Architectural Distortion of Nailfold Capillaries: Is it a Predictor of Systemic Vascular Damage?


Fatemah Baron, Rajneet Singh, Amina Gsel, John Carey, Bernadette Lynch


Department of Rheumatology, University College Hospital Galway (UCHG)


The early detection of microvascular changes in autoimmune connective tissue diseases (CTD) is the main goal of using nailfold capillaroscopy (NFC). This method, when used in conjunction with clinical information and autoantibodies is considered a powerful tool for identifying and differentiating CTDs based on microscopic features. CTDs are multisystemic diseases with a myriad of clinical complications including digital ulceration (DU) and pulmonary arterial hypertension (PAH).


To compare the spectrum of NFC findings with autoantibody profile, clinical diagnosis and systemic involvement to identify any association with the degree of NFC findings and the clinical complications of the underlying CTD.


A single center, retrospective, observational study, which evaluated patients who attended NFC clinic between Feb 2017 and July 2018. All patients were evaluated by a rheumatologist prior to attending the clinic and had immunology workup performed. At appointment, patients underwent detailed NFC evaluation through the acquisition of images from eight fingers (excluding thumbs). All the images were performed by a single examiner and images were interpreted by two rheumatologists. A qualitative assessment of video NFC was generated focussing on the presence or absence of avascular areas, haemorrhages, haemosiderin deposition, giant loop capillaries and architectural distortion.


91 patients were investigated with video NFC. Seven of 91 patients had architectural distortion, of whom six had a clinical diagnosis of Systemic Sclerosis (SSc) and one had a clinical diagnosis of undifferentiated CTD. Of the seven patients with complete architectural distortion, four patients had vascular complication; two had PAH and two had DU. PAH and DU was not described in any other patient in this cohort. Of the seven patients with complete architectural distortion, five were anticentromere (ACA) antibody positive.


NFC explores microvascular damage of the nailbeds. Architectural distortion on NFC is seen almost exclusively in SSc and had a strong association with PAH and DU, which are severe systemic manifestations of vascular damage. Further longitudinal studies with a larger sample size are warranted to investigate the assocation between microvascular damage of the nailbeds and systemic vascular damage leading to PAH and DU. Is architectural distortion a harbinger of PAH and DU in CTDs?