Nailfold capillaroscopy - An underutilised investigation in rheumatology

Nailfold capillaroscopy (NFC) is a simple, noninvasive, outpatient procedure that permits direct visualization of capillaries through the skin of terminal nailfold with the help of digital microscope. Autoimmune Rheumatic diseases (AIRDs) are associated with abnormalities of microcirculation (microangiopathy) that can be visualized with NFC. Among all AIRDs, systemic sclerosis (SSc) is known to have prominent microangiopathy that contributes to Raynaud's phenomenon, digital ulceration, and pulmonary hypertension in this disease. These microcirculation abnormalities are labeled “the scleroderma pattern”. They occur in a clearly defined sequence of “early”, “active”, and “late” pattern and correlate with internal organ involvement. Apart from SSc, microangiopathy can be seen in dermatomyositis and the scleroderma-spectrum disorders. NFC is invaluable in differentiating primary from secondary Raynaud's phenomenon. NFC despite being simple and noninvasive is underutilized in clinical practice.