İlke Coşkun Benlidayı1, Esra Kayacan Erdoğan2, Aylin Sarıyıldız3

1Department of Physical Medicine and Rehabilitation, Çukurova University Faculty of Medicine, Adana, Turkey
2Department of Rheumatology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
3Department of Physical Medicine and Rehabilitation, Silopi State Hospital, Şırnak, Turkey

We deeply thank to Dr. Lambova for her appreciable point of view and comments on our recent article entitled “The Evaluation of Nailfold Capillaroscopy Pattern in Patients With Fibromyalgia”. The results of our study revealed a significantly higher mean capillary loop diameter, higher number of avascular areas, micro-aneurysms, and neoangiogenic capillaries in patients with fibromyalgia, compared to healthy controls.[1] On the other hand, none of the patients reported symptoms of Raynaud’s phenomenon. However, patients with certain findings in capillaroscopy could be candidates of future Raynaud’s phenomenon/disease.

It is well-accepted that abnormal capillaroscopic findings such as micro-aneurysms, avascular areas, and neoangiogenic capillaries are not expected in primary Raynaud’s phenomenon, that is to say, Raynaud’s disease. Nevertheless, primary Raynaud’s phenomenon may transit to secondary Raynaud’s phenomenon, and an abnormal nailfold capillaroscopy pattern is regarded as the best predictor of this transition.[2,3] In a prospective study by Hirschl et al.,[4] the annual incidence of transition to suspected secondary Raynaud’s phenomenon and secondary Raynaud’s phenomenon was found to be 2% and 1%, respectively.

On a different point of view, concomitant fibromyalgia is a frequent comorbidity in patients with autoimmune and inflammatory rheumatic diseases.[5,6] In this regard, it is also likely that these patients, particularly those with abnormal capillaroscopic findings, present with signs/ symptoms of autoimmune and inflammatory rheumatic diseases in the future. Generalized pain may be the early symptom of an autoimmune inflammatory rheumatic disease among this particular subgroup of patients. In the light of this hypothesis, it is of worthy to follow the patients with abnormal capillaroscopic findings for autoimmune inflammatory rheumatic diseases.

Abnormal capillaroscopic findings among a certain number of patients with fibromyalgia may be related to the potential role of inflammation in fibromyalgia etiopathogenesis.[7] Further research would be of value to clarify this hypothetic consideration. Moreover, the findings of our study highlight the need for observing these patients for the development of possible primary or secondary Raynaud phenomenon. In this regard, regular clinical observation of these individuals, along with laboratory examination when necessary, would be of paramount importance.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

References

  1. Coşkun Benlidayı İ, Kayacan Erdoğan E, Sarıyıldız A. The evaluation of nailfold capillaroscopy pattern in patients with fibromyalgia. Arch Rheumatol 2021;36:341-8.
  2. Bernero E, Sulli A, Ferrari G, Ravera F, Pizzorni C, Ruaro B, et al. Prospective capillaroscopy-based study on transition from primary to secondary Raynaud's phenomenon: Preliminary results. Reumatismo 2013;65:186-91.
  3. Spencer-Green G. Outcomes in primary Raynaud phenomenon: A meta-analysis of the frequency, rates, and predictors of transition to secondary diseases. Arch Intern Med 1998;158:595-600.
  4. Hirschl M, Hirschl K, Lenz M, Katzenschlager R, Hutter HP, Kundi M. Transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon identified by diagnosis of an associated disease: Results of ten years of prospective surveillance. Arthritis Rheum 2006;54:1974-81.
  5. Coskun Benlidayi I. Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases. Rheumatol Int 2020;40:849-58.
  6. Giacomelli C, Talarico R, Bombardieri S, Bazzichi L. The interaction between autoimmune diseases and fibromyalgia: Risk, disease course and management. Expert Rev Clin Immunol 2013;9:1069-76.
  7. Coskun Benlidayi I. Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int 2019;39:781-91.