engleski

Nailfold capillaroscopy, computerized color telethermography and immunological findings in 224 children with Raynaud's phenomenon

Introduction: Raynaud's phenomenon (RP) is a condition characterized by periodical vasospasm in response to cold temperatures or emotional stress exposure, that in the vast majority of patients exists without other disorders, but sometimes is associated with several autoimmune rheumatic diseases and, to distinguish between these two types, clinical examination, laboratory findings, nailfold capillaroscopy and computerized color telethermography (CCTT) are necessary. Objectives: The aim of this research was to analyze RP features in children in correlation with the most frequently associated laboratory tests, CCTT and nailfold capillaroscopy. Methods: This retrospective study included children who were clinically recognized as RP in the period from 2011 to 2017 at University Hospital Centre Zagreb. Laboratory data included serum level of IgG, C3, C4, CH50, RF, presence of ANA and ANCAs. Nailfold capillaroscopy and CCTT were utilized to distinguish between primary and secondary RP. McNemar's test was used to evaluate whether capillaroscopy or CCTT was more effective in the diagnosis of secondary RP and to estimate was there a difference between capillaroscopy and CCTT in matching with the results of immunological laboratory findings. Results: Out of 224 children with RP, 169 were females (75.4%) and 55 were males (24.6%) with female/male ratio 3:1. CCTT was performed in 188 patients (83.9%), nailfold capillaroscopy in 89 patients (39.7%) and both investigations in 80 patients (35.7%). CCTT classificated 15 patients as primary RP, 57 patients as secondary RP (among them, 33 had at least one pathological laboratory finding), while in 47 patients no classification could be made. In 69 patients clinically recognized as RP, CCTT findings were normal. Among patients classificated as secondary RP on CCTT, the most of them, 14 (24.6%), were diagnosed with juvenile idiopathic arthritis (JIA). There were 5 patients (8.8%) with systemic sclerosis (SSc), 2 (3.5%) with mixed connective tissue disease (MCTD), 1 (1.7%) with systemic lupus erythematosus, 11 (19.3%) with undifferentiated connective tissue disease (UCTD), whilst 24 patients (42.1%) had no evident other disease. The appearance of abnormal capillaroscopic pattern was found in 17 patients (among them, 11 had at least one pathological laboratory finding) and nonspecific capillaroscopic alterations were noticed in 27 patients (among them, 16 had at least one pathological laboratory finding), while 45 patients had normal capillaroscopic findings. Among patients with the appearance of abnormal capillaroscopic pattern, 5 (29.4%) were diagnosed with SSc, 3 (17.6%) with JIA, 2 (11.8%) with MCTD, 1 (5.9%) with dermatomyositis, 2 (11.8%) with UCTD, whilst 4 patients (23.5%) had no evident rheumatic disease. All patients with RP diagnosed with SSc and MCTD had both the appearance of abnormal capillaroscopic pattern and CCTT findings consistent with secondary RP. No statistically significant difference between capillaroscopy and CCTT in predicting the diagnosis of secondary RP was determined (McNemar's test, χ2 = 0.042, p = 0.838) nor was there significant difference between capillaroscopy and CCTT in regard to the results of laboratory findings (χ2 = 1.042, p = 0.307). Conclusion: Both nailfold capillaroscopy and CCTT have important role in the diagnosis of RP in children. We found that both methods were equally effective in the diagnosis of secondary RP and that there was no difference between them in regard to the results of immunological laboratory findings distinctive with secondary RP.

computerized color telethermography ; nailfold capillaroscopy ; Raynaud's phenomenon ; children

Sažetak je objavljen kao suplement časopisu (indeksiran u CC-u): Pediatric Rheumatology 2018 ; 16(Suppl 2):52