Nailfold capillaroscopy: tips and challenges

Clin Rheumatol. 2022 Dec;41(12):3629-3640. doi: 10.1007/s10067-022-06354-1. Epub 2022 Aug 30.


Although nailfold capillaroscopy (NFC) appears to have a bright future in clinical practice, the lack of familiarity with the technique and how to interpret its outcomes is major barriers which have made nailfold capillaroscopy an underutilized method in standard clinical practice. Traditional methods for assessment and measurement of capillary patterns, density, and blood flow are falling behind and face some challenges. In fact, there have been calls for improvement, hence the recent publication of the standardization of NFC by the EULAR Study Group on Microcirculation in Rheumatic Diseases. Nailfold capillaroscopy has the advantage of being a non-invasive technique that provides a window into the digital microcirculation. This paved the way for a rapidly growing interest in using capillaroscopy parameters as outcome measures in research. In standard clinical practice, whilst its main application is in the identification of an underlying systemic sclerosis spectrum disorder in patients presenting with Raynaud's phenomenon, its use has expanded to include other clinical features possibly suggestive of an underlying connective tissue disease. This article presents the challenges, provides tips, and highlights the exciting potential of nailfold capillaroscopy in standard practice.

Keywords: Blood flow; Challenges; Connective tissue disease; Microangiopathy; Musculoskeletal diseases; Nailfold capillaroscopy (NFC); Raynaud’s phenomenon; Standards; Systemic sclerosis; Tips.

Publication types

  • Review

MeSH terms

  • Capillaries / diagnostic imaging
  • Connective Tissue Diseases* / diagnostic imaging
  • Humans
  • Microscopic Angioscopy / methods
  • Nails / blood supply
  • Nails / diagnostic imaging
  • Raynaud Disease* / diagnostic imaging
  • Scleroderma, Systemic* / diagnostic imaging