Nailfold capillaroscopy (NVC) is today considered to be safe biomarker in order to make an early diagnosis of slected Connective Tissue Diseases (CTDs) in presence of Raynaud' phenomenon, and to measure progressive microvascular and tissues damage including response to long term treatment,
Systemic sclerosis is the only CTD to date in which prognostic indices have been described to predict clinical complications. Predictions have been made based on baseline capillaroscopic images and based on sequential capillaroscopic follow-up.
Baseline qualitative-assessed scleroderma patterns have been described to be linked with future organ involvement in any of the nine organ systems affected by SSc according to the disease severity scale of Medsger (general, peripheral vascular, skin, joint, muscle, gastrointestinal tract, lung, heart and kidney) (1). Additionally, baseline capillaroscopic evaluations have been linked to future development of digital trophic lesions in SSc. A simple scoring system has been used recently in the largest pan-European study evaluating the role of capillaroscopy in predicting digital ulcers in SSc (2). More specifically, in this study, simply the number of capillaries per linear mm had been evaluated. Besides counting the number of capillaries/capillary alterations, dimensions can also be measured. The latter has also been used in prediction of patients with RP whether, because of SSc, there will be a possibility for them to develop a secondary RP. Similarly, it has recently been attested that if the average capillary diameter (average of the largest apical, efferent and afferent limb in 16 fields, more specifically 2 fields per finger, fingers 2–5 from each hand) is less than 30 μm in a group of patients with RP but without scleroderma characteristic findings on nailfold videocapillaroscopy (NVC), the patient has a low chance of developing SSc, while if >30 μm, then the patient has 50% chance to develop SSc (3). Concerning the ability of capillaroscopy to measure response to treatment, there are yet no prospective randomized, double-blind, placebo-controlled trials, evaluating the ability of capillaroscopy to monitor response to therapy concerning RP-related outcome measures. It is noteworthy and promising that in small studies showing response of immunosuppressive/vasomodulating treatment on disease severity, outcome measures are available (4–6).
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Disclosure of Interest None declared