in vascular medicine at our institutions. Included subjects were divided in two groups: those developing rheumatic disease during follow-up, and those without subsequent diagnosis of CTD. Notably, we excluded subjects who presented with an evident scleroderma pattern or rheumatic disease during their initial examination. RESULTS We included a total of 76 patients, 60 who developed CTD during follow-up, which spanned in this group 23±7 months, and 16 who did not develop CTD during follow-up, which spanned 23±9 months. The following features were significantly associated with Raynaud's phenomenon: 1) angiotectonic disorder (p<0.001), 2) nonhomogeneous loop morphology (p<0.001), 3) avascular areas (p<0.001), 4) pseudo-avascular areas (p<0.001), and, albeit to a lesser degree, 5) ectasias (p=0.050). Notably, the initial capillaroscopic pattern did not undergo any changes in subsequent tests. CONCLUSIONS Although certain pathological characteristics of the capillaroscopic pattern are nonspecific and not diagnostic if considered individually, they can be significantly suggestive for latent CTD when found in combination. At the very least, they warrant an in-depth diagnostic analysis and a lengthy follow-up.