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The digital skin microcirculation was studied by vital capillaroscopy in 32 consecutive patients with Raynaud's phenomenon. A detailed classification (stages 0-6) of the capillary abnormalities based upon observations of the capillaries in many different sites of the fingers was used. Associated diseases were searched for by an extensive clinical and immunological investigation. Seventeen (53%) of the patients had distinct structural changes in the capillaries but only 6 of them showed a restricted total digital circulation. Fifteen (88%) of these 17 patients displayed an underlying disease and/or immunological abnormalities. The corresponding figure for patients with mild or no capillary changes was 40% (p less than 0.01). Thus, the presence of marked (greater than or equal to stage 3) skin capillary abnormalities seems to be a good indicator of an associated systemic disease. The majority of patients in this category improved their capillary status during successful treatment of the underlying disease. We conclude that the form of capillaroscopy used in this study is a sensitive method for evaluating disturbances of the skin microcirculation in patients with Raynaud's phenomenon. The method may also contribute to the clinical evaluation of patients with this syndrome by identifying those with an underlying systemic disease.

Eighteen of 24 patients with rheumatoid arthritis showed intermediate IgG-containing complexes on preparative ultracentrifugation before treatment with D-penicillamine. Serial analyses of these showed strikingly close correlation in reduction of IgG as well as alpha 1-antitrypsin-IgA complexes. Three patients did not respond to treatment clinically, and retained both types of complexes. Complexes virtually disappeared in all responders. Only small changes were found in total IgG or IgM levels and the reduction of IgA levels was moderate, except for one case who developed IgA deficiency. The importance of further analysis of non-responders is stressed.