Nailfold Capillaroscopy in Rheumatological Diseases

Nailfold capillaroscopy allows non-invasive assessment of the finger microvasculature. At the nailfold, capillaries run parallel rather than perpendicular to the skin surface, allowing their structure to be visualised under magnification.

The main clinical indication for nailfold capillaroscopy is the assessment of the patient with Raynaud’s phenomenon (RP). Normal nailfold capillaries are reassuring, consistent with primary (‘benign’) RP, whereas abnormal capillaries (dilated capillaries, reduced capillary density) raise suspicion of an underlying systemic sclerosis-spectrum disorder. Although the significance of abnormal nailfold capillaries was recognised over 50 years ago, only within the last 20 years has there been a surge of interest in capillaroscopy, fuelled by the recognition that abnormal nailfold capillaries are an independent risk factor for development of systemic sclerosis and by abnormal nailfold capillaries being included in the 2013 classification criteria for systemic sclerosis. The increased interest in nailfold capillaroscopy is evidenced by capillaroscopy courses of the British Society for Rheumatology and of EULAR being over-subscribed.

This textbook is aimed primarily at rheumatologists diagnosing connective tissue disease (i.e. the majority of rheumatologists) and who undertake/wish to undertake nailfold capillaroscopy. The book is also of interest to scientists with an interest in the microvasculature. It provides an authoritative guide which allows the reader to feel confident in their clinical practice, and to understand the background to nailfold capillaroscopy and its ongoing potential. Topics discussed include the indications for nailfold capillaroscopy, how to acquire and interpret images (including the different methodologies), capillary abnormalities found in different connective tissue diseases (especially systemic sclerosis and dermatomyositis), progress in quantitative and automated analyses, and capillaroscopic research. Finally, a series of case histories is presented to put into context the role of capillaroscopy in diagnosis and in predicting risk.

Ariane Herrick is Professor of Rheumatology at the University of Manchester: Honorary Consultant Rheumatologist at the Northern Care Alliance NHS Foundation Trust: Consultant Rheumatologist, NHS Grampian: Honorary Clinical Professor at the University of Aberdeen. Her main clinical and research interests are Raynaud's phenomenon, systemic sclerosis-spectrum disorders, and assessment of the microvasculature (including nailfold capillaroscopy).

Andrea Murray is Senior Lecturer at the University of Manchester, Centre for Musculoskeletal Research, the Photon Science Institute and the NIHR Manchester Biomedical Research Centre. She is a physicist with a major interest in light-tissue interaction. She has a longstanding interest in nailfold capillaroscopy.

Chris Taylor is Professor of Medical Biophysics and Professor of Computer Science at the University of Manchester. His core research is in computer vision and medical image analysis. He has a well-established interest in nailfold capillaroscopy, with a particular focus on quantitative and automated analysis.  He has a long history of involvement in technology transfer.

Vanessa Smith is Head of Clinics at the Ghent University Hospital since 2011 and Full Professor of Rheumatology at the Ghent University  Professor Smith is steering committee and founding member of the European Commission Reference Network on Rare CONnective tissue and complex musculoskeletal diseases NETwork (ERN- ReCONNET) since 2016 and executive board member of ERN- ReCONNET as coordinator of systemic sclerosis since 2017. She serves as Belgian national expert contact point for Health Authorities and is the chair of the Flemish network for rare connective tissue diseases. Professor Smith currently holds a position as Senior Clinical Investigator of the Research Foundation – Flanders, and is the chair of the EULAR study group on Microcirculation in Rheumatic diseases. She is an organizing/scientific board member of the 2nd up the 14^th EULAR courses on capillaroscopy and chairs the EULAR network of training and research, Ghent center for microcirculatory imaging. Since 2020 Prof. Smith is member of the scientific organizing committee of the Systemic Sclerosis World Congresses as well. At the same time, Professor Smith is co-editor of several books, as well as co-author of book chapters and several manuscripts on SSc/microcirculation (more than 350 publications with a disease specific H-index of 60).

Maurizio Cutolo is Professor of Rheumatology and Internal Medicine, Director of the Laboratories of Experimental Rheumatology and Senior Consultant of the Academic Division of Clinical Rheumatology, University of Genova, Italy. MC is former President of the European Alliance of Associations for Rheumatology (EULAR) and Chairman of the International League of Associations for Rheumatology (ILAR). MC is Chairman of the Scientific Commission of the Italian Society for Rheumatology (SIR), Advisor of the EULAR School of Rheumatology Education Committee (EsOR) and International Adviser of the American College of Rheumatology (ACR). MC was awarded ACR Master (MACR) and EULAR Meritory Service in Rheumatology. MC serves as Deputy-Chair of the European Commission network on Rare and Complex Connective Tissue Disease (ReCONNET-ERN) and is chair of the ERN ReCONNET WG on Education & Training. MC is author-coauthor of more than 800 publications (PUB MED) and his H index is 104 (Scopus) and 129 (Google Scholar).