Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Rheumatologists Find Nailfold Capillaroscopy an Increasingly Useful Diagnostic Tool

Ruth Jessen Hickman, MD  |  Issue: October 2017  |  October 18, 2017

Different tools for nailfold capillaroscopic analysis.

Different tools for nailfold capillaroscopic analysis.

Interest in viewing the nail capillaries dates to the late 17th century. Later research by Maurice Raynaud and others in the late 19th and early 20th century first established a direct link between the nailfold capillaries and certain medical conditions. Although underutilized in the past, with the advent of modern digital equipment and the validation of evidence-based methodologies, this is changing. Capillaroscopy is set to become a more important tool for rheumatologists, especially in the evaluation of Raynaud’s phenomenon and systemic sclerosis.1,2

Nail Capillary Anatomy

Capillaroscopy is a method used to examine a patient’s microcirculation and assess pathological changes. It is completely safe and noninvasive. Using some sort of microscopy, the clinician looks through the epidermis of the nailfold to view the capillaries of the distal papillae.3

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Ariane Herrick, MD, is professor of rheumatology at the University of Manchester and honorary consultant rheumatologist at Salford Royal NHS Foundation Trust, England. She explains that nailfold anatomy makes it an ideal place to evaluate the microcirculation. In most of the skin, capillaries run perpendicular to the skin surface, and only the tip of the loop is visible.

Dr. Herrick explains, “At the nailfold, capillaries run parallel, rather than perpendicular, to the skin surface, and they can, therefore, be visualized noninvasively when magnified. Capillaries themselves are invisible, but what can be seen is the column of red blood cells within the capillaries.”

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

This is of interest to rheumatologists in evaluating systemic diseases that involve vascular damage. In some cases, pathogenic changes in capillary morphology may long predate the onset of clinical symptoms. And in patients already diagnosed with a systemic disease, such as systemic sclerosis, the level of capillary damage may reflect internal organ involvement.2

Normal Capillaroscopic Findings

During a capillaroscopic assessment, the practitioner assesses a number of different morphological and functional changes in the capillaries. These include capillary visibility, morphology, diameter, length, distribution and density, microhemorrhages and blood flow. Normal capillary loops display a hairpin “U,” with capillaries running parallel to the skin surface, with no hemorrhages or dilated capillary loops. Capillary density should be 9–12 per mm.1,3,4

Tortuous loops frequently signify pathology, as do abnormally large capillary vessel diameters and decreased capillary density. Microhemorrhages are pathognomonic for systemic sclerosis, especially when seen alongside megacapillaries.1,4

Devices for Nailfold Capillary Exam

A variety of different types of devices can be used to examine the nailfold capillaries. These include dermatoscopes, ophthalmoscopes, traditional microscopes, stereo microscopes or digital video capillaroscopes.2

Page: 1 2 3 4 5 6 7 8 9 | Single Page
Share: 

Filed under:ConditionsOther Rheumatic Conditions Tagged with:Clinicaldiagnostic toolnailfold capillaroscopyoffice visitpatient carePractice ManagementRaynaud’s phenomenonrheumatologistrheumatologysymptomSystemic sclerosis

Related Articles

    Capillaroscopy a Safe and Direct Method for SSc Diagnosis

    June 13, 2011

    Seeing vessels clearly can help with discovery and timely treatment

    Nailfold Videocapillaroscopy Provides a Window into Inflammatory Myopathies

    December 3, 2019

    A recent study investigated the possible differences in nailfold videocapillaroscopy in four types of inflammatory myopathies. Researchers observed giant capillaries, disorganization and major capillary loss in dermatomyositis and overlap myositis patients, finding dermatomyositis and overlap myositis imaging was different from that of antisynthetase syndrome and immune-mediated necrotizing myopathy…

    Scleroderma & ILD: Practical Tips on the Diagnosis & Management of Systemic Sclerosis-Associated Interstitial Lung Disease

    June 15, 2022

    No one-size-fits-all approach exists for the care and treatment of patients with systemic sclerosis (SSc) and SSc with pulmonary involvement. Here, experts discuss some best clinical practices for these patients.

    Progress Continues in Systemic Sclerosis

    March 1, 2010

    Advances in genetics and potential therapies shed new light on the disease

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences