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Normal Capillaroscopy — SCE Rheumatology MCQ

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EasyMusculoskeletal ImagingNormal CapillaroscopySCE Rheumatology

A 50-year-old man undergoing assessment for possible secondary Raynaud phenomenon has nailfold capillaroscopy. This shows regularly arranged capillary loops with preserved density and no giant capillaries, haemorrhages or avascular areas. Which interpretation is most appropriate?

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Correct answer: D — It lowers the probability of systemic sclerosis but does not exclude it or another connective tissue disease

A normal nailfold capillaroscopic pattern makes systemic sclerosis (SSc) less likely because SSc typically produces a scleroderma pattern comprising giant capillaries, microhaemorrhages, capillary loss and disorganised neoangiogenesis. In a UK Raynaud cohort, absence of an SSc pattern had a negative predictive value of approximately 90% for SSc-related criteria. It therefore reduces probability rather than absolutely excluding SSc. Nor does it confirm primary Raynaud phenomenon: the result must be integrated with history, examination, ANA and SSc-specific antibodies. Other connective tissue diseases may also occur without a scleroderma pattern. Thus B and D overstate exclusion, while A and E incorrectly treat capillaroscopy as independently diagnostic.

Reference: Bissell LA et al. Absence of Scleroderma pattern at nail fold capillaroscopy valuable in the exclusion of Scleroderma in unselected patients with Raynaud's Phenomenon. BMC Musculoskeletal Disorders. 2016;17:342. https://pubmed.ncbi.nlm.nih.gov/27526772/