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Background. Nailfold videocapillaroscopy (NVC) is a valuable tool for assessing microvascular abnormalities in connective tissue diseases. While well established in systemic sclerosis, its role in systemic lupus erythematosus (SLE) remains less defined. This study aims to systematically analyze capillaroscopic patterns in SLE patients, describe their most frequent features, and compare them with findings observed in individuals with primary Raynaud’s phenomenon (pRP).   Methods. We retrospectively analyzed NVC images from 64 SLE patients (mean age 49.5 years) and a matched control group of 70 pRP patients. Parameters assessed included capillary density, giant capillaries, microhemorrhages, neoangiogenesis, ectasias, tortuosity, and capillary loss. Findings were correlated with clinical and serological markers, including organ involvement and autoimmune markers (ANA, ENA, antiphospholipid antibodies).   Results. NVC abnormalities were observed in 58 (90.6%) of SLE patients. The most frequent alterations in SLE were tortuosity (76.6%), ectasia (42.2%), microhemorrhages (29.7%), neoangiogenetic features (20.3%), and giant capillaries (10.9%). Compared to pRP patients, SLE patients exhibited a significantly higher prevalence of giant capillaries and angiogenetic features (p = 0.028 and p < 0.001, respectively). An SSc-like pattern was detected in 7.8% of cases, though no direct correlation was found with autoimmunity markers or clinical manifestations. Notably, both neoangiogenetic features and giant capillaries demonstrated a strong positive correlation with interstitial lung disease (ILD) (p = 0.012 and p = 0.021, respectively), highlighting the potential role of capillaroscopic markers in identifying lupus patients at risk for pulmonary involvement.   Conclusion. Capillaroscopic alterations serve as key microvascular markers in SLE, providing insights into their prevalence and clinical significance. The strong correlation between neoangiogenesis, giant capillaries, and ILD underscores vascular involvement in pulmonary manifestations. NVC emerges as a valuable non-invasive tool for early ILD identification, potentially improving diagnosis and risk stratification. The detection of an SSc-like pattern in some cases reinforces the concept of shared vascular dysfunction among autoimmune diseases, highlighting the need for further research. Future studies should focus on refining the predictive role of capillaroscopic parameters, evaluating their impact on ILD progression, and integrating NVC into routine clinical assessments to improve early detection and personalized management strategies for patients with SLE and other connective tissue diseases.

Purpose To determine whether non-invasive measurements of the nailfold capillaries (NCs) are associated with the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes. Methods Eighty-three eyes of 83 patients with type 2 diabetes were enrolled. Sixty-three age-matched non-diabetic subjects served as controls. Diabetic patients were classified by the severity of their DR: non-DR (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). We used nailfold capillaroscopy to measure NC parameters, including number, length, width, and turbidity. Results Four NC parameters in the diabetic patients were significantly lower than in the controls (all P  < 0.001). There was a statistically significant decrease in the NC parameters along with the increasing severity of DR (number: P  = 0.02; all others: P  < 0.001). Logistic regression analysis revealed that combining the systemic characteristics of age, sex, systolic blood pressure, estimated glomerular filtration rate, hemoglobin A1c level, and history of hypertension and dyslipidemia could indicate the presence of DR and PDR (the area under the receiver operating characteristic curve [AUC] = 0.81, P  = 0.006; AUC = 0.87, P  = 0.001, respectively). Furthermore, the discriminative power of DR was significantly improved ( P  = 0.03) by adding NC length to the systemic findings (AUC = 0.89, P  < 0.001). Conclusion NC measurement is a simple and non-invasive way to assess the risk of DR and its severity.

Video nailfold capillaroscopy (NFC), considered as an extension of the widefield technique, allows a more accurate measuring and storing of capillary data and a better defining, analyzing, and quantifying of capillary abnormalities. Capillaroscopic study is often performed on the patients suspected of having microcirculation problems such as Raynaud’s phenomenon as the main indication for nailfold capillaroscopy. Capillaroscopic findings based on microcirculation studies can provide useful information in the fields of pathophysiology, differential diagnosis, and monitoring therapy. Nailfold capillaroscopy provides a vital assessment in clinical practices and research; for example, its reputation in the early diagnosis of systemic sclerosis is well established and it is also used as a classification criterion in this regard. This review focuses on the manner of performing video nailfold capillaroscopy and on a common approach for measuring capillary dimensions in fingers and toes.

Nailfold Capillaroscopy (NFC) is a simple, non-invasive diagnostic tool used to detect microvascular changes in nailfold. Chronic pathological changes associated with a wide range of systemic diseases, such as diabetes, cardiovascular disorders, and rheumatological conditions like systemic sclerosis, can manifest as observable microvascular changes in the terminal capillaries of nailfolds. The current gold standard relies on experts performing manual evaluations, which is an exhaustive time-intensive, and subjective process. In this study, we demonstrate the viability of a deep learning approach as an automated clinical screening tool. Our dataset consists of NFC images from a total of 225 participants, with normal images accounting for 6% of the dataset. This study introduces a robust framework utilizing cascade transfer learning based on EfficientNet-B0 to differentiate between normal and abnormal cases within NFC images. The results demonstrate that pre-trained EfficientNet-B0 on the ImageNet dataset, followed by transfer learning from domain-specific classes, significantly enhances the classifier’s performance in distinguishing between Normal and Abnormal classes. Our proposed model achieved superior performance, with accuracy, precision, recall, F1 score, and ROC_AUC of 1.00, significantly outperforming both models of single transfer learning on the pre-trained EfficientNet-B0 and cascade transfer learning on a convolutional neural network, which each attained an accuracy, precision, recall, and F1 score of 0.67 and a ROC_AUC of 0.83. The framework demonstrates the potential to facilitate early preventive measures and timely interventions that aim to improve healthcare delivery and patients’ quality of life.

Although nailfold capillaroscopy (NFC) appears to have a bright future in clinical practice, the lack of familiarity with the technique and how to interpret its outcomes is major barriers which have made nailfold capillaroscopy an underutilized method in standard clinical practice. Traditional methods for assessment and measurement of capillary patterns, density, and blood flow are falling behind and face some challenges. In fact, there have been calls for improvement, hence the recent publication of the standardization of NFC by the EULAR Study Group on Microcirculation in Rheumatic Diseases. Nailfold capillaroscopy has the advantage of being a non-invasive technique that provides a window into the digital microcirculation. This paved the way for a rapidly growing interest in using capillaroscopy parameters as outcome measures in research. In standard clinical practice, whilst its main application is in the identification of an underlying systemic sclerosis spectrum disorder in patients presenting with Raynaud’s phenomenon, its use has expanded to include other clinical features possibly suggestive of an underlying connective tissue disease. This article presents the challenges, provides tips, and highlights the exciting potential of nailfold capillaroscopy in standard practice.

ObjectivesMicrovascular damage is thought to play a role in the pathogenesis of sarcoidosis. We aimed to evaluate the nailfold capillaroscopy (NVC) pattern to detect microvascular changes in patients with sarcoidosis and the relationship of capillaroscopic parameters with clinical variables and disease-related measurements.Patients and methodsForty-two patients with sarcoidosis and 42 age- and sex-matched patients with systemic sclerosis (SSc) and healthy individuals were included in this cross-sectional case–control study. Patients aged 18–80 years who met the current American Thoracic Society criteria for sarcoidosis were included. NVC was performed by a digital microscope under a magnification of × 200. Capillary density, number of dilated, giant and neoangiogenic capillaries, capillary loop diameter, capillary shape, micro-hemorrhages, and number of avascular areas, were evaluated by an assessor who was blind to the groups allocation.ResultsAmong the capillaroscopic parameters, neoangiogenesis and dilated capillaries, which can be seen in the pattern of scleroderma, were detected in patients with sarcoidosis but not significantly different from the control group (p = 0.055; p = 0.433, respectively). The rate of tortuosity and crossing capillaries of 50% and above was significantly higher in the sarcoidosis group than in SSc and healthy controls (p < 0.05). In patients with sarcoidosis, the only statistically significant finding was; forced expiratory volume (FEV1) in one second was lower in patients with a crossed capillary rate > 50% than in patients with a crossed capillary rate of less than 50% (FEV1; 87.21 ± 19.3, 102.5 ± 14.8, p = 0.04; respectively).ConclusionPatients with a diagnosis of sarcoidosis have different capillaroscopic patterns. The presence of these nonspecific abnormal patterns may reflect microvascular damage in the pathophysiology of sarcoidosis.Key Points• Microvascular damage may play a role in the pathogenesis of sarcoidosis.• There may be some nonspecific abnormal findings in capillaroscopy findings in sarcoidosis.• Capillaroscopy may be valuable in reflecting sarcoidosis lung injury.

Background Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by specific vascular and obstetric manifestations and by antiphospholipid antibodies (aPL) positivity. Microvascular damage in the course of APS and “aPL carrier” patients without symptoms is poorly investigated. Objectives This study aims to compare nailfold videocapillaroscopy (NVC) microvascular parameters in APS patients and non-symptomatic \"aPL carriers\" and to investigate their possible correlations with different aPL subtypes. Methods NVC was performed during standard evaluations in 18 APS patients (mean age 50 ± 13.8 years), 24 \"aPL carriers\" without symptoms (mean age 46.4 ± 16.4 years), and 18 control patients (CTR) (mean age 74 ± 12.5 years) taking oral anticoagulants for non-immunological indications (i.e., cardiovascular accidents). All patients were investigated for the presence of dilated capillaries, giant capillaries, microhemorrhages, capillary loss, and further non-specific/specific abnormalities (i.e., branched “bushy” capillaries, sign of neoangiogenesis) by NVC. Every alteration was also classified according to a semi-quantitative score. Lupus anticoagulant, anticardiolipin antibodies, and antibeta2 glycoprotein I antibodies were tested in each patient. Results APS patients showed at NVC increased frequency of microhemorrhages ( p = 0.039)—particularly a “comb-like” pattern (parallel hemorrhages) ( p = 0.002)—than \"aPL carriers\". Of note, there were no significant differences concerning the isolated number of microhemorrhages between APS and the CTR group ( p = 0.314), but “comb-like” hemorrhages were significantly more frequent in the APS group ( p = 0.034). Not any significant correlation was found between the aPL subtypes and NVC parameters. Conclusions APS patients showed significantly a greater number of non-specific NVC abnormalities than \"aPL carriers\", particularly the “comb-like” NVC pattern. Oral anticoagulants may represent a confounding factor for isolated microhemorrhages. Not any correlation was found between aPL subtypes and NVC parameters. Further investigations are needed to better characterize the microvascular endothelium damage induced by aPL.

Nailfold capillaroscopy is a non-invasive investigation, which allows for the study of the microvasculature (anatomical and functional). Rheumatoid arthritis (RA) is associated with a high risk of cardiovascular atherosclerotic diseases, with endothelial dysfunction (macrovascular and microvascular) representing the first step in atherosclerosis development. The aim of this study is represented by the assessment of microvascular endothelial dysfunction in RA patients by means of nailfold capillaroscopy and to assess its evolution after a period of 12 months of anti TNF-alpha treatment. The study included 70 consecutive patients with RA and 70 healthy subjects, matched for age and gender, as the control group. Rheumatoid factor, anti-cyclic citrullinated peptide antibodies, serum TNF-α, C reactive protein, and erythrocytes sedimentation rate were evaluated in all patients, but in controls, only rheumatoid factor, serum TNF-α, C reactive protein, and erythrocytes sedimentation rate were measured. The RA activity was measured by DAS28. Nailfold capillaroscopy was carried out in all patients and controls, determining the baseline nailfold capillary density (Db), nailfold capillary density during reactive hyperemia (Dh), and nailfold capillary density after venous congestion (Dc). Data were presented as mean ± standard deviation. Statistical analysis was performed using ANOVA and Pearson’s correlation, with p < 0.05 being statistically significant. Db, Dh, and Dc were lower in RA patients than in controls (p < 0.0001), correlating with RA activity and TNF-α (p < 0.05). After 12 months of anti TNF-α treatment, microvascular endothelial dysfunction improved (p < 0.0001). Microvascular endothelial dysfunction can be assessed by nailfold capillaroscopy, with anti TNF-α medication contributing to its improvement.

Nailfold capillaroscopy (NC) is a highly sensitive, safe, and non-invasive technique to assess involvement rate of microvascularity in dermatomyositis and systemic sclerosis. A large number of studies have focused on NC pattern description, classification, and scoring system validation, but minimal information has been published on the accuracy and precision of the measurement. The objective of this review article is to identify different factors affecting the reliability and validity of the assessment in NC. Several factors can affect the reliability of the examination, e.g., physiological artifacts, the nailfold imaging instrument, human factors, and the assessment rules and standards. It is impossible to avoid all artifacts, e.g., skin transparency, physically injured fingers, and skin pigmentation. However, minimization of the impact of some of these artifacts by considering some protocols before the examination and by using specialized tools, training, guidelines, and software can help to reduce errors in the measurement and assessment of NC images. Establishing guidelines and instructions for automatic characterization and measurement based on machine learning techniques also may reduce ambiguities and the assessment time.