Background/Purpose: Nailfold capillaroscopy is a fundamental tool in rheumatology for assessing capillary morphology, allowing the differentiation between primary and secondary Raynaud’s phenomenon, identifying risks associated with systemic sclerosis, and exploring vascular alterations in various autoimmune diseases. This study aimed to describe capillaroscopic patterns in a cohort of patients with autoimmune disorders.

Methods: A cross-sectional, observational, and descriptive study was conducted in 136 patients with autoimmune rheumatic diseases. Sociodemographic, clinical, and capillaroscopic data were collected using the RedCap platform; images were obtained with the Smart G-Scope device and processed using Capillary.io software. Statistical analysis was performed using STATA 18.

Results: The cohort included 136 patients, mostly women (86.76%), with a median age of 59 years. Systemic sclerosis was the most prevalent disease (50.74%), followed by Sjögren’s syndrome and systemic lupus erythematosus; 24.2% presented with polyautoimmunity. Pulmonary arterial hypertension (PAH), confirmed or suspected, was found in 25 patients (18.3%). Capillary dilations (91.91%), giant capillaries (51.47%), and decreased capillary density (41.98%) were documented, particularly in systemic sclerosis. Microhemorrhages were observed in 58.82% of patients, most frequently in those with systemic sclerosis (49 out of 69 patients, 71.01%), followed by inflammatory myopathy (3 out of 5 patients, 60%) and Sjögren’s syndrome (16 out of 29 patients, 55.17%). Tortuosity was the most frequent morphological abnormality (26.47%) (See Table). In inflammatory myopathy, all patients exhibited at least one type of abnormal capillary morphology, with arborized capillaries being the most common. Systemic sclerosis, in turn, showed the greatest diversity and number of abnormal capillary forms. The most frequently observed pattern was nonspecific, followed by the active pattern in systemic sclerosis and inflammatory myopathies. The nonspecific pattern (n=50, 36.76%) was the most common overall, prevalent in all diseases except systemic sclerosis and inflammatory myopathy, where the active pattern predominated (n=27, 39.13% and n=3, 60%, respectively), reflecting greater microvascular aggressiveness in these conditions. Patients with positive ANAs had reduced capillary density (Fisher’s exact = 0.018), as did those with polyautoimmunity (p = 0.043), who also showed a higher number of microhemorrhages per millimeter (p = 0.020). Patients with PAH exhibited a higher number of capillary dilations per millimeter (p = 0.022) and reduced capillary density (≤6 capillaries/mm; p = 0.0444).

Conclusion: These findings support the use of videocapillaroscopy as a diagnostic and prognostic tool not only in systemic sclerosis but also in broader autoimmune contexts like polyautoimmunity and PAH.

Summary of the frequencies of the most relevant capillaroscopic findings in autoimmune diseases

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/capillaroscopic-signatures-in-autoimmune-rheumatic-diseases-unveiling-patterns-in-systemic-sclerosis-polyautoimmunity-and-pah/