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Kapillarmikroskopie

Durchführung und Nomenklatur

Capillaroscopy

Procedure and nomenclature

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Zusammenfassung

Die Kapillarmikroskopie hat hohen diagnostischen und prognostischen Wert bei Vorliegen eines Raynaud-Phänomens. Unsere Arbeitsgruppe hat einen Konsens zur Nomenklatur, technischen Ausstattung, Durchführung und diagnostischen Bewertung der Untersuchungsergebnisse erarbeitet. Das Kapillaroskop sollte verschiedene Vergrößerungen sowie digitale Archivierung ermöglichen. Die Dokumentation definierter Befunde ist unabdingbar. Pathologisch ist ein Nebeneinander mehrerer Abweichungen vom altersentsprechenden Normalbefund, wie Kaliberschwankungen, Ektasie, Verzweigung, Elongation (Länge >350 µm), Torquierung (Kreuzung der Schenkel an mindestens 2 Stellen), Sludge, Blutung und Ödem.

Schon als Einzelbefund pathologisch sind meist Büschelkapillaren (mehrfache Verzweigung), Kapillarthrombosen, Megakapillaren (Kapillarlumen >50 µm) und avaskuläre Areale (Kapillarverlust). Die beiden letzten Befunde zusammen sind hochspezifisch für eine systemische Sklerose. Andere Befundkonstellationen sind mit Kollagenosen vereinbar.

Die begriffliche und definitorische Klärung und Einheitlichkeit verbessert die Qualität und Vergleichbarkeit der kapillarmikroskopischen Untersuchung

Abstract

Capillaroscopy has high diagnostic and prognostic value in autoimmune connective tissue diseases, in particular systemic sclerosis (SSc). Our working group has developed a consensus on nomenclature, technical equipment, procedure, and diagnostic interpretation of results. The following are required: binocular microscopes with at least 20-/50- and 160-/200-fold magnification and digital archiving. Documentation of defined findings is mandatory. The simultaneous occurrence of, e.g. caliber variations, ectasia, ramifications, elongation (length >350 μm), torsion (at least two crossing segments per capillary loop), sludge, hemorrhage, and edema is of pathological significance.

The isolated occurrence of bushy capillaries (multiple ramifications), thrombosis, giant capillary (capillary lumen >50 μm), and avascular areas also indicates disease. The latter two findings are highly specific for SSc. Other findings are consistent with connective tissue diseases.

These standardized definitions increase quality and comparability of nailfold capillaroscopy in Germany.

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Interessenskonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Treffen der Arbeitsgruppe wurden durch Reisekostenzuschüsse der Deutschen Gesellschaft für Rheumatologie ermöglicht. Der korrespondierende Autor hat zur Kapillarmikroskopie Vortragshonorare erhalten von der Rheumaakademie Berlin, Fa. Actelion Freiburg und dem Rheumazentrum Rhein-Ruhr Düsseldorf. Ferner erhält er Drittmittelförderung für Projekte zur Kapillarmikroskopie durch die Firmen Actelion, Freiburg und Pfizer Pharma Berlin.

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Authors and Affiliations

  1. Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    O. Sander, B. Ostendorf & C. Iking-Konert

  2. Klinik für Dermatologie und Venerologie, Universität Münster, Münster, Deutschland

    C. Sunderkötter & I. Herrgott

  3. Medizinische Klinik II, Rheumatologie, Universität Tübingen, Tübingen, Deutschland

    I. Kötter

  4. SANA Rheumazentrum Rheinland-Pfalz, Bad Kreuznach, Deutschland

    I. Wagner & A. Schwarting

  5. Medizinische. Klinik III, Rheumatologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    M. Becker

  6. Rheumaklinik und Rheumaforschungsinstitut, Aachen, Deutschland

    E. Genth

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  1. O. Sander
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  2. C. Sunderkötter
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  3. I. Kötter
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  4. I. Wagner
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  5. M. Becker
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  8. B. Ostendorf
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  9. C. Iking-Konert
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  10. E. Genth
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Correspondence to O. Sander.

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Sander, O., Sunderkötter, C., Kötter, I. et al. Kapillarmikroskopie. Z. Rheumatol. 69, 253–262 (2010). https://doi.org/10.1007/s00393-010-0618-0

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  • DOI: https://doi.org/10.1007/s00393-010-0618-0

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