Nailfold Capillaroscopy in Systemic Disease Diagnosis

Primary Diagnostic Role in Scleroderma Spectrum Disorders

• The European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) recommend nailfold capillaroscopy as part of routine assessment for patients with systemic sclerosis, as it is included in the 2013 EULAR/ACR classification criteria for systemic sclerosis 2

Clinical Applications Beyond Diagnosis

Screening and Monitoring in Systemic Sclerosis

• Nailfold capillaroscopy should be performed using a cutaneous assessment tool at diagnosis and follow-up, as it can detect capillary density, a sensitive measure of both skin and muscle disease activity 1
• Capillary density is a sensitive measure of both skin and muscle disease activity 1
• Persistent capillary abnormalities are associated with longer time to remission 1

Juvenile Dermatomyositis

• Nailfold capillaroscopy is particularly useful in predicting severity of disease and monitoring clinical course in juvenile dermatomyositis 3
• Nailfold capillaroscopy should be performed with magnification using an otoscope, ophthalmoscope, dermatoscope, or formal capillaroscopy 1

Practical Implementation

When to Perform Capillaroscopy

• Patients with puffy fingers, specific SSc-associated antibodies, or other features suggesting prescleroderma should undergo nailfold capillaroscopy 4

Technical Approach

• The examination can be performed using various magnification tools, including otoscope, ophthalmoscope, or dermatoscope, with focus on nailfold of fingers (typically 2nd through 5th digits) 1