Published: 2017-01-17

Nail fold capillaroscopy in patients of systemic sclerosis and its association with disease severity as evidenced by high resolution computed tomography lung: a hospital based cross sectional study

Majid Jehangir, Seema Qayoom, Shazia Jeelani, Rahil Yousuf


Background: The specific nail fold capillary (NFC) pattern found in systemic sclerosis (SSc), can be examined using a dermascope, which can prove as a simple and cost effective procedure for early diagnosis and proper management of patients with SSc.

Methods: A case-control study was conducted on 65 subjects – 10 patients with primary raynauds phenomenon (RP), 40 patients with the SSc and 15 age and gender matched controls. Pattern of NFC using a dermascope was studied in all the subjects. HRCT lung was done in all the SSc patients and the findings were correlated with NFC pattern.

Results: Out of the 65 subjects under study, Nail Fold Capillary (NFC) pattern was abnormal in (40/65) 61.54%. NFC changes were seen in all the (100%) patients of SSc. None of the patients with primary raynauds phenomenon had any positive findings on NFC. High resolution computed tomography (HRCT) lung in patients of SSc when correlated with NFC pattern revealed that overall 20 patients (50%) had interstitial lung disease (ILD). Only one patient with early sclerodermoid pattern of NFC showed ILD whereas 55% and 100% of the patients with active and late pattern of NFC respectively showed ILD on HRCT lungs.

Conclusions: Our study serves to show that NFC pattern can be used as a screening tool in patients with history of RP for diagnosis of systemic sclerosis. The study has shown an association between advanced changes as observed in NFC pattern and systemic involvement in SSc patients as evidenced by HRCT lung.



Nail Fold Capillaries, Dermascopy, Systemic sclerosis, High resolution computed tomography lung

Full Text:



Kreig T, Takehara K. Skin disease: a cardinal feature of systemic sclerosis. Rheumatology (Oxford). 2009;48 (suppl 3):iii14-8.

Bergman R, Sharony L, Schapira D. The Handheld Dermatoscope as a Nailfold Capillaroscope instrument. Arch Dermatol. 2003;139:1027-30.

Fischer A, Meehan RT, Feghali-Bostwick CA, West SG, Brown KK. Unique characteristics of systemic sclerosis sine scleroderma-associated interstitial lung disease. Chest. 2006;130(4):976-81.

Sato LT, Kayser C, Andrade LE. Nailfold capillaroscopy abnormalities correlate with cutaneous and visceral involvement in systemic sclerosis patients. Acta Reumatol Port. 2009;34(2A):219-27.

Maricq HR, LeRoy EC. Patterns of finger capillary abnormalities in connective tissue disease by ‘wide-field’ microscopy. Arthritis Rheum. 1973;16:619-28.

Carpentier PH, Maricq HR. Microvasculature in systemic sclerosis. Rheum Dis Clin North Am. 1990;16:75-91.

Maricq HR, LeRoy EC, D’Angelo WA, Medsger TA Jr, Rodnan GP, Sharp GC, et al. Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum. 1980;23(2):183-9.

Blockmans D, Beyens G, Verhaeghe R. Predictive value of nailfold capillaroscopy in the diagnosis of connective tissue disease. Clin Rheumatol. 1996;15:148-53.

Grassi W, Core P, Carlino G, Cervini C. Acute effects of single dose nifedipine on cold-induced changes of microvascular dynamics in systemic sclerosis. Br J Rheumatol. 1994;33:1154-61.

Chandran G, Smith M, Ahern MJ, Roberts-Thomson PJ. A study of scleroderma in South Australia: prevalence, subset characteristics and nailfold capillaroscopy. Aust NZJ Med. 1995;25:688-94.

Mannarino E, Pasqualini L, Fedeli F. Nailfold capillaroscopy in the screening and diagnosis of Raynaud's phenomenon. Angiology. 1994;45:37-42.

Pope JE, Johnson SR. New Classification Criteria for Systemic Sclerosis (Scleroderma). Rheum Dis Clin North Am. 2015;41(3):383-98.

Silver RM, Miller KS. Lung involvement in systemic sclerosis. RheumDis Clin North Am. 1990;16:199-216.

Gilliland BC, et al. Systemic sclerosis (scleroderma) in: BraunwaldE, Fauci AS, Kasper DL, et al., editors. Harrison’s Principles of Internal Medicine. New York:McGraw-Hill, 2001.

Goldin JG, LynchDA, StrolloDC. High resolution CT findings in scleroderma-related lung diseases: findings from Scleroderma Lung Study. Chest. 2008;134:358-67.

Cutolo M, Sulli A, Pizzorni C, Accardo S. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000;27:155-60.

Russo RA, Katsicas MM. Clinical characteristics of children with Juvenile Systemic Sclerosis: follow-up of 23 patients in a single tertiary center. Pediatr Rheumatol Online J. 2007;5:6.

Cutolo M, Sulli A, Secchi ME, Paolino S, Pizzorni C. Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement? Rheumatology. 2006;45(suppl 4):iv43-6.

Khan F. Vascular abnormalities in Raynaud’s phenomenon. Scott Med J. 1999;44:4-6.

Piotto DG, Len CA, Hilario MO, Terreri MT. Nailfold capillaroscopy in children and adolescents with rheumatic diseases. Rev Bras Reumatol. 2012;52(5):722-32.

Nagy Z, Czirjak L. Nailfold digital cappillaroscopy in 447 patients with connective tissue disease and Raynaud’s disease. J Eur Acad Dermatol Venereol. 2004;18:62-8.

Lovy M, Mac Carter D, Steigerwald JC. Relationship between nailfold capillary abnormalities and organ involvement in systemic sclerosis. Arthritis Rheum. 1985;28(5):496-501.

Corrado A, Carpagnano GE, Gaudio A, Foschino-Barbaro MP, Cantatore FP. Nailfold capillaroscopic findings in systemic sclerosis related lung fibrosis and in idiopathic lung fibrosis. Joint Bone Spine. 2010;77(6):570-4.