Nailfold Videocapillaroscopy Is a Useful Tool to Recognize Definite Forms of Systemic Sclerosis and Idiopathic Inflammatory Myositis in Interstitial Lung Disease Patients

Abstract

Nailfold videocapillaroscopy (NVC) is an easy tool used for the assessment of patients with Raynaud’s phenomenon (RP) as possibly associated with systemic sclerosis (SSc). Recent insights have also highlighted its role in the diagnostic assessment of idiopathic inflammatory myopathies (IIMs). The aim of this study is to describe the diagnostic role of NVC in a series of 361 consecutive patients with interstitial lung disease (ILD). All the patients were assessed by clinical pulmonary and rheumatic examinations, blood exams, high-resolution computed tomography and NVC. NVC was considered positive only in the presence of avascular areas or giant capillaries, but also, the presence of bushy capillaries (BCs) was recorded. NVC was positive in 17.7% of ILD patients and in 78.1% of ILD patients associated with a diagnosis of connective tissue disease (CTD). In 25% of SSc-ILD patients, NVC proved necessary for a correct diagnosis. The presence of BCs and/or NVC positivity in ILD patients with normal levels of creatine phosphokinase is associated with amyopathic IIM, regardless the presence of RP. In conclusion, NVC is useful for the diagnostic assessment of incomplete forms of CTD and in amyopathic IIMs. NVC should be considered in the diagnostic assessment of ILD patients regardless of the presence of RP.

Interstitial pneumonia with autoimmune features: challenges and controversies

“…Additionally, the IPAF cohort of AHMAD et al [26] was notable for a number of patients with abnormal nailfold capillaroscopy and salivary gland biopsy, investigations not typical of a pulmonologist. In fact, abnormal nailfold capillaroscopy, together with the presence of ILD, may be sufficient to satisfy SSc diagnostic criteria (table 3), removing such cases from the IPAF entity [27]. LEVI et al [28] observed that, following rheumatological review, 40% of selected ILD multi-disciplinary meeting cases received a rheumatology-related ILD diagnosis, including IPAF.…”

Nailfold capillaroscopy by smartphone-dermatoscope for connective tissue disease diagnosis in interstitial lung disease: a prospective observational study

“…These data raise the important question of how to define "abnormal" NFC in ILD populations. Capillaroscopy studies in non-CTD ILD populations are limited, but prior IIP cohorts have reported major nailfold abnormalities in 5.7% to 46.7% [25][26][27]. No non-CTD ILD patients with nailfold abnormalities developed a definable CTD during our study, recognising that diagnostic CTD features can develop many years after ILD onset [2].…”

Idiopathic inflammatory myopathies: one year in review 2021

“…The presence of bushy capillaries and/or NVC positivity in ILD patients with normal levels of creatine phosphokinase is associated with amyopathic IIM, regardless the presence of Raynaud's phenomenon (54).…”

“…dominant involvement on WB-MRI (50, 51). • Specific NVC alterations are associated with different clinical phenotypes (53,54). • Cricopharyngeal bar on VFS has a high specificity for IBM and seem to be a risk factor for aspiration pneumonia (56,57).…”