Capillaroscopy as a method for diagnosing microvascular disorders in systematic diseases, Raynaud’s syndrome and vibration disease
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Capillaroscopy, Scleroderma, Raynaud’s phenomenon, Vibration Disease

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Doncheva-Dilova, J., Boyadzhieva, V., Stoilov, N. and Kuneva, T. 2021. Capillaroscopy as a method for diagnosing microvascular disorders in systematic diseases, Raynaud’s syndrome and vibration disease. Rheumatology (Bulgaria). 29, 2 (Jul. 2021), 61-72. DOI:


Capillaroscopy is a basic, easily applicable and non-invasive method for assessing skin microcirculation. Using a digital videocapillaroscope and immersion oil, after the appropriate acclimatization, the capillaries in the area of the eponychium of the fingers of both hands are examined. Certain parameters are evaluated (background of the capillaroscopic field, morphology of the capillaries, presence of enlarged and giant capillaries, hemorrhages, avascular zones, neoangiogenesis, nature of the blood flow). In order to establish an abnormal capillaroscopic finding, the changes must be observed on at least two fingers. As early as 2000, Cutolo et al. defined the so-called “scleroderma pattern” (early, active and late) and “sclerodermalike pattern” capillaroscopic finding in patients with systemic scleroderma and diseases of the scleroderma spectrum. Eight years later Ingegnoli et al. based on capillaroscopic changes offered a prognostic model for the detection of patients with Raynaud’s phenomenon and an increased risk of developing scleroderma spectrum disease. In 2012 Sebastiani et al., again based on the capillaroscopic findings, proposed a quantitative index to predict the development of digital ulcers in patients with systemic scleroderma. Capillaroscopic changes are one of the classification criterion recognized by the European League Against Rheumatism (EULAR) for early diagnosis of systemic sclerosis. According to various authors, including Hirschl M. et al., Lambova & Mueller – Landner, Smith V. et al., Prof. Z. Stoyneva, capillaroscopy has diagnostic and prognostic value for the development of the diseases. This reliable and safe method is used in clinical practice mainly in the diagnosis of systemic diseases and is extremely valuable for the differential diagnosis of primary from secondary Raynaud’s phenomenon – a common pathological condition characterized by peripheral circulatory disorders. Despite the studies of Prof. Stoyneva, QuigSong Chen et al. and Maria Maddalena Sirufo et al. the capillaroscopic findings in patients with Vibration Disease – a specific occupational disease, in which damage to the small blood vessels of the type of secondary Raynaud’s phenomenon is observed – are still scarce and poorly defined. Some authors describe capillaroscopic changes as a “non-specific abnormal videocapillaroscopic model”. Early diagnosis of systemic diseases, Raynaud’s phenomenon and Vibration Disease by the videocapillaroscopy can significantly improve the clinical condition of the patients.
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