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Re: Nailfold capillaroscopy in scleroderma

Dear Editor,

I read with great interest the article by Sulli et al[1] on scoring the nailfold microvascular changes during the capillaroscopic analysis in systemic sclerosis patients. The capillary abnormalities occurring in scleroderma-spectrum disorders were described by Maricq et al over 30 years ago and include enlarged capillary loops, areas of avascularity and haemorrhages. Since than many cross-sectional studies of nailfold capillaroscopy have been published, most of them being qualitative. Only a few longitudinal studies have been performed. Sulli et al concluded that their capillaroscopic score is a tool to quantify and monitor the scleroderma microvascular damage.

I would like to make some comments with respect to performance and definition:

1. each parameter was scored in the middle of the nailfold. For most of the parameters this is the most ideal location except for the giant loops, which manifest at the lateral edges of the nailfold, especially in the early phase of scleroderma-like disorders[2]. In our experience it is preferred to include the entire nailfold.

2. it is remarkable that the number of giant capillaries at follow-up is decreased as compared to the baseline values. Giant loops persisted in patients with scleroderma-like disorders in other studies[3]. Unfortunately, criteria for early systemic sclerosis and antibody profiles of the patients were lacking.

More longitudinal studies are needed to define prognostic value, especially in relation to clinical characteristics including specific organ involvement.

References

1. Sulli A, Secchi ME, Pizzorni C, Cutolo M. Scoring the nailfold microvacular changes during the capillaroscopic analysis in systemic sclerosis patients. Ann Rheum Dis 2008;67:880-884.

2. Maricq HR. Widefield capillary microscopy. Technique and rating scale for abnormalities in scleroderma and related disorders. Arthritis Rheum 1981;24:1159-65.