Nailfold capillaroscopy provides a clear window to the microvasculature, allowing definition of various disease processes. Its role is increasingly being emphasised in the medical literature, and its uses are evolving, though its application is limited by the equipment’s expense and the need for specialised training.

ARRC has completed a number of projects that explore the differences in nail and nail capillary appearance in people that live with autoimmune conditions as compared to those without illness.  These studies have been in both adult and paediatric populations and have helped to identify diagnostic and clinical management of diseases through identification of warning signs of deterioration.

Past projects have included:

  1. Identification of Nailfold Capillary Appearance (INCA)

  2. Paediatric INCA (PINCA)

  3. Detection of Vascular Injury in Diabetes through Eye and Nailfold Data (DIVIDEND)

An established role for capillaroscopy is in defining the subset of individuals with Raynaud’s phenomenon and ANA positivity which will progress to develop autoimmunity (scleroderma, lupus) [1]  However, through research new and emerging areas of use are being identified.

ARRC, through the generosity of the LIONS club Charlestown, has recently purchased a new Optilia Capiscope and is looking forward to increasing its capillaroscopy projects to further our understanding of autoimmune illness and its management.

Evolving Projects:

  1. Selecting the subset of patients with interstitial lung disease which will benefit from immunosuppression (as opposed to antifibrotic therapies).

  2. Predicting risk of digital ulceration in scleroderma

  3. Defining the subset of patients with digital ulceration for whom aggressive vasodilation with prostanoids will be required.

  4. Monitoring treatment responsiveness for digital ischaemia

  5. Distinguishing dermatomyositis from scleroderma

  6. Nailfold capillary density is associated with presence and severity of PAH in scleroderma

References

[1] M. Bukhari, S. Hollis, T. Moore, A.L. Herrick.  Quantitation of microcirculatory abnormalities in patients with primary Raynaud's phenomenon and systemic sclerosis by video capillaroscopy  Rheumatology (Oxford), 39 (2000), pp. 506–512

 

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