Nailfold capillaroscopy — SCE Rheumatology MCQ

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ModerateMusculoskeletal InvestigationsNailfold capillaroscopySCE Rheumatology

A 36-year-old woman has new Raynaud's phenomenon with puffy fingers. ANA is positive but ENA is pending. Examination shows no fixed skin thickening. The clinician wants to distinguish primary from secondary Raynaud's and assess early systemic sclerosis risk. What is the most appropriate investigation?

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Correct answer: E — Nailfold capillaroscopy

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

Nailfold capillaroscopy is best because nailfold capillaroscopy can identify a scleroderma pattern in secondary Raynaud's and early systemic sclerosis. B is less suitable because serum urate assesses gout; C is less suitable because DEXA assesses bone density; D is less suitable because anti-CCP assesses RA risk but not Raynaud's microangiopathy; E is less suitable because lumbar radiograph does not assess digital microvasculature. Clinical pearl: abnormal nailfold capillaries plus SSc-specific antibodies are strong predictors of systemic sclerosis evolution.

Reference: BSR systemic sclerosis guideline 2024; EULAR systemic sclerosis recommendations 2024