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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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Researchers have also used semi-quantitative and quantitative scoring systems in nailfold capillaroscopy to evaluate treatment response in systemic sclerosis. This remains a promising area of research development.

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Dr. Cutolo and colleagues evaluated the effect of the vasodilator iloprost compared to iloprost taken with bosentan (an endothelin receptor antagonist). They found that the group taking both iloprost and bosentan had increases in capillary number as assessed by nailfold capillaroscopy at two to three years follow-up.13 Later studies have shown that the drug combination exerts a remodeling effect on the microvasculature, decreasing the likelihood of digital ulceration and helping to stabilize lung function.14

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Capillaroscopy may also be of benefit in evaluating certain patients with interstitial lung disease. Such lung disease is commonly found in SSc and related diseases, but it can also be found in other situations, such as from environmental factors or infection. Patients with interstitial lung disease and capillaroscopic findings indicative of systemic sclerosis are likely to soon develop the full feature of systemic sclerosis or a closely associated disease.2

Similarly, capillaroscopy can provide an initial screening technique for interstitial lung disease in patients with mixed connective tissue disease or scleromyositis. The technique can also sometimes be beneficial in helping to distinguish dermatomyositis from polymyositis. In the former, severe capillary abnormalities are common, similar to the scleroderma pattern; in polymyositis, any abnormalities tend to be mild.2

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Researchers have extensively examined nailfold capillary characteristics in many other rheumatic diseases, but for the most part have not found repeatable patterns of significance. Patients with lupus, antiphospholipid syndrome, Sjögren’s syndrome or other connective tissue diseases may also show nonspecific abnormalities. It should be noted that nonspecific abnormalities on capillaroscopy can also be found as sequelae from other medical conditions, such as advanced diabetes or hypertension.2

Barriers to Use

Early structural changes in a patient with Raynaud’s phenomenon (left picture) that should identify very early alterations of the microvessels (dilations under 50 micrometers). The subsequent early morphological changes that identify the secondary associated systemic sclerosis are the presence of symmetrical dilations over 50 micrometers, called giant capillaries (right picture).

Early structural changes in a patient with Raynaud’s phenomenon (left picture) that should identify very early alterations of the microvessels (dilations under 50 micrometers). The subsequent early morphological changes that identify the secondary associated systemic sclerosis are the presence of symmetrical dilations over 50 micrometers, called giant capillaries (right picture).

Capillaroscopy has been relatively slow to be accepted and widely used as a tool, but that is changing. Dr. Cutolo explains that the slow adoption was mainly due to the absence of clear validation and scoring and classification of capillaroscopic patterns. It has become more adopted as researchers have addressed these concerns and as the technique has demonstrated its value in early differential diagnosis and prediction for clinical complications in SSc.

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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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