Longitudinal nailfold capillaroscopy tracking of microangiopathic changes in systemic sclerosis

A 51-year-old female with a 20-year history of lcSSc (RP, sclerodactyly, digital pitting, ACA, abnormal nailfold capillaries) had no history of digital ulceration but developed calcinosis of several fingers. RP was relatively mild.

Regular high-magnification (300×) capillaroscopic assessment (for research purposes) was recorded from 2002, ∼4 years post-diagnosis. The microscope system used throughout was a modified KK Technology system, Honiton, Devon, UK, with green LED illumination for maximum contrast and custom software allowing whole-nailfold mosaic images to be captured [1]. Seven images of the non-dominant ring finger were captured during the 9.9 year period ending August 2012 (See Fig. 1).

The image sequence describes the progression of the nailfold microvasculature from an early/active scleroderma pattern [2] initially, with many enlarged and giant capillaries, through a period of relative avascularity, concluding with evidence of neoangiogenesis by the final image, and demonstrates the potential of capillaroscopy as a biomarker of microvascular disease. This tracking of change is possible via the image capture system, which combines high magnification with a whole nailfold view. Capillaroscopy provides a unique non-invasive window into evolution of SSc pathogenesis over time: in this patient, microvascular disease progression might be driving development of calcinosis.