Characteristic abnormalities include dilated capillaries, areas of avascularity, distortion of the normal nailfold architecture and haemorrhage 15 – 17 ( Figure 2). Abnormal nailfold capillaries are an early manifestation of SSc 10, 11 providing the rationale for capillaroscopy as a key investigation in patients presenting with RP. 13, 14 Specialist centres may have access to thermography and this too can help differentiate between PRP and SSc-related RP.Īt the nailfold, capillaries lie parallel (rather than perpendicular to) the skin surface and can be visualized noninvasively using the technique of nailfold capillaroscopy. A SSc-specific autoantibody and abnormal nailfold capillaries are independent predictors for the development of SSc in a patient with RP. If connective tissue disease is suspected, then more extensive immunology testing will be required, for example for SSc-specific autoantibodies (anticentromere, anti-topoisomerase, anti-RNA polymerase III). 12 Additional investigations depend on the index of suspicion as to what (if any) underlying disease might be present. Most rheumatologists would additionally request a biochemical profile with thyroid function, immunoglobulins with protein electrophoresis, and a chest or thoracic outlet radiograph (looking for a cervical rib). The minimal set of investigations for a patient with RP (dictated by the criteria for PRP) 8, 9 comprises a blood count and ESR, ANA and nailfold capillaroscopy. Digital pitting in a patient with systemic sclerosis.
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