Videocapillaroscopy

• Videocapillaroscopy (VC) is imaging of nailfold capillaries by computerized light microscopy. Fingers 2-5 in both hands are examined, assessing the number, structure and form of blood vessels, and the number and type of haemorrhages (see pictures).
• The examination is safe and painless. It is done by a rheumatologist with expertise in the method.
• Capillaries can be examined to confirm clinical suspicion of disease, assess the prognosis and check the effectiveness of treatment
• VC should be done for all new patients over 30 with Raynaud's phenomenon.
• VC is interpreted considering the clinical situation and antibody findings.
• VC is the best screening method presently available.

A. Normal capillaries. The capillaries are narrow, hairpin-shaped and arranged in a neat pattern alongside each other with more than 9 capillaries per millimetre. The picture shows normal nailfold capillaries 220 times magnified.

B. Active systemic sclerosis. There are no normal hairpin-shaped capillaries. The number of capillaries is reduced, and they are dilated and thickened.

C. Normal capillaries are missing. Advanced systemic sclerosis. There are no normal hairpin-shaped capillaries. There are 3 deformed capillaries per millimetre. There is a microthrombus inside capillary number 2.

D. Bleeding and fibrosis, no normal capillaries. Advanced systemic sclerosis. There are no normal hairpin-shaped capillaries. The capillaries are partly footprint-shaped, and the shapes vary. There is a fresh haemorrhage centrally in the picture. Blood has oozed down towards the nail in a laminar pattern. There is fibrosis between the capillaries.

Pictures and text: Riitta Luosujärvi