Nailfold capillaroscopic examination is a noninvasive technique with a substantial potential for the evaluation of the acral microcirculation in vivo. In addition, it is the only available technique for an on-demand analysis of the nutritional capillaries. At present, the main indication for capillaroscopic examination in rheumatology is the presence of RP. The method is currently applied for differentiation of primary RP from RP in the context of SSc and other scleroderma-spectrum-disorders. However, the sparse knowledge about specific capillaroscopic patterns in other rheumatic diseases and the absence of guidelines for analysis of capillaroscopic images are still limiting factors for application of nailfold capillaroscopy in the everyday practice when diagnosing rheumatologic patientsTherefore, this thesis addresses novel aspects of the application of nailfold capillaroscopy in rheumatology. Chapter 1 provides an overview of the current application of nailfold capillaroscopy and includes the analysis of the actuality of the subject. Chapter 2 addresses the aim and tasks of the dissertation and Chapter 3 presents the materials and methods included in the dissertation. The study includes 297 patients with rheumatic diseases, who were examined during routine in- and outpatient consultation at the Chair for Internal Medicine and Rheumatology in the Justus-Liebig-University Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim. The investigated patient groups consisted of 36 SSc patients, 30 SLE patients, 31 patients with UCTD, 62 RA patients, 9 patients with early arthritis, 34 patients with PsA with a RA-like form and with a subtype of the disease with involvement of the distal interphalangeal joints, 31 patients with primary RP, 26 patients with primary fibromyalgia, 3 patients with paraneoplastic RP, 35 patients with essential mild-to-moderate AH without systemic rheumatic disease and control group with 42 healthy volunteers without known disease, who did not receive medications. Nailfold capillaroscopy was performed with a commercially high-end videocapillaroscope (Videocap 3.0, DS Medica, Italy). The findings were analysed qualitatively and quantitatively and were compared with clinical, laboratory and immunological data of the patients.Based on the results of the examinations of the thesis, the following novel contributions have been achieved: analysis and characterization of the capillaroscopic pattern of the toes of SSc patient, capillaroscopic pattern in the primary fibromyalgia, RA with and without RP, early undifferentiated arthritis, paraneoplastic RP, AH patients, who receive antihypertensive therapy. In addition, the qualitative and quantitative methods for evaluation of capillaroscopic images have been evaluated (Chapters 4 and 5). In conclusion, it could be demonstrated that nailfold capillaroscopy is a method that provides valuable and valid information in several common rheumatic diseases with and without symptoms of peripheral vasospasm. Therefore, the results from the dissertation will contribute to the establishment of capillaroscopic analysis in hitherto uncharacterized clinical situations in the rheumatologic practice.
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