Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1985 Sep;44(9):603–609. doi: 10.1136/ard.44.9.603

Decreased nailfold capillary density in Raynaud's phenomenon: a reflection of immunologically mediated local and systemic vascular disease?

P M Houtman, C G Kallenberg, A A Wouda, T H The
PMCID: PMC1001718  PMID: 4037886

Abstract

Nailfold capillary patterns were studied in 107 patients with Raynaud's phenomenon (RP), including patients wih (n = 39) and without (n = 68) connective tissue disease (CTD). Capillary density was decreased in patients with sclerodactyly, digital ulcers, tuft resorption, and telangiectasia, compared with patients without these symptoms. In addition, an inverse relationship was found between the severity of RP at first presentation (as graded by photoelectric plethysmography during cooling) and the capillary density in patients with CTD (r = -0.45; p less than 0.05). In the total group of patients nailfold capillary density was inversely related to organ system involvement (r = -0.52; p less than 0.01). Decreased nailfold capillary density was observed, in particular, in patients with oesophageal hypomotility and in patients with chest x-rays compatible with interstitial fibrosis. As to factors supposedly involved in the pathogenesis of vascular changes in CTD, the presence of autoantibodies, increased levels of circulating immune complexes, and increased levels of acute phase reactants were all associated with a decreased number of nailfold capillaries. We conclude that loss of nailfold capillaries as observed by microscopy is a reflection of local and systemic vascular disease.

Full text

PDF
603

Images in this article

605Image
on p.605

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alarcon-Segovia D., Ruiz-Arguelles A., Fishbein E. Antibody to nuclear ribonucleoprotein penetrates live human mononuclear cells through Fc receptors. Nature. 1978 Jan 5;271(5640):67–69. doi: 10.1038/271067a0. [DOI] [PubMed] [Google Scholar]
  2. Bennett R., Bluestone R., Holt P. J., Bywaters E. G. Survival in scleroderma. Ann Rheum Dis. 1971 Nov;30(6):581–588. doi: 10.1136/ard.30.6.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blunt R. J., George A. J., Hurlow R. A., Strachan C. J., Stuart J. Hyperviscosity and thrombotic changes in idiopathic and secondary Raynaud's syndrome. Br J Haematol. 1980 Aug;45(4):651–658. doi: 10.1111/j.1365-2141.1980.tb07188.x. [DOI] [PubMed] [Google Scholar]
  4. Campbell P. M., LeRoy E. C. Pathogenesis of systemic sclerosis: a vascular hypothesis. Semin Arthritis Rheum. 1975 May;4(4):351–368. doi: 10.1016/0049-0172(75)90017-7. [DOI] [PubMed] [Google Scholar]
  5. Christian C. L., Sergent J. S. Vasculitis syndromes: clinical and experimental models. Am J Med. 1976 Sep;61(3):385–392. doi: 10.1016/0002-9343(76)90376-4. [DOI] [PubMed] [Google Scholar]
  6. Cunningham P. H., Andrews B. S., Davis J. S., 4th Immune complexes in progressive systemic sclerosis and mixed connective tissue disease. J Rheumatol. 1980 May-Jun;7(3):301–308. [PubMed] [Google Scholar]
  7. D'Angelo W. A., Fries J. F., Masi A. T., Shulman L. E. Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med. 1969 Mar;46(3):428–440. doi: 10.1016/0002-9343(69)90044-8. [DOI] [PubMed] [Google Scholar]
  8. Ellman M. H., Pachman L., Medof M. E. Raynaud's phenomenon and initially seronegative mixed connective tissue disease. J Rheumatol. 1981 Jul-Aug;8(4):632–634. [PubMed] [Google Scholar]
  9. Fessel W. J. Systemic lupus erythematosus in the community. Incidence, prevalence, outcome, and first symptoms; the high prevalence in black women. Arch Intern Med. 1974 Dec;134(6):1027–1035. [PubMed] [Google Scholar]
  10. Follansbee W. P., Curtiss E. I., Medsger T. A., Jr, Steen V. D., Uretsky B. F., Owens G. R., Rodnan G. P. Physiologic abnormalities of cardiac function in progressive systemic sclerosis with diffuse scleroderma. N Engl J Med. 1984 Jan 19;310(3):142–148. doi: 10.1056/NEJM198401193100302. [DOI] [PubMed] [Google Scholar]
  11. Furst D. E., Davis J. A., Clements P. J., Chopra S. K., Theofilopoulos A. N., Chia D. Abnormalities of pulmonary vascular dynamics and inflammation in early progressive systemic sclerosis. Arthritis Rheum. 1981 Nov;24(11):1403–1408. doi: 10.1002/art.1780241111. [DOI] [PubMed] [Google Scholar]
  12. Hunninghake G. W., Fauci A. S. Pulmonary involvement in the collagen vascular diseases. Am Rev Respir Dis. 1979 Mar;119(3):471–503. doi: 10.1164/arrd.1979.119.3.471. [DOI] [PubMed] [Google Scholar]
  13. Kallenberg C. G., Vellenga E., Wouda A. A., The T. H. Platelet activation, fibrinolytic activity and circulating immune complexes in Raynaud's phenomenon. J Rheumatol. 1982 Nov-Dec;9(6):878–884. [PubMed] [Google Scholar]
  14. Kallenberg C. G., Wouda A. A., The T. H. Systemic autoimmune disease and Raynaud's phenomenon: a common, immunologically mediated, vascular basis? Neth J Med. 1984;27(9):322–326. [PubMed] [Google Scholar]
  15. Kallenberg C. G., Wouda A. A., The T. H. Systemic involvement and immunologic findings in patients presenting with Raynaud's phenomenon. Am J Med. 1980 Nov;69(5):675–680. doi: 10.1016/0002-9343(80)90417-9. [DOI] [PubMed] [Google Scholar]
  16. Maricq H. R. Wide-field capillary microscopy. Arthritis Rheum. 1981 Sep;24(9):1159–1165. doi: 10.1002/art.1780240907. [DOI] [PubMed] [Google Scholar]
  17. Nimelstein S. H., Brody S., McShane D., Holman H. R. Mixed connective tissue disease: a subsequent evaluation of the original 25 patients. Medicine (Baltimore) 1980 Jul;59(4):239–248. [PubMed] [Google Scholar]
  18. Norton W. L., Hurd E. R., Lewis D. C., Ziff M. Evidence of microvascular injury in scleroderma and systemic lupus erythematosus: quantitative study of the microvascular bed. J Lab Clin Med. 1968 Jun;71(6):919–933. [PubMed] [Google Scholar]
  19. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980 May;23(5):581–590. doi: 10.1002/art.1780230510. [DOI] [PubMed] [Google Scholar]
  20. Rodnan G. P., Myerowitz R. L., Justh G. O. Morphologic changes in the digital arteries of patients with progressive systemic sclerosis (scleroderma) and Raynaud phenomenon. Medicine (Baltimore) 1980 Nov;59(6):393–408. doi: 10.1097/00005792-198011000-00001. [DOI] [PubMed] [Google Scholar]
  21. Seibold J. R., Medsger T. A., Jr, Winkelstein A., Kelly R. H., Rodnan G. P. Immune complexes in progressive systemic sclerosis (scleroderma). Arthritis Rheum. 1982 Oct;25(10):1167–1173. doi: 10.1002/art.1780251004. [DOI] [PubMed] [Google Scholar]
  22. Sharp G. C., Irvin W. S., Tan E. M., Gould R. G., Holman H. R. Mixed connective tissue disease--an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med. 1972 Feb;52(2):148–159. doi: 10.1016/0002-9343(72)90064-2. [DOI] [PubMed] [Google Scholar]
  23. Thompson R. P., Harper F. E., Maize J. C., Ainsworth S. K., LeRoy E. C., Maricq H. R. Nailfold biopsy in scleroderma and related disorders. Correlation of histologic, capillaroscopic, and clinical data. Arthritis Rheum. 1984 Jan;27(1):97–103. doi: 10.1002/art.1780270116. [DOI] [PubMed] [Google Scholar]
  24. Wiener-Kronish J. P., Solinger A. M., Warnock M. L., Churg A., Ordonez N., Golden J. A. Severe pulmonary involvement in mixed connective tissue disease. Am Rev Respir Dis. 1981 Oct;124(4):499–503. doi: 10.1164/arrd.1981.124.4.499. [DOI] [PubMed] [Google Scholar]
  25. Wouda A. A. Raynaud's phenomenon. Photoelectric plethysmography of the fingers of persons with and without Raynaud's phenomenon during cooling and warming up. Acta Med Scand. 1977;201(6):519–523. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES