Standstill of Nailfold Capillary Blood Flow during Cooling in Scleroderma and Raynaud’s Syndrome

Abstract

Capillary blood flow in nailfold capillaries, observed continuously by capillary microscopy during standardized cold exposure (16 °C) has been compared in 15 patients with scleroderma (SD), 6 patients with Raynaud’s syndrome (RS) without known organic pathology, and 9 normal controls. Capillary microscopy affords direct observation of capillary blood flow and allows one to determine if standstill of capillary circulation occurs (as defined by the movement of the red blood cell column), a state impossible to differentiate from near zero flow by conventional methods. Complete standstill of capillary blood flow occurred in 10 of 15 patients with SD and in 1 of 6 patients with RS. Intermittent standstill was observed in 5 of 15 SD and in 4 of 6 RS patients. In all normal subjects and in 1 of 6 patients with RS the capillary blood flow continued throughout the cooling period. Thus all 15 patients with SD and 5 of 6 patients with RS could be distinguished from control subjects by the development of capillary standstill on cooling. It is concluded that capillary microscopy can separate SD and RS patients from control subjects during cold exposure and may be useful in early diagnosis and prognosis of rheumatic syndromes and in the evaluation of therapy designed to improve the nutritional capillary blood flow of the skin. Whereas the complete standstill of capillary blood flow appears to be definitely associated with pathology, the intermittent standstill pattern as defined in this study may be an exaggerated form of flow fluctuation also seen in normal subjects. A larger number of subjects will have to be studied to determine whether patients with RS of the vasospastic type without connective tissue disease can be distinguished from normal subjects with low finger blood flow rates in cold conditions.

Nailfold video-capillaroscopy in systemic sclerosis

“…An increased vascular permeability and a reduced blood flow is observed in all NVC groups confirming previous studies [3]. Furthermore, NVC makes in particular in SSc, it possible to observe the prolonged phases of reduced or ceased capillary perfusion as a result of cold-induced peripheral vasospasm.…”

“…The best technique currently available to study such an involvement is surprisingly the oldest: capillaroscopy. The better characterized capillaroscopic patterns are in systemic sclerosis (Ssc) [1][2][3][4][5]. According to population-based surveys of various ethnic groups, the prevalence of RP is approximately 3 to 5% with geographic variations in prevalence reflecting differences in climate [6,7].…”

Nonneural beta-adrenergic vasodilating mechanism in temperature biofeedback.

“…In addition, these patients retained the ability to voluntarily increase their finger temperature and capillary blood flow during 1-and 2-year followup tests. The latter finding is important MECHANISMS OF TEMPERATURE FEEDBACK because finger capillary blood flow may perature feedback, as opposed to relaxabe reduced to very low levels or stop tion, in the treatment of idiopathic Raycompletely during cold conditions in naud's disease, these patients (15,16). In contrast, patients who received autogenic training, a This work was supported by research relaxation-based procedure, showed in-grant HL-30604 from the National Heart, significant changes in attack frequency, Lung, and Blood Institute, National Instifinger temperature, and blood flow.…”

Raynaud's phenomenon and the role of capillaroscopy

“…In fact, 30 years ago, those authors published the first paper describing the specific capillaroscopic patterns in SSc (20). Moreover, in 1976, the same authors observed the continuous modification of the capillary blood flow during exposure to cold, both in primary and secondary RP (21). They noted that the capillary blood flow was completely at a standstill in SSc and intermittent in primary RP, while it was continuous in healthy subjects.…”