Joyal et al graded the severity of changes in nailfold capillaries seen in patients with systemic sclerosis. The authors are from the University of Montreal and University of Toronto in Canada.
Technique: nailfold capillary microscopy
Patient groups studied:
(1) S1 - skin involvement proximal to the metacarpo-phalangeal joint (major ARA criterion)
(2) S2 - 2 or 3 of the minor ARA criteria for systemic sclerosis (sclerodactyly, finger changes or bibasilar pulmonary fibrosis)
(3) S3 - 2 or more CREST criteria
Parameters:
(1) capillary telangiectasia
(2) capillary dilatation
(3) avascular areas (capillary loss)
|
Parameter
|
Finding
|
Code
|
|
capillary telangiectasia
|
absent
|
absent
|
|
|
present
|
present
|
|
capillary dilatation
|
normal (no dilatation)
|
0
|
|
|
1.1 to 1.9 times normal (less than 2 times)
|
1
|
|
|
2 to 4 times normal
|
2
|
|
|
> 4 times normal
|
3
|
|
avasuclar areas
|
none
|
A
|
|
|
rare
|
B
|
|
|
moderate
|
C
|
|
|
extensive
|
D
|
where:
• Venular telangiectasia are excluded.
• There was no specific code for capillary telangiectasia.
|
Telangiectasia
|
Dilatation
|
Avascular Areas
|
Profile
|
|
none
|
none
|
none
|
none
|
|
none
|
0 or 1
|
A or B
|
mild
|
|
none
|
1 to 3
|
B to D
|
moderate
|
|
present
|
1 to 3
|
B to D
|
severe
|
Performance:
• A moderate or severe profile showed a 94% sensitivity for S1 and S2 clinical groups and 70% for S3. A higher profile was associated with a higher disease severity score.
• Telangiectasia is seen in patients with higher disease severity scores.
• Capillary loss and loop enlargement are seen in patients with more severe organ involvement.
