Nailfold Capillaroscopy: A technique to enable earlier intervention

Date: Wed 5th December 2018

In 2010, SRUK awarded a grant to Professor Ariane Herrick and her team at the University of Manchester for research to be conducted on nailfold capillaroscopy, which provides rheumatologists with a non-invasive window into the circulation in the nailbeds of patients.

The primary aim of the study was to validate capillaroscopic imaging as a tool in the clinic to identify and monitor systemic scleroderma (SSc)–related digital vascular disease in patients presenting with Raynaud's phenomenon (RP). This is because the capillaries of the finger nailfold are almost always abnormal in individuals with SSc disorders. Research into this technique directly benefits patients as successful diagnosis using this technique would allow early intervention with new treatments, as well as assessment of these treatments.

A key factor that was taken into account was that the assessment of capillaroscopic images is challenging, as it requires training and can be subjective. It was thus also important to use reliable measures and capillaroscopic parameters. The clinical benefits of this study were that recommendations based on the results could be made to both rheumatologists and to the wider research community. A longstanding question has been if the low-cost, hand-held dermatoscope, which performs a similar function, is as reliable as videocapillaroscopy, as it would be cheaper and quicker to use. Agreed recommendations would mean that either technique would become widely used, increasing the likelihood of diagnosing SSc disorders earlier. Agreed measures of outcome would also allow nailfold capillaroscopy to become standardised as an outcome measure for drug trials targeting small blood vessels, such as remodelling drugs.

The results so far demonstrate that using videocapillaroscopy to obtain images and for image analysis is reproducible, and that nailfold capillaroscopy can provide reliable outcome measures for clinical studies, especially for treatment response trials.

This is a very exciting study as it lays out a path for clinicians to make objective diagnoses and to pre-empt if there is a risk of SSc development, hopefully improving upon diagnostic waiting times. Furthermore, it would be possible to examine if a drug is having advantageous effects on nailfold capillaries. The team are currently focussing on comparing and analysing the images taken with lower magnification dermoscopy and high magnification videocapillaroscopy.

If you are interested in helping SRUK to fund more work like this, then please visit our donations page. We rely on the generosity of our community to continue to support groundbreaking research in both scleroderma and Raynaud's.

If you would like more information on getting diagnosed with scleroderma, please visit: Scleroderma: getting diagnosed.

Information on another piece of new research on scleroderma can be found here: SRUK funding a clinical study to treat fibrosis.