Video Nailfold Capillaroscopy: A Single Centre Experience.
Fatemah Baron, Rajneet Singh, Amina Gsel, John Carey, Bernadette Lynch
Department of Rheumatology, University College Hospital Galway (UCHG)
Nailfold capillaroscopy (NFC) is a simple, non-invasive, sensitive and low-cost imaging method used to detect early microvascular changes of capillaries in the nailfold area in association with some connective tissue diseases (CTD). When used together, autoantibodies and capillaroscopy findings are generally accepted as a powerful diagnostic tool for detecting emerging CTDs in patients with Raynaud’s phenomenon (RP). Nowadays, it is commonly used in the differentiation of primary and secondary RP and in the diagnosis of Systemic Sclerosis (SSc).
To evaluate the role of NFC in the early diagnosis of CTD.
In this single centre, retrospective, observational cohort study, we evaluated patients who attended NFC clinic between Feb 2017 and July 2018. Patients referred from outside the Rheumatology department of our centre were excluded. All patients were evaluated by a rheumatologist prior to attending the clinic and had immunology workup performed. At appointment, patients underwent detailed video NFC evaluation through the acquisition of images from eight of ten fingers (excluding thumbs). All the images were performed by a single examiner and images were interpreted by two rheumatologists.
77 patients were included in this study, 60 female and 17 male patients. 79% of the studies were reported as abnormal. Almost one-third of patients were discharged from the service following analysis of video NFC in conjunction with clinical history and examination and results of immunology testing. The commonest diagnosis post Video NFC was Undifferentiated CTD (25% of patients) and SSc (25% of patients).
Video NFC is a valuable tool in supporting early diagnosis of a CTD. It should be included in the work-up algorithm for patients with Raynaud's phenomenon or/and those with features of early CTD. Further studies are required to explore its utility in excluding CTD and facilitating early discharge of patients from Rheumatology clinic.