Kapilaroskopie nehtového lůžka v dětskérevmatologii

Nailfold Capillaroscopy inPaediatric Rheumatology

The study objectives were twofold:
1. To develop a method of direct nailfold capillaroscopy (NFC)applicable to a wide range of paediatric patients. 2. To analyze capillaroscopy images in a representative group of healthy children and rheumatology patients using this method. We examined 157healthy children aged 7 months to 17 years and 46 children with various diseases: juvenile idiopathicarthritis (JIA: 18), diffuse connective tissue diseases (CTD: 10), systemic lupus erythematosus (SLE:5), primary vasculitis (Henoch-Schönlein purpura, HSP: 9, other types of vasculitis, VAS: 6) andRaynaud’s disease (RS: 3). A stereomicroscope with fibreoptic illumination was used. The followingparameters were analysed in the end capillary row: linear density, tortuosity, abnormal loops,avascularity and disarrangement. The mean linear density in healthy children ranged from 7.3 – 8.7cap/mm, the tortuosity was 20 – 60 % (grade 0.8 – 1.4). In healthy children abnormal capillaries aswell as avascularity were present extremely rarely, the degree of disarrangement was also lowranging from 0.7 – 1.4 in a 4-point scale. Children under 4 years of age had lower capillary countsand a higher tortuosity as well as disarrangement degree (p < 0.01). In the whole group tortuositydecreased significantly with age (p < 0.01). Patients with CTD had lower linear density (6.0 cap/mm),higher number of abnormal loops, higher avascularity as well as degree of disarrangement whilechildren in JIA, HSP, VAS and RS groups had normal capillaroscopic findings. The NFC methodpresented is technically feasible in children of the widest age range. Despite a relatively highinterindividual variability of capillaroscopic parameters our NFC modification provides valuableinformation on the presence and degree of microangiopathy, characteristic for certain rheumaticdiseases in childhood. NFC should be performed routinely when diffuse connective tissue diseaseis suspected even in the presence of isolated Raynaud’s phenomenon.

Key words:
nailfold capillaroscopy, children, microangiopathy