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Despre Capilaroscopie 20.06.2017 PDF
Despre Capilaroscopie 20.06.2017 PDF
Scurt istoric
Dintre toate bolile de esut conjunctiv, ScS are cel mai specific model
(pattern) capilaroscopic, caracterizat prin apariia megacapilarelor i a ariilor
avasculare la nivelul patului unghial, aspect prezent la 95-100% din pacienii cu
ScS. Acest model capilaroscopic sclerodermic a fost descris iniial de HR Maricq, care
l-a definit ca asocierea de capilare foarte dilatate, zone avasculare i hemoragii, cu
pierderea aranjamentului arhitectural normal al patului capilar periunghial (9).
Ulterior, cercettoarea american a definit dou subtipuri de pattern sclerodermic:
cel activ, care asociaz megacapilare i scderea densitii anselor, corelat cu
formele de ScS cu afectare cutanat difuz i activitate crescut a bolii, i cel lent,
descris ca prezena de megacapilare fr alterarea densitii anselor, asociat cu ScS
cu afectare cutanat limitat i cu un prognostic mai bun (10). Foarte important, s-a
demostrat c includerea modificrilor capilaroscopice specifice n criteriile de
clasificare a ScS ar crete sensibilitatea acestora de la 67% la 99%, ntruct permite
o mai bun detecie a cazurilor cu afectare cutanat limitat (11), care nu satisfac
actualele criterii de clasificare pentru ScS ale Colegiului American de Reumatologie
(ACR). n studii care au explorat valoarea diagnostic a pattern-ului sclerodermic n
grupuri de pacieni cu diferite boli reumatologice autoimune (ScS, lupus eritematos
sistemic, poliartrit reumatoid), sensibilitatea aceestuia pentru ScS a fost de cca.
80%, iar specificitatea de 89-93% (6,10,12).
Bibliografie
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