The role of capillaroscopy in the assessment of children with Raynaud Phenomenon

Abstract

Background. Raynaud's Phenomenon (RP) is an episodic reaction to cold or stress, manifested as a change in extremity skin color. There are two types of RP. Primary RP is due to functional changes in the vessels, while secondary is due to endothelial injury in the context of systemic diseases. Objective of the study. Assessment of capillaroscopy role for the differentiation of primary and secondary Raynaud's Phenomenon in children Material and Method. A search was conducted in PubMed database with the following search-terms: ”Raynaud phenomenon in children”, ”Pediatric Raynaud phenomenon”, ”Capillaroscopy in children”, ”Capillaroscopy in childhood”. A specialized literature review was made to assess the existing data on the evaluation and monitoring of Raynaud phenomenon in children. Results. RP is reported as a first symptom of rheumatic disease in 61-70% of patients with systemic sclerosis, 58% of patients of patients with mixed connective tissue disease and 56% of patients with overlap syndrome. Therefore, the differentiation of primary RP from secondary RP as well as detecting the markers that suggest its progression to connective tissue diseases could facilitate early diagnosis of these diseases. Capillaroscopy is a simple, non-traumatic and cost-efficient tool with a major role in the differentiation of RP based on the capillaries look. Normal aspect suggests primary RP while altered shape and density – the presence of a connective tissue disease. Conclusion. The application of capillaroscopy for differential diagnosis between primary and secondary Raynaud phenomenon in children for an early diagnosis of rheumatic conditions could shed light on new pathogenetic and evolutive aspects, but also on the treatment response. Introducere. Fenomenul Raynaud (FR) este un răspuns episodic la frig sau stres, manifestat prin schimbarea culorii tegumentelor extremităților. Se distinge FR primar și secundar. La baza FR primar se află schimbările funcționale ale vaselor, iar a celui secundar - injuria vasculară în cadrul maladiilor sistemice. Scopul lucrării. Evaluarea rolului capilaroscopiei pentru diferențierea fenomenului Raynaud primar de cel secundar la copii. Material și Metode. În baza de date PubMed, s-a efectuat căutarea articolelor din anii 2010-2020, conform cuvintelor-cheie: Raynaud phenomenon in children, Pediatric Raynaud phenomenon, capillaroscopy in children, capillaroscopy in childhood. S-a efectuat un review al literaturii specializate pentru a aprecia datele existente cu privire la evaluarea și monitorizarea fenomenului Raynaud la copii. Rezultate. FR este raportat ca primul simptom al bolii reumatice la 61- 70% de pacienți cu sclerodermie sistemică, 58% de pacienți cu boală mixtă de țesut conjunctiv, 56% de pacienți cu overlap. Astfel, diferențierea FR primar de cel secundar, dar și identificarea marcherilor care ar sugera progresia FR spre colagenoză ar putea favoriza diagnosticul precoce al acestor boli. Capilaroscopia este o metodă simplă, non-traumatică și cost-eficientă, cu un rol major în diferențierea FR, prin evaluarea aspectului capilarelor. Aspectul normal sugerează FR primar, iar capilarele modificate sugerează o maladie de fond. Concluzii. Aplicarea capilaroscopiei cu scop de diagnosic diferențial dintre fenomenul Raynaud primar și secundar la copii, pentru depistarea patologiilor reumatice la debut, ar putea elucida noi aspecte patogenetice, evolutive și a răspunsului la tratament.