Objective. To analyze the diagnostic performance and reliability of different parameters evaluated by widefield nailfold capillaroscopy (NFC) with those obtained by videocapillaroscopy in patients with Raynaud's phenomenon (RP). Methods. Two hundred fifty-two individuals were assessed, including 101 systemic sclerosis (SSc; scleroderma) patients, 61 patients with undifferentiated connective tissue disease, 37 patients with primary RP, and 53 controls. Widefield NFC was performed using a stereomicroscope under 10 -25؋ magnification and direct measurement of all parameters. Videocapillaroscopy was performed under 200؋ magnification, with the acquirement of 32 images per individual (4 fields per finger in 8 fingers). The following parameters were analyzed in 8 fingers of the hands (excluding thumbs) by both methods: number of capillaries/mm, number of enlarged and giant capillaries, microhemorrhages, and avascular score. Intra-and interobserver reliability was evaluated by performing both examinations in 20 individuals on 2 different days and by 2 long-term experienced observers.Results. There was a significant correlation (P < 0.000) between widefield NFC and videocapillaroscopy in the comparison of all parameters. Kappa values and intraclass correlation coefficient analysis showed excellent intra-and interobserver reproducibility for all parameters evaluated by widefield NFC and videocapillaroscopy. Bland-Altman analysis showed high agreement of all parameters evaluated in both methods. According to receiver operating characteristic curve analysis, both methods showed a similar performance in discriminating SSc patients from controls. Conclusion. Widefield NFC and videocapillaroscopy are reliable and accurate methods and can be used equally for assessing peripheral microangiopathy in RP and SSc patients. Nonetheless, the high reliability obtained may not be similar for less experienced examiners.

Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma ("SD") pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.

BackgroundVideocapillaroscopy (NVC) is a safe, non-invasive, and cost-effective tool useful in the detection of individuals who are at risk for developing autoimmune rheumatic diseases (ARDs). However, few studies have assessed the use of NVC in the pediatric population.Objectives1. to describe the normal patterns of NVC in healthy children and adolescents in different age groups; 2. to quantify the linear relationship between the age and the capillary dimensions, intercapillary distance and number of capillaries/mm; 3. to evaluate the inter and intraobserver concordance in capillary measurements.MethodsThis was a cross-sectional study including 100 healthy participants aged 5 to 18 years. NVC was performed using the stereomicroscope under 100x magnification. The capillary dimensions (capillary loop length, capillary width and intercapillary distance) and the number of capillaries/mm were evaluated. Three consecutive images were acquired in nine capillaries per individual, totalizing 900 capillaries examined and photographed. Four age groups were studied: 5-7 years (17); 8-10 years (24); 11-14 years (30) and 15-18 years (29). The intra and inter observer agreement were tested in 25% of subjects.ResultsThe capillary dimensions (mean ± SD) were: capillary loop length 278.6±60.3 μm, intercapillary distance 124.1±28.1 μm, capillary width 15.0±2.6 μm. The intercapillary distance was higher in girls (p=0.011). The intercapillary distance remained constant over time (p=0.088). Teenagers between 15 and 18 years had longer (318.7±64.4 μm) and more enlarged (16.2±3.3 μm) capillaries when compared to other age groups (p<0.001 and p=0.012 respectively). There was a significant increase in the number of capillaries/mm with age: 6.1 capillaries/mm (5-7 years); 7.0 (8 to 10 years); 8.0 (11-14 years) and 9.3 (15-18 years) (p<0.001). Additionally, there was a positive correlation between age and the number of capillaries/mm, capillary length, and capillary width (p<0.001, R=0.796; p<0.001, R=0.368; p=0.004, R=0.285, respectively). There was a good intra and interobserver concordance in all capillary measurements. Morphological abnormalities including enlarged capillary (capillary width percentile>97.5) and avascular areas (intercapillary distance percentile>97.5) were present in 11% and 10% of the capillaries respectively. A weak negative correlation was found between the intercapillary distance and the number of capillaries/mm (p=0.05; R=-0.20).ConclusionsThere is a wide variability in the capillary morphology among healthy individuals. There was a positive correlation between age and the number of capillaries/mm, capillary length, and capillary width. There was a significant difference in the capillary length and width between the older and younger participants. In addition, NVC has been showed to be a reproducible method.ReferencesCutolo M, Suli A, Smith V. How to perform and interpret capillaroscopy. Best Pract Res Clin Rheumatol. 2013; 27:237-48.Ingegnoli F, Herrick AL. Nailfold capillaroscopy in pediatrics. Arthritis Care Re...

Early SSc patients showed functional changes and vascular injury marker levels similar to patients with established disease. Nonetheless, the morphological changes were less severe in early SSc, thus providing an opportunity for further prevention of vasculopathy progression.

In this multicentre study in a continental country with different climates, patients with SSc living in a subtropical climate region had a 5.4 times higher risk of developing DUs than patients living in a warmer region (tropical climate), suggesting a more severe course of peripheral vasculopathy among patients living in geographic regions with relatively cold weather.