Raynaud's Diagnosis: Nailfold Capillaroscopy

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Primary Raynaud's & Capillaroscopy
Secondary Raynaud's & Capillaroscopy
Photos of Nailfold Capillaroscopy


Magniffyer, Painting by Shelley EnszNailfold capillaroscopy is the best way to tell if someone has primary or seconday Raynaud's. Capillaries are very tiny blood vessels. Capillaries are very close to the surface of the skin, particularly near the base of fingernails.

For nailfold capillaroscopy, the doctor puts drop of oil at the base of each fingernail and then looks at them under a strong magnifier.

Normal patterns indicate primary Raynaud's. Abnormal patterns indicate an underlying connective tissue disease, such as scleroderma, dermatomyositis, or lupus. (Also see What is Raynaud's?, What is Scleroderma?, Types of Scleroderma and Systemic Symptoms)

Arterial stiffness correlates with progressive nailfold capillary microscopic changes in systemic sclerosis (SSc): results from a cross-sectional study. These data suggest that arterial stiffness correlates with microvascular damage in patients with SSc. PubMed, Arthritis Res Ther, 2019 Nov 27;21(1):253. (Also see Vascular Involvement)

Serum klotho concentrations inversely correlate with the severity of nailfold capillaroscopic patterns in patients with systemic sclerosis. In line with previous studies, our findings confirm that klotho plays a role in preventing microvascular damage detected with nailfold capillaroscopy. PubMed, Reumatismo, 2019 Apr 1;71(1):19-23.

An evaluation of two novel capillaroscopy techniques in suspected scleroderma–spectrum disorders: A single–centre cross–sectional study. New technologies could help to improve accessibility to nailfold capillaroscopy, an important diagnostic tool and putative biomarker in scleroderma–spectrum disorders, whilst retaining accurate results. PubMed, Mod Rheumatol, 2017 Dec 20:1-5.

State of the art on nailfold capillaroscopy (NFC) in dermatomyositis (DM) and polymyositis (PM). The overview confirms that NFC is a safe and noninvasive tool able to help the clinician in the diagnosis of DM and PM and to better characterize the phase of disease activity of these patients. PubMed, Semin Arthritis Rheum, 06/28/2017. (Also see Dermatomyositis and Polymyositis)

New tools can potentially play key role in early diagnosis of systemic sclerosis. The results of two studies presented today at the Annual European Congress of Rheumatology (EULAR) 2017 press conference highlight the use of two new tools. News Medical, 06/14/2017. (Also see Antibodies)

Nailfold digital capillaroscopic findings in patients with diffuse and limited cutaneous systemic sclerosis (LcSSc). We found no association between the patterns of capillaroscopy and SSc subtypes; early scleroderma pattern of capillaroscopy was significantly associated with early LcSSc, compatible with the slower course of the disease in LcSSc. PubMed, Reumatologia, 2017;55(1):15-23.

Primary Raynaud's. When Raynaud's appears by itself, without any other medical condition, it is called Primary Raynaud's, or Raynaud's Disease. More than 80% of people with Raynaud's have it by itself, not caused by any serious underlying illness. ISN.

Nailfold Cap. for Primary Raynaud's
Nailfold Capillaroscopy vs. Doppler
HRQOL with Primary Raynauds
Seconday Raynaud's

Secondary Raynaud's and Nailfold Capillaroscopy

Secondary Raynaud's. When Raynaud's appears along with autoimmune diseases such as scleroderma, systemic lupus erythematosus, or rheumatoid arthritis, it is called Secondary Raynaud's, or Raynaud's Phenomenon. ISN.

Diagnosis of Primary vs Secondary
Raynaud's Secondary to Scleroderma
Raynaud's Secondary to Other Diseases

Photos of Nailfold Capillaroscopy

Photo Copyright European Journal of DermatologySystemic scleroderma in a 16-year-old boy: the diagnostic relevance of capillaroscopy and fluorescence video microscopy. Illustrations include pictures of nailfold capillaroscopy in systemic sclerosis (SSc). Abstract and Photo: European Journal of Dermatology. Volume 7, Numéro 5, 381-4.

Handheld Dermatoscope photo, copyright Archives of DermatologyThe Handheld Dermatoscope as a Nail-Fold Capillaroscopic Instrument. The presence of nailfold capillary abnormalities may be useful in diagnosing several connective tissue disorders, including scleroderma, dermatomyositis, and mixed connective tissue disease, and in differentiating primary Raynaud phenomenon from Raynaud phenomenon due to scleroderma and mixed connective tissue disease. Abstract and Photo: Archives of Dermatology. (Also see Common Medical Tests)

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