Department for Propedeutics of Internal Medicine, Clinic of Rheumatology, Medical University - Plovdiv, Bulgaria.
J Clin Rheumatol. 2011 Sep;17(6):311-4. doi: 10.1097/RHU.0b013e31822be4e8.
The aim of the study was to compare nail fold capillaroscopic findings of the fingers with those of the toes in patients with systemic sclerosis (SSc).
Thirty-six patients with SSc were included in the study: 30 patients had limited SSc, 5 patients had diffuse SSc, and 1 patient had an overlap syndrome. Of these 36 patients, 30 were women and 6 were men (mean [SD] age, 56 [14] years). The severity of the Raynaud phenomenon (RP), the presence of digital ulcers, and skin scores at the fingers and feet were assessed. Nail fold capillaroscopy was performed with a videocapillaroscope (Videocap 3.0; DS Medica).
All 36 patients (100%) reported about symptoms of RP in the hands and 34 (94.4%) reported episodes of RP in the feet; the difference is not significant (P > 0.05). In most patients with RP symptoms of both hands and feet, the symptoms were more severe at the hands (82%, 28/34). Digital ulcers of the fingers were found in 36% (13/36) of the case and those of the toes were found in 8.3% (3/36) of the cases. Nail fold capillaroscopy of the hands showed the classic "scleroderma"-type capillaroscopic pattern in 97.2% (35/36) of the patients. In the toes, a scleroderma-type capillaroscopic pattern was found only in 66.7% (24/36) of patients (P < 0.05). With respect to distinct differences, in the toes, the dilated capillaries were found in 72.2% (26/36) of the cases, giant capillaries in 30.6% (11/36) of the cases, hemorrhages in 8.3% (3/36) of the cases, avascular areas in 41.7% (15/36) of the cases, and neoangiogenesis in 22.1% (8/36) of the cases. This difference in frequency of the findings regarding the toes and the fingers of patients with SSc was statistically significant for all parameters.
Capillaroscopy of the toes of SSc also shows patterns characteristic of SSc. However, these patterns differ from the respective patterns of the fingers, which is probably related to less-severe RP and lower skin score at the feet.
本研究旨在比较系统性硬化症（SSc）患者手指和脚趾的甲襞毛细血管变化。
本研究纳入了 36 例 SSc 患者：30 例为局限性 SSc，5 例为弥漫性 SSc，1 例为重叠综合征。这些患者中，30 例为女性，6 例为男性（平均[标准差]年龄为 56[14]岁）。评估了手指和脚趾的雷诺现象（RP）严重程度、指端溃疡和皮肤评分。使用视频显微镜（Videocap 3.0；DS Medica）进行甲襞毛细血管镜检查。
所有 36 例（100%）患者均报告手部有 RP 症状，34 例（94.4%）报告足部有 RP 症状；差异无统计学意义（P＞0.05）。在大多数手部和足部均有 RP 症状的患者中，手部症状更为严重（82%，28/34）。手指指端溃疡见于 36%（13/36）的病例，而脚趾指端溃疡见于 8.3%（3/36）的病例。手部甲襞毛细血管镜检查显示 97.2%（35/36）的患者存在典型的“硬皮病”型毛细血管镜改变。在脚趾中，仅 66.7%（24/36）的患者存在硬皮病型毛细血管镜改变（P＜0.05）。差异显著的是，脚趾的扩张毛细血管见于 72.2%（26/36）的病例，巨毛细血管见于 30.6%（11/36）的病例，出血见于 8.3%（3/36）的病例，无血管区见于 41.7%（15/36）的病例，新血管生成见于 22.1%（8/36）的病例。这些发现的频率差异在所有参数方面在 SSc 患者的脚趾和手指之间具有统计学意义。
SSc 患者的脚趾毛细血管镜也显示出 SSc 的特征性模式。然而，这些模式与手指的相应模式不同，这可能与足部的 RP 较轻和皮肤评分较低有关。
