Examenul capilaroscopic la copiii cu fenomen Raynaud

Abstract

Introducere. Fenomenul Raynaud (FR) reprezintă o afecțiune vazospastică, caracterizată prin schimbări trifazice a culorii tegumentelor. Conform studiilor, cel mai frecvent, fenomenul Raynaud este izolat (primar). Însă, la o parte de pacienți cu FR, acesta face parte din tabloul clinic al unei afecțiuni autoimune specificate. Scopul lucrării. Evaluarea modificărilor capilaroscopice la pacienții cu fenomen Raynaud primar și secundar. Material și metode. S-a efectuat un studiu prospectiv pe un lot de 61 copii cu FR în perioada anului 2022. Diagnosticul de FR a fost stabilit conform International Consensus Criteria for the Diagnosis of Raynaud’s Phenomenon. Tehnica examinării și interpretarea rezultatelor s-a efectuat în baza consensului Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Rezultate. Au fost studiați 61 pacienți cu FR, vârsta medie de 14,5±3,27 ani, dintre care 45 (73%) erau fete, iar 19 (17%) - băieți. Paternul capilaroscopic normal a fost detectat la 13 pacienți (21%), aceștia toți fiind cu FR primar. Paternul capilaroscopic nespecific a fost vizualizat la 39 copii (64%), dintre care au predominat, de asemenea, pacienții cu FR izolat - 27 pacienți (69%). Paternul scleroderma a fost depistat la 7 pacienți (11,5%), dintre care, 4 (57%) au avut diagnosticul de sclerodermie sistemică sau dermatomiozită juvenilă. Concluzii. Capilaroscopia este o metodă non-invazivă și informativă, cu impact important asupra stratificării riscului de dezvoltare a unei boli autoimune sistemice. Astfel, pacienții cu un pattern capilaroscopic normal au cel mai mic risc de progresie, pe când cei cu patern sclerodermic, au cea mai mare rată de tranziție.

Background. Raynaud’s phenomenon (RP) is a vasospastic disorder, characterized by triphasic color changes of the skin. Most of the patients with RP will have no other health issues, thus RP is considered isolated. In a small subgroup of patients, RP will be the first sign of a connective tissue disease (secondary RP). Objective of the study. Evaluation of capillary changes in children with primary and secondary RP. Material and methods. A prospective study that included 61 children diagnosed with RP was performed during 2022. The diagnosis of RP was based on “International Consensus Criteria for the Diagnosis of Raynaud’s Phenomenon”. Examination technique and the reading of the results based on „Standardization of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis”. Results. 61 patients with RP were studied, with a mean age of 14.5±3.27, of which 43 (73%) were girls. A normal capillaroscopic pattern were seen in 13 patients (21%), all of them being diagnosed with primary RP. Non-specific capillaroscopic pattern was seen in 39 children (64%), of which 27 patients (69%) also had primary RP. Scleroderma pattern was seen in 7 patients, of which 4 patients (54%) had an underlying connective tissue disease (systemic sclerosis and juvenile dermatomyositis). Conclusion. Capillaroscopy is a non-invasive but informative method with an important impact on the risk stratification for patients RP. Thus, patients with normal pattern have the lowest risk, but those with scleroderma – the highest risk to progress to a specified connective tissue disease.