Rheumatology Clinic, University “Politecnica delle Marche”, Italy

Abstract

Nailfold capillaroscopy is currently the best method to investigate microvascular abnormalities in systemic sclerosis and related conditions, and in other rheumatic conditions in which there is a clinical suspicion of microangiopathy. Although easy to perform, it is essential that the operators have been properly trained about correct method of images acquisition and interpretation. There are some parameters to indicate a normal/healthy capillaroscopic picture, but it is important to consider that there is a great variability in the capillary structure both interindividual and intraindividual. The early differential diagnosis between primary and secondary RP is the best advantage that the technique may offer. Remarkable capillaroscopic alterations are found in the majority of cases of systemic sclerosis and the so-called “scleroderma spectrum disorders” (dermatomyositis, mixed connective tissue disease, undifferentiated connective tissue disease). Nevertheless, some capillaroscopic changes have been observed in systemic lupus erythematosus, Sjogren’s syndrome, psoriatic and rheumatoid arthritis. Discussion about controversies on this topic should be encouraged, leading to a progressive development of capillaroscopy as a routine investigation in rheumatology.