Current issue
Archive
Online first
About the Journal
Editorial Office
Editorial Board
Publisher
Editorial Policies
Ethical standards and procedures
Abstracting and indexing
Reviewers
Honorary Reviewers
Subscription
Contact
Most read articles
Instructions for authors
Article processing charge (APC)
Books and Events
Books
Events
ORIGINAL PAPER
Value of nailfold videocapillaroscopy and high-sensitivity C-reactive protein test in diagnosis of microangiopathy in adolescents with Raynaud’s phenomenon
Submission date: 2013-02-19
Final revision date: 2013-04-11
Acceptance date: 2013-04-11
Online publication date: 2013-06-26
Publication date: 2013-06-28
Reumatologia 2013;51(3):189-194
KEYWORDS
TOPICS
ABSTRACT
Introduction: Nailfold videocapillaroscopy allows assessment of structural abnormalities in the peripheral microcirculation in patients with Raynaud’s syndrome (RS), whereas an increased level of high-sensitivity C-reactive protein (hsCRP) is an acknowledged marker of even low-intensity inflammation of vascular endothelium in many autoimmune diseases, and also in atherosclerosis.
Objective: Assessment of capillaroscopic structural abnormalities in microcirculation with regard to the duration of Raynaud’s phenomenon (RP), the level of hsCRP and the presence of ANA in the serum of children and adolescents with RS.
Material and methods: The study involved 144 patients (104 girls and 40 boys) at the mean age of 16.07 ±3.66 years, who had undergone at least two capillaroscopies. The study patients were divided into 3 groups depending on RP duration ( 2 years, 2–5 years and over 5 years). A STEMI 2000 capillaroscope (ZEISS) was used. Capillaries were measured using the computer program NIS-Elements D2.30 Nikon Corp. Japan. Capillary loops wider than 50 µm were considered dilated. In 59 patients with abnormal patterns of microvessels and low classical inflammatory markers, hsCRP was determined using the immunoturbidimetric method by means of a HITACHI 912 analyser.
Results: Secondary RS was diagnosed in 43 (39.8%) and primary RP in 101 (70.2%) patients. Disorders in capillaroscopic pictures were more enhanced in patients with longer disease duration (p < 0.01). The mean levels of hsCRP (0.44 ±0.47 mg/dl) correlated significantly with patients’ age and RS duration. The mean width of the arterial arm (35.4 ±11.4 µm) and venous arm (45.3 ±26.5 µm) correlated significantly with the mean level of hsCRP (p < 0.05).
Conclusions: In patients with Raynaud’s syndrome, structural abnormalities in microcirculation, together with elevated level of hsCRP, suggest the presence of subclinical vasculitis, with possible endothelial dysfunction.
Further investigation into impairment of microcirculation in patients with secondary Raynaud’s syndrome could support the therapeutic option oriented at suppressing proinflammatory and prothrombotic endothelial activation.
Objective: Assessment of capillaroscopic structural abnormalities in microcirculation with regard to the duration of Raynaud’s phenomenon (RP), the level of hsCRP and the presence of ANA in the serum of children and adolescents with RS.
Material and methods: The study involved 144 patients (104 girls and 40 boys) at the mean age of 16.07 ±3.66 years, who had undergone at least two capillaroscopies. The study patients were divided into 3 groups depending on RP duration ( 2 years, 2–5 years and over 5 years). A STEMI 2000 capillaroscope (ZEISS) was used. Capillaries were measured using the computer program NIS-Elements D2.30 Nikon Corp. Japan. Capillary loops wider than 50 µm were considered dilated. In 59 patients with abnormal patterns of microvessels and low classical inflammatory markers, hsCRP was determined using the immunoturbidimetric method by means of a HITACHI 912 analyser.
Results: Secondary RS was diagnosed in 43 (39.8%) and primary RP in 101 (70.2%) patients. Disorders in capillaroscopic pictures were more enhanced in patients with longer disease duration (p < 0.01). The mean levels of hsCRP (0.44 ±0.47 mg/dl) correlated significantly with patients’ age and RS duration. The mean width of the arterial arm (35.4 ±11.4 µm) and venous arm (45.3 ±26.5 µm) correlated significantly with the mean level of hsCRP (p < 0.05).
Conclusions: In patients with Raynaud’s syndrome, structural abnormalities in microcirculation, together with elevated level of hsCRP, suggest the presence of subclinical vasculitis, with possible endothelial dysfunction.
Further investigation into impairment of microcirculation in patients with secondary Raynaud’s syndrome could support the therapeutic option oriented at suppressing proinflammatory and prothrombotic endothelial activation.
REFERENCES (30)
1.
LeRoy EC, Medsger TA. Raynaud's phenomenon: a proposal for classification. Clin Exp Rheumatol 1992; 10: 485-488.
2.
Maricq HR, Volter I. A working classification of scleroderma spectrum disorders: a proposal and the results of testing on a sample of patients. Clin Exp Rheumatol 2004; 22 (3 Suppl 33): S5-13.
3.
Bakst R, Merola JF, Franks AGJr, Sanchez M. Raynaud's phenomenon: pathogenesis and management. J Am Acad Dermatol 2008; 59: 633-653.
4.
Baumhäkel M, Böhm M. Recent achievements in the management of Raynaud’s phenomenon. Vasc Health Risk Manag 2010; 6: 207-214. .
5.
Kaplan MJ. Endothelial damage and autoimmune diseases. Autoimmunity 2009; 42: 561-562.
6.
Kim HS, Park MK, Kim HY, Park SH. Capillary dimension measured by computer-based digitalized image correlated with plasma endothelin-1 levels in patients with systemic sclerosis. Clin Rheumatol 2010; 29: 247-254.
7.
Sulli A, Soldano S, Pizzorni C, et al. Raynaud's phenomenon and plasma endothelin: correlations with capillaroscopic patterns in systemic sclerosis. J. Rheumatol 2009; 36: 1235-1239.
8.
Szekanecz Z, Koch AE. Vascular endothelium and immune responses: implications for inflammation and angiogenesis. Rheum Dis Clin North Am 2004; 30: 97-114.
9.
Kuryliszyn-Moskal A, Ciołkiewicz M, Klimiuk PA, et al. Clinical significance of nailfold capillaroscopy in systemic lupus erythematosus: correlation with endothelial cell activation markers and disease activity. Scand J Rheumatol 2009; 38: 38-45.
10.
Groner JA, Joshi M, Bauer JA. Pediatric precursor of adult cardiovascular disease: noninvasive assessment of early vascular changes in children and adolescents. Pediatrics 2006; 118: 1683-1691.
11.
Górska A, Kowal-Bielecka O, Urban M, et al. Impairment of microcirculation in juvenile idiopathic arthritis – studies by nailfold videocapillaroscopy and correlation with serum levels of sICAM and VEGF. Folia Histochem Cytobiol 2008; 46: 443-447.
12.
Ridker PM. High-sensivity C-reactive protein, inflammation, and cardiovascular risk: from concept to clinical practice to clinical benefit. Am Heart J 2004; 148: S19-26. .
13.
Lambova SN, Müller-Ladner U. The specificity of capillaroscopic pattern in connective autoimmune diseases. A comparison with microvascular changes in diseases of social importance: arterial hypertension and diabetes mellitus. Mod Rheumatology 2009; 19: 600-665.
14.
Anderson ME, Allen PD, Moore T, Hillier V, Taylor CJ, Herrick AL. Computerized nailfold video capillaroscopy – a new tool for assessment of Raynaud's phenomenon. J Rheumatol 2005; 32: 841-848.
15.
Cutolo M, Sulli A, Secchi ME. Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement? Rheumatol (Oxford) 2006; 45:suppl. 4: IV43-IV46.
16.
Kuryliszyn-Moskal A, Kowal-Bielecka O: Kapilaroskopia. Przegl Reumatol 2006; 2 (4): 9-11.
17.
Ingegnoli F, Zeni S, Gerloni V, Fantini F. Capillaroscopic observations in childhood rheumatic diseases and healthy controls. Clin Exp Rheumatol 2005; 23: 905-911.
18.
Bollinger A, Fagrell B. Clinical Capillaroscopy. Hogrefe & Huber Publishers, Toronto–Stuttgart 1990; 77-92.
19.
Luggen M, Belhorn L, Evans T, et al. The evolution of Raynaud's phenomenon: a longterm prospective study. J Rheumatol 1995; 22: 2226-2232.
20.
Koenig M, Joyal F, Fritzler MJ, et al. Autoantibodies and microvascular damage are independent predictive factors for the progression of Raynaud’s phenomenon to systemic sclerosis. Arthritis Rheum 2008; 58: 3902-3912.
21.
Kuryliszyn-Moskal A, Klimiuk PA, Sierakowski S, et al. Vascular endothelial growth factor in systemic lupus erythematosus: relationship to disease activity, systemic organ manifestation, and nailfold capillaroscopic abnormalities. Arch Immunol Ther Exp 2007; 55: 179-185.
22.
Fitzgerald O, Hess EV, O'Connor GT, Spencer-Green G. Prospective study of the evolution of Raynaud's phenomenon. Am J Med 1988; 84: 718-726.
23.
Herrick AL, Cutolo M. Clinical implications from capillaroscopic analysis in patients with Raynaud's phenomenon and systemic sclerosis. Arthritis Rheum 2010; 62: 2595-2604.
24.
Pavlov-Dolijanovic S, Damjanov N, Ostojic P, et al. The prognostic value of nailfold capillary changes for the development of connective tissue disease in children and adolescents with primary raynaud phenomenon: a follow-up study of 250 patients. Pediatr Dermatol 2006; 23: 437-442.
25.
Herrick AL, Moore T, Hollis S, Jayson MI. The influence of age on nailfold capillary dimensions in childhood. J Rheumatol 2000; 27: 797-800.
26.
Hirschl M, Hirschl K, Lenz M, Katzenschlager R, Hutter HP, Kundi M. Transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon identified by diagnosis of an associated disease: results of ten years of prospective surveillance. Arthritis Rheum 2006; 54: 1974-1981.
27.
Cutolo M, Pizzorni C, Sulli A. Identification of transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon by nailfold videocapillaroscopy: comment on the article by Hirschl et al. Arthritis Rheum 2007; 56: 2102-2103.
28.
Juonala M, Viikari JS, Ronnemaa T, et al. Childhood C-reactive protein in predicting CRP and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. Arterioscler Thromb Vasc Biol 2006; 26: 1883-1888.
29.
Järvisalo MJ, Harmoinen A, Hakanen M, et al. Elevated serum C-reactive protein levels and early arterial changes in healthy children. Arterioscler Thromb Vasc Biol 2002; 22: 1323-1328.
30.
Blake GJ, Rifai N, Buring JE, Ridker PM. Blood pressure, C-reactive protein, and risk of future cardiovascular events. Circulation 2003; 108: 2993-2999.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
