Stellenwert der Nagelfalzkapillarmikroskopie in der Differenzialdiagnostik von Kollagenosen und Vaskulitiden

Zusammenfassung

Kollagenosen und Vaskulitiden gehören als komplexe entzündliche Systemerkrankungen zu den anspruchsvollsten Krankheitsbildern der klinischen Rheumatologie und durch die diversen möglichen Organmanifestationen zu den großen Herausforderungen der Inneren Medizin generell. Ihre Diagnostik und Behandlung erfordert ein multidisziplinäres Vorgehen. Während Kollagenosen meist durch eine Kombination aus typischer Klinik, spezifischen Laborauffälligkeiten und entsprechenden bildgebenden Befunden schon in den Anfangsstadien gut unterschieden werden können, sind Vaskulitiden oftmals schwieriger zu diagnostizieren, zumal ein Gutteil keine spezifischen Laborbefunde aufweisen muss. Daher sind klinische und bildgebende Veränderungen mit ihrer entsprechenden Topik umso bedeutsamer. Der Stellenwert der Kapillarmikroskopie in der Differenzialdiagnostik von Kollagenosen und Vaskulitiden besteht darin, dass die verschiedenen, insbesondere kollagenotischen Erkrankungen teils unterschiedliche pathognomonische Kapillarmuster aufweisen, deren Visualisierung einen wesentlichen Beitrag zur deren Differenzierung liefern kann. Bei Vaskulitiden ist dies abermals schwieriger und weniger spezifisch möglich.

Summary

Connective tissue diseases and vasculitic abnormalities as complex inflammatory systemic disorders are among the most demanding entities of clinical rheumatology. Due to their many possibilities of organ involvement, they represent great challenges of internal medicine in general. Their diagnosis and treatment require a multidisciplinary approach. While connective tissue diseases can already be distinguished at initial stages based on a combination of typical symptoms, specific laboratory findings and particular imaging, vasculitides are difficult to diagnose, the more so as many of them do not show specific blood results. Therefore, clinical and imaging changes with their corresponding topical mapping are all the more important. The significance of capillaroscopy within the differential diagnosis of connective tissue disease and vasculitis consists in the fact that the different ailments exhibit partially distinguishable pathognomonic capillary patterns, the visualization of which may considerably contribute to their discrimination. This is, however, more difficult and less specific with vasculitides once again.

Schlüsselwörter

Kapillarmikroskopie - Kollagenose - Vaskulitis

Keywords

Capillaroscopy - connective tissue disease - vasculitis

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