Nailfold Capillaroscopy in the Screening and Diagnosis of Raynaud's Phenomenon

Raynaud's phenomenon is in most cases idiopathic, but it may appear as secondary to other diseases. Since clinical evaluation is often inadequate to dis tinguish between these two forms, simple noninvasive methods are needed for an early diagnosis of the secondary form. The authors used nailfold capillaros copy to study 58 patients with Raynaud's phenomenon—44 apparently idio pathic and 14 secondary to connective tissue diseases. In all patients affected by secondary Raynaud's phenomenon nailfold capillaroscopy confirmed the pres ence of an abnormal pattern with typical systemic sclerosis alterations in 5 cases. Twenty-one (48%) of the other 44 patients presented a normal capillaro scopic pattern, 15 (34%) had alterations compatible with long-term idiopathic Raynaud's phenomenon, and 8 (18%) showed abnormal capillaroscopic pat terns, 2 of which were identified as the sclerodermic pattern. Nailfold capillaroscopy distinguishes between primary and secondary Ray naud's phenomenon and may be used to identify patients presenting no evidence of underlying disease who could be at risk of developing connective tissue dis ease.