Training in Capillaroscopy: A Growing Interest: Figure 1.

Abstract

The pilot study by Gutierrez, et al in this issue of The Journal suggests that after a short intensive one-week training program, novice investigators with little or no experience in nailfold videocapillaroscopy (NVC) are able to interpret the main capillary abnormalities in systemic sclerosis (SSc, scleroderma patterns) and to achieve good interreader agreement rates1. This attempt, worthy of encomium, also merits a detailed analysis to show its correct place in the “state of the art” of capillaroscopy with respect to rheumatology and in particular to systemic sclerosis. Although capillaroscopy was born in the 18th Century, when the Italian physician Giovanni Rasori (1766–1837) first noted the close relationship between conjunctival inflammation and the presence of an “inextricable knot of capillary loops” using a “magnifying glass,” it was only in 1973 that Maricq and LeRoy published the first article describing the specific capillaroscopic pattern in SSc2. However, for several decades thereafter capillaroscopy had difficulties to become an accepted and widely used diagnostic technique in SSc. Interestingly, a Medline search performed using the term “capillaroscopy” (retrieving a total of 759 articles from 1973 to today) revealed 22 articles published between 1973 and 1980 (7 years), 548 articles between 1980 and 2008 (28 years), and 189 articles between 2008 and 2011 (only 3 years). Further, among 200 articles that focused on “capillaroscopy and systemic sclerosis” from 1973 up to 2011, almost 80 articles (40%) were published between 2008 and 2011. These aspects of its evolution were discussed in a 2009 editorial supporting the growing need for nailfold capillaroscopy in rheumatology and suggesting the main reason for its limited past use: a lack of dissemination of its value in rheumatology circles3. In fact, other reasons may account for the slow growth of the use of capillaroscopy, despite its being … Address correspondence to Prof. M. Cutolo, Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy. E-mail: email: mcutolo{at}unige.it