류마티스 질환에서 손톱주름 모세혈관경의 임상적 유용성
The Clinical Efficacy of Nailfold Capillaroscopy in Rheumatic Diseases
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초록
류마티스 질환에서 손톱주름 모세혈관경 검사의 유용성은 이미 수많은 검증이 완료된 상태이다. 손톱주름 모세혈관경 검사는 항핵항체와 더불어 일차성과 이차성 레이노현상의 감별에 매우 유용하며, 미세혈관순환을 평가하는 임상에서 쉽게 적용 가능한 검사로 이를 적정하게 적용하기 위해서는 “정상적인/정상에 가까운” 소견에 대한 숙지가 필요하며 균일한 헤어핀 모양뿐 아니라 구불구불하거나 1-2회 교차하는 모양도 비특이적인 정상 범주에 포함된다. 거대혈관, 모세혈관의 개수 감소인 무혈관 지역을 평가하는 것이 전신경화증을 포함한 경피증 범주 질환의 진행을 예측한다. 무혈관 지역은 수지궤양, 폐동맥고혈압의 발생과 중증도와도 일부 상관관계를 보여 이를 임상에서 쉽게 활용할수 있는 단일화된 반정량평가와 지속적인 교육 프로그램이필요하다.
Abstract
Nailfold capillaroscopy (NFC) is a non-invasive morphological study that routinely used to differentiate between a primary and secondary Raynaud’s phenomenon (RP). Secondary RP is a manifestation of an underlying rheumatic disease that occurs in 80-95% of patients with systemic sclerosis (SSc), 75% of patients with mixed connective tissue disease and in 20-25% of patients with systemic lupus erythematosus or rheumatoid arthritis. These RP frequently precedes the underlying disease by many years. The well-established roles of NFC are the early diagnosis of SSc, and potential for predicting clinical complication, as like digital ulcers. The following review will present a technique about how to perform NFC and optimal assessment with emphasis on its possible role as a reliable diagnostic tool.
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