Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement?

Abstract

Raynaud's phenomenon (RP) represents the most frequent clinical aspect of cardio/microvascular involvement and is a key feature of several autoimmune rheumatic diseases. Moreover, RP is associated in a statistically significant manner with many coronary diseases. In normal conditions or in primary RP (excluding during the cold-exposure test), the normal nailfold capillaroscopic pattern shows a regular disposition of the capillary loops along with the nailbed. On the contrary, in subjects suffering from secondary RP, one or more alterations of the capillaroscopic findings should alert the physician of the possibility of a connective tissue disease not yet detected. Nailfold capillaroscopy (NV) represents the best method to analyse microvascular abnormalities in autoimmune rheumatic diseases. Architectural disorganization, giant capillaries, haemorrhages, loss of capillaries, angiogenesis and avascular areas characterize >95% of patients with overt scleroderma (SSc). The term 'SSc pattern' includes, all together, these sequential capillaroscopic changes typical to the microvascular involvement in SSc. The capillaroscopic aspects observed in dermatomyositis and in the undifferentiated connective tissue disease are generally reported as 'SSc-like pattern'. Effectively, and early in the disease, the peripheral microangiopathy may be well recognized and studied by nailfold capillaroscopy, or better with nailfold video capillaroscopy (NVC). The early differential diagnosis between primary and secondary RP is the best advantage NVC may offer. In addition, interesting capillaroscopic changes have been observed in systemic lupus erythematosus, anti-phospholipid syndrome and Sjogren's syndrome. Further epidemiological and clinical studies are needed to better standardize the NCV patterns. In future, the evaluation of nailfold capillaroscopy in autoimmune rheumatic diseases might represent a tool for the prediction of microvascular heart involvement by considering the systemic microvascular derangement at the capillary nailfold.

Increased Intrarenal Arterial Stiffness May Predict the Occurrence of New Digital Ulcers in Systemic Sclerosis

“…The nailfold of the second, third, fourth, and fifth finger was examined in each patient. According to Cutolo et al, the patterns identified within the SSc pattern included early, active, and late (11).…”

The role of nail-videocapillaroscopy in early diagnosis of scleroderma

“…In normal conditions, the microvascular pattern is characterized by a regular array of microvessels with large intra/interindividual variability [19]. Usually, capillaries show a perpendicular disposition to the nailfold edge, with a capillary diameter lower than 20 μm, and at least 9 capillaries per linear millimeter are present.…”

“…Blood flow is also altered, with an average slowing of flow and increased periods of stasis [19]. Nagy et al found specific abnormalities in 87.5% of patients with diffuse and in 61.6% with limited form of SSc [5] by evaluating advanced capillary changes.…”

“…Several studies have graded the morphological aspects of the vascular damage in patients with SSc, as assessed by nailfold capillaroscopy [19]. Maricq et al [15] described two types of capillaroscopic changes in SSc.…”

Impairment of microcirculation in juvenile idiopathic arthritis - studies by nailfold videocapillaroscopy and correlation with serum levels of sICAM and VEGF.

“…Capillaroscopy is an non-invasive technique which allows in vivo investigation of the smallest blood vessels [8][9][10].…”