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You are here: Home / Articles / Rheumatologists Find Nailfold Capillaroscopy an Increasingly Useful Diagnostic Tool

Rheumatologists Find Nailfold Capillaroscopy an Increasingly Useful Diagnostic Tool

October 18, 2017 • By Ruth Jessen Hickman, MD

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Dr. Cutolo

Dr. Cutolo

Ophthalmoscopes and traditional microscopes are two, low-cost options that are widely available and can be used with minimal training. Dermatoscopes are portable devices at intermediate cost that allow nailfold capillary viewing. Stereo microscopes are the main tools used in national centers due to their ease of use and intermediate cost. But Stereo microscopes can be difficult to use on patients with joint contractures. Dermatoscopes, ophthalmoscopes and traditional microscopes can provide only low magnification, whereas stereo microscopes and video capillaroscopes can provide either low- or high-level magnification.3,5

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A video capillaroscope is the most expensive option. It consists of an optical microscope and a digital video camera combined and connected to a computer. The computer can be used to calculate such measurements as the capillary loop diameter and the intercapillary distance.4 It has a handheld probe that can be used for bedside examination or in patients with severe flexion contractures.2 It is available as a portable system, allowing for easy clinical use. Videocapillaroscopy is considered the gold standard for noninvasive examination of the microcirculation. Currently, relatively few rheumatologists have access to this tool, except at large clinical centers, although this may be changing.3

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Of note, all of these tools have shown reliability in allowing clinicians to distinguish a normal capillaroscopy exam from the specific changes found in systemic sclerosis.3

Other methods are also available to analyze the microcirculation in detail, including flow Doppler ultrasonography and laser Doppler perfusion imaging.6 However, as Dr. Herrick points out, “Capillaroscopy is the only widely available noninvasive test of the structural microvascular disease, which occurs in systemic sclerosis. Other techniques give an idea of microvascular function (e.g., laser Doppler imaging and, albeit indirectly, infrared thermography). However, these are not a substitute for capillaroscopy but rather provide complementary information.”

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Assessment of Raynaud’s Syndrome

Classical morphological changes of the microvessels (irreversible and pathological) that identify different steps of the sclerodermic microangiopathy (magnification 200X).

Classical morphological changes of the microvessels (irreversible and pathological) that identify different steps of the sclerodermic microangiopathy (magnification 200X).

Currently, capillaroscopy’s main application is in the assessment of patients with Raynaud’s phenomenon. Raynaud’s phenomenon is characterized by paroxysmal reversible episodes of vasospasm in the peripheral small vessels of the fingers or toes. In primary Raynaud’s phenomenon (about 80% of patients), this occurs without the presence of underlying disease. However, secondary Raynaud’s phenomenon is associated with other medical conditions, most commonly connective tissue disease. In secondary Raynaud’s phenomenon, unlike primary Raynaud’s phenomenon, patients have structural vascular damage that can be viewed via nailfold-viewing methods.7

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Filed Under: Conditions, Systemic Inflammatory Syndromes Tagged With: Clinical, diagnostic tool, nailfold capillaroscopy, office visit, patient care, Practice Management, Raynaud’s phenomenon, rheumatologist, rheumatology, symptom, Systemic sclerosisIssue: October 2017

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About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

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