An international SUrvey on non-iNvaSive tecHniques to assess the mIcrocirculation in patients with RayNaud's phEnomenon (SUNSHINE survey)

Rheumatol Int. 2017 Nov;37(11):1879-1890. doi: 10.1007/s00296-017-3808-0. Epub 2017 Sep 11.


To canvas opinion concerning the role of non-invasive techniques in the assessment of patients with Raynaud's phenomenon (Rp) in clinical and research settings: four nailfold capillaroscopy methods [videocapillaroscopy (NVC), dermoscopy, stereomicroscopy, digital USB microscopy], four laser Doppler methods (laser Doppler flowmetry, imaging, anemometry/velocimetry, laser speckle contrast analysis), thermographic imaging, and upper limb arterial Doppler ultrasound. Emails with a link to the survey were sent to physicians from the European Scleroderma Trials and Research group (EUSTAR), the EULAR Study Group on Microcirculation in Rheumatic Diseases (SG_MC/RD) and members of the pediatric rheumatology Email board. The main descriptive analysis related to physicians looking after adult patients, with some analysis also of opinions from paediatric rheumatologists. 106 'adult physicians' responded (a response rate of 25.8%), of whom 68.9% were European, and 81.1% practising for more than 10 years. Nineteen paediatricians responded. The most widely available technique was NVC (72.7%). Nailfold capillaroscopy was most frequently performed by the physician him/herself, using different types of equipment relating to availability. Most rheumatologists reported high levels of appropriateness for NVC in both clinical and research settings for global assessment and differential diagnosis of Rp. Other techniques were less used. Of all the different techniques, nailfold capillaroscopy was the one most used in both clinical and research settings by adult physicians, the majority of whom use NVC in their everyday practice. The low proportion of clinicians using other techniques suggests that these are currently mainly research tools, available only in specialist centres.

Keywords: Anemometry/velocimetry; Connective tissue disease; Dermoscopy; Laser Doppler flowmetry; Laser Doppler imaging; Laser speckle contrast analysis; Nailfold capillaroscopy; Raynaud’s phenomenon; Systemic sclerosis; Thermographic imaging; Upper limb arterial Doppler ultrasound; Videocapillaroscopy.

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Humans
  • Microcirculation*
  • Microscopic Angioscopy / methods*
  • Raynaud Disease / physiopathology*
  • Surveys and Questionnaires