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Background. Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterized by inflammation of the muscle with clinical manifestations such as skin rash, interstitial lung disease, heart involvement or arthritis. Within IIM, we distinguish dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM), anti-synthetase syndrome (ASyS), inclusion body myositis (IBM), and Polymyositis (PM). Nailfold video-capillaroscopy (NVC) is a useful technique to study microvascular abnormalities in autoimmune diseases and a scleroderma-like (SL) pattern has been reported in about 70% of DM patients and in 35% of those with ASyS. Histologically, muscular findings are shared across IIM subgroups, such as sarcolemmal expression of MHC I and inflammatory infiltrates. Others are more specific: perifascicular atrophy (PFA) in DM or perifascicular necrosis (PFN) in ASyS. The aim of our study was to evaluate qualitatively and quantitatively the capillaroscopic alterations in IIM patients, for their possible associations with histological data.   Materials and Methods. Patients with IIM who underwent muscle biopsy and NVC were prospectively enrolled. Morphological parameters were assessed qualitatively (number, length, distribution, and size of capillary loops, as well as microhemorrhages and neoangiogenesis). We also assigned a semiquantitative score (0–3) and other quantitative scores (total megacapillary count, mean of megacapillaries apex width, mean capillary density, number of hemorrhages, and mean of avascular areas).   Results. We enrolled 20 patients including 9 with DM, 4 with ASyS, and 7 with PM. Table 1 presents the main clinical, histological, and capillaroscopic features of our cohort. Regarding capillaroscopic findings, we observed a significant association between the presence of a SL pattern and DM diagnosis (p=0.0098). Comparing the biopsies regardless of the type of idiopathic inflammatory myopathy (IIM), we observed a higher mean semiquantitative score in patients exhibiting perifascicular fiber hypotrophy compared to those without (mean 2, IQR 0–2 vs mean 0, IQR 0–1;p=0.0359), as well as a significant association with the presence of an SL pattern (p=0.0246). This group of patients also showed a marked reduction in capillary density (p=0.0190) and an increased mean number of avascular areas (p=0.0058). ASyS patients displayed a significant association with perifascicular necrosis (p=0.0010), consistent with previous reports, but also with perifascicular fiber hypotrophy (p=0.0260), whereas we did not confirm the described association with DM.   Conclusions. To our knowledge, this study is the first to explore the relationship between NVC findings and muscle biopsy features in IIM patients using both qualitative and quantitative methods. Our data suggest a link between perifascicular muscle fiber hypotrophy—where muscle vasculature damage is believed to originate—and specific capillaroscopic abnormalities in DM and ASyS cases. Expanding our understanding of the underlying peripheral vasculopathy in the different forms of IIM requires a larger patient cohort and a deeper histological evaluation of muscular and vascular injury.

Background. Nailfold videocapillaroscopy (NVC) is a validated, non-invasive tool for evaluating microvascular ab-normalities, increasingly explored in interstitial lung diseases (ILDs) with suspected autoimmune fea-tures. However, data on capillaroscopic patterns across ILD subtypes, especially in Caucasian popu-lations, are limited. Objectives: To compare NVC findings in patients with idiopathic pulmonary fibrosis (IPF), interstitial pneumonia with autoimmune features (IPAF), and connective tissue disease-associated ILD (CTD-ILD), and to assess correlations with autoantibody status—particularly myositis-specific antibodies (MSA – Jo-1, KS, PL7/PL12, NXP-2, MDA-5).   Materials and Methods. Fifty-nine Caucasian ILD patients underwent NVC during routine evaluation. Based on multidiscipli-nary diagnosis, they were classified as IPF (n=9), IPAF (n=10), or CTD-ILD (n=40), further subdivided into systemic sclerosis (SSc, n=20) and non-SSc CTD-ILD (n=20). A validated 6-item semiquantitative scoring system (range 0–3 per item, max 18) was used; individual items are listed in Table 1. Clinical data included demographics and autoimmune serology (ANA, ENA, MSA). Statistical comparisons employed ANOVA and Student’s t-test.   Results. Total capillaroscopic scores differed significantly across diagnostic groups: CTD-ILD (6.1±3.09), IPAF (4.6±3.31), and IPF (3.4±1.74) (p=0.0042). Within CTD-ILD, SSc patients showed higher scores than non-SSc (7.4±2.87 vs 4.8±3.22; p=0.0105). A four-group comparison confirmed this trend (p=0.0042). Among individual items, only “loss of capillaries” differed significantly across groups (p<0.0001), with highest scores in SSc. Subsequently, the total capillaroscopic score was analyzed in relation to autoimmune serology: it was not significantly different between MSA+ and MSA- pati-ents (5.21±3.51 vs 5.51±3.17; p=0.7805). After excluding the 9 patients with IPF, the comparison between MSA+ and MSA- subjects still revealed no significant difference in total score (5.21±3.51 vs 5.95±3.25; p=0.5052).   Conclusions. Nailfold videocapillaroscopy reveals distinct microvascular alterations among ILD subtypes, with sig-nificantly higher scores in CTD-ILD—particularly in SSc—compared to IPAF and IPF. While no signifi-cant differences emerged in relation to MSA, the observed gradient in capillaroscopic severity across autoimmune categories underscores the potential value of NVC as a complementary tool in the early diagnostic workup of ILD, especially in identifying autoimmune-driven forms and possibly refining IPAF classification. These findings support the integration of capillaroscopy into multidiscip-linary ILD assessment, where it may assist in detecting early autoimmune features and guiding im-munological testing. Moreover, expanding the cohort in future studies may help uncover more ro-bust associations between NVC findings and specific autoantibody subsets, particularly MSA.

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.

Percentages of capillaroscopic changes and average percentage of finger involvement Condition Enlarged Capillaries % (APFI) Avascular Areas % (APFI) Tortuous-Twisted Capillaries % (APFI) Ramified-Bushy Capillaries % (APFI) Hemorrhages % (APFI) Primary RP – – 77.8 (2.94) 5.6 (0.05) 22.2 (0.33) SLE – 7 (0.07) 78.6 (3) 21.4 (0.28) 21.4 (0.28) RA 8.3 (0.08) – 75 (3.08) 33.3 (0.41) 50 (1) SSc 71.4 (2.85) 85.7 (5) 71.4 (1.78) 42.9 (1.92) 64.3 (2.14) Primary SS 42.9 (1.71) 14.3 (0.28) 85.7 (4) 14.3 (0.14) 57.1 (1.28) UCTD 57.1 (1.71) 28.6 (1.57) 100 (2.14) 28.6 (0.42) 71.4 (2.14) Control Group – – 84.8 (2.24) 3 (0.03) 27.3 (0.45) Primary RP Primary raynaud's phenomenon, SLE Systemic lupus erythematosus, RA Rheumatoid arthritis, SSc:Systemic sclerosis (SSc),Primary SS Primary sjögren's syndrome, UCTD Undifferentiated connective tissue disease, Average Percentage of Finger Involvement (APFI) Capillaroscopic examination showed that the 4th and 5th fingers on both hands were the most clearly observed (TableS1). Limitations of the study included a small sample size and the lack of evaluation of capillary changes over time. [...]this study demonstrates that a computerized dermatoscope can be effectively used for capillaroscopic examination, supporting the integration of modern technology into clinical practice.

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.

Nailfold capillaroscopy (NFC) has gained remarkable interest among rheumatologists because of its utility in both clinical practice and research activity. Nevertheless, there has been scarce attention on its potential in other rheumatic disorders such as vasculitis. We perform a systematic review of literature on NFC in noninfectious vasculitides, with the aim to provide an overview of the main NFC changes described, to discuss the current evidence supporting its clinical impact and applications in daily practice and to provide future research fields.

Background Rosacea is a chronic inflammatory skin condition characterized by facial erythema, telangiectasia, and papules. Although clinical assessment is essential for diagnosis, objective criteria for evaluating severity are lacking. This study aimed to investigate the relationship between rosacea severity, disease duration, and associated microvascular changes through oral mucosal capillaroscopy. Methods This cross‐sectional case–control study included patients with rosacea and healthy controls. Oral capillaroscopy was performed to evaluate capillary morphology, analyzing parameters such as capillary arrangement (regular or irregular), presence of dot vessels, microhemorrhages, glomerular vessels, megacapillaries, tortuous vessels, areas of discoloration, and hyperkeratosis. Results A total of 100 patients diagnosed with rosacea and 100 healthy controls were included in the study. Oral capillaroscopic findings revealed significantly higher rates of family history of rosacea and tortuous capillaries in the patient group. Patients with microhemorrhages exhibited a longer disease duration. No significant differences in tortuous capillary positivity were found between the papulopustular and erythematotelangiectatic subtypes; however, phymatous rosacea demonstrated no positive findings. Additionally, moderate‐severity patients had lower rates of microhemorrhage positivity, whereas the presence of tortuous capillaries increased with severity. Conclusion Oral mucosal capillaroscopy is a valuable tool for assessing microvascular damage in rosacea and may serve as a diagnostic and prognostic marker for effective management.

ObjectiveThe aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice.MethodsA written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina.ResultsThe participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus.ConclusionThis is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique.Key Points• The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases.• This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology.• The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.

Systemic sclerosis (SSc) is a connective tissue disease affecting the skin and multiple organs. Most of the evidence on ocular involvement comes from small studies. We evaluated the retinal vascular changes in patients with SSc and its associations with types, disease duration, skin score, and nailfold capillaroscopy changes. We evaluated the demographic, clinical and nailfold capillaroscopy data of 52 patients referring to the clinic of scleroderma with SSc according to the 2013 ACR/EULAR SSc criteria. In addition, full ophthalmic examination in 52 patients and fundus photography in 40 patients were done in the ophthalmology clinic. There were 52 (49 women and 3 men, 17 diffuse and 35 limited) patients with SSc with mean disease duration of 8 ±5 years and mean age of 40 ±9 years. Retinal changes in the ophthalmologic examination were seen in 30.7% as increased vascular tortuosity. None of the patients had cotton wool spot, hemorrhage or hard exudate. Forty patients underwent fundus photography and 22.5% of them had vascular tortuosity. Only the presence of hemorrhage in the nailfolds was correlated with retinal tortuosity, and the other characteristics of nailfold capillaroscopy did not have any association with retinal changes. Retinal vascular changes were seen in about one third of our patients. There was no correlation between nailfold capillaroscopy, disease duration, type and skin score of SSc patients and retinal vascular changes. These findings suggest that the mechanisms or the quality of changes in the retinal vessels and nailfold vasculature may be different.

To investigate the correlations between finger microvascular morphology and function in patients with systemic sclerosis (SSc) and the status of ocular microcirculation, as detected by nailfold videocapillaroscopy (NVC), laser speckle contrast analysis (LASCA), and optical coherence tomography angiography (OCTA). The enrollment included 32 SSc patients, classified according to the 2013 ACR/EULAR criteria, and 27 sex- and age-matched healthy controls. The participants underwent comprehensive rheumatological and ophthalmological examinations, as well as NVC, LASCA, and OCTA analysis on the same day at a single center from March to October 2022. SSc patients receiving intravenous prostanoids cycles were assessed at least 1 month after infusion. Statistical analysis was conducted using Stata® 15.1. Significant direct correlations were observed between the mean capillary number (at NVC) and the mean perfusion of fingers (at LASCA) with the retinal and choroidal perfusion (at OCTA) (all p < 0.05). In addition, a significantly reduced retinal and choroidal perfusion was detected in SSc patients vs controls (all p < 0.05). Interestingly, diffuse cutaneous SSc (dcSSc) patients exhibited a lower choroidal perfusion (p = 0.03) but an increased choroidal thickness (CT) than limited cutaneous SSc patients (p < 0.001). CT was increased also in patients with positive Scl70 antibodies and with a history of digital ulcers directly correlating with disease duration (r = 0.67, p = 0.001). Finally, the combination of LASCA and OCTA parameters showed a significant discrimination capacity between SSc patients and controls, with an area under the curve of 0.80 [95% CI (0.74, 0.87)]. Peripheral microvascular damage is correlated with impaired ocular microcirculation in SSc. The increased choroidal thickness observed in dcSSc may be related to local sub-endothelial extracellular matrix deposition. The combined analysis of choroidal and fingertip perfusion offers preliminary insights that may complement traditional diagnostic methods for SSc.