Capillaroscopy in Systemic Autoimmune Rheumatic Diseases: A Clinical Tool Linking Diagnosis and Pathogenesis

Authors

  • Roko P.A. Nikolic, MD University of Calgary Division of Rheumatology, Calgary, Canada
  • Maggie Larché, MBChB, PhD, MRCP (UK) University of Calgary Division of Rheumatology, Calgary, Canada Arthritis Research Canada, Vancouver, Canada
  • Mohammed Osman, MD, PhD, FRCPC University of Alberta Division of Rheumatology, Edmonton, Canada Li Ka Shing Institute of Virology, Women and Children’s Health Research Institute

DOI:

https://doi.org/10.58931/crt.2025.2157

Abstract

Systemic autoimmune rheumatic diseases (SARDs) including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and idiopathic inflammatory myopathies (IIMs) are multisystemic, potentially life-threatening autoimmune diseases. These diseases are associated with the highest frequency of disease-associated morbidity and mortality among rheumatic diseases, largely because their complex pathophysiology remains poorly and incompletely understood. Mortality in SARDs is associated with profound vascular dysfunction ranging from cardiovascular disease to more discreet localized vascular complications including Raynaud’s phenomenon (RP), digital ulcers, and pulmonary arterial hypertension (PAH). These vascular complications stem from damage to endothelial cells caused by immune complex deposition, platelet activation, autoantibodies that promote thrombosis (e.g., antiphospholipid antibodies), and immune dysregulation.

The relationship between endothelial cell dysfunction and SARDs was first recognized by Maurice Raynaud in the 19th-century, particularly in the context of localized digital ischemia and gangrene. RP is a frequently-encountered problem in clinical practice, with a prevalence in the general population ranging from approximately 5–18%. While most cases of RP are not associated with SARDs, patients with SARDs commonly experience RP. This underscores the importance of vasculopathy related to endothelial dysfunction in the pathogenesis of SARDs.

RP is often the earliest presenting feature in up to 20% of patients with SARDs. Indeed, greater than 95% of patients with SSc experience RP.11 Patients with SLE, IIMs including anti‑synthetase syndrome (ASyS), and Sjögren’s disease are also commonly affected. Hence, a closer evaluation for microvascular changes is paramount in the clinical assessment of patients with SARDs. This article will review how nailfold video capillaroscopy is emerging as a valuable point-of-care tool for diagnosis and risk stratification by providing a window into the underlying endothelial dysfunction observed in these conditions.

Author Biographies

Roko P.A. Nikolic, MD, University of Calgary Division of Rheumatology, Calgary, Canada

Dr. Roko Nikolic is currently completing his residency in internal medicine at the University of Calgary, where he will also begin his rheumatology residency training in July 2025. Dr. Nikolic studied biochemistry at the University of Victoria and completed his medical education at the University of Calgary. His interests include systemic autoimmune rheumatic diseases, nailfold video capillaroscopy, clinical practice guidelines, patient-centred care, and medical education. He has contributed to the development of several national clinical practice guidelines in rheumatology with the Canadian Rheumatology Association.

Maggie Larché, MBChB, PhD, MRCP (UK), University of Calgary Division of Rheumatology, Calgary, Canada Arthritis Research Canada, Vancouver, Canada

As the director of the Canadian Scleroderma Research Group, a clinician‑scientist, and a Professor at the University of Calgary, Dr. Maggie Larché has successfully established and maintained educational and research initiatives in systemic sclerosis (SSc) across Canada. With over 15 years of experience treating patients with SSc, she is well-placed to understand the need for improved biomarkers, including video nailfold capillaroscopy.

Mohammed Osman, MD, PhD, FRCPC, University of Alberta Division of Rheumatology, Edmonton, Canada Li Ka Shing Institute of Virology, Women and Children’s Health Research Institute

Dr. Osman is a Clinician-Scientist, Associate Professor, and Consultant Rheumatologist with a focus in Immunology within the Division of Rheumatology at the University of Alberta. Prior to his recruitment (March 2019), he earned a PhD in immunology (2007), a Doctor of Medicine (2011) and completed clinical training in internal medicine (2014), and rheumatology with a focus on clinical immunology (2016), all at the University of Alberta. He also completed a postdoctoral research fellowship in translational research (2018) and advanced vascular imaging fellowships in systemic sclerosis at the University of Genoa in Italy and the University Medical Centre of Groningen in the Netherlands. He regularly performs nailfold video capillaroscopy (NVC) and has founded the first Microvascular Clinic in Western Canada. He utilizes NVC to better risk‑stratify patients with systemic autoimmune rheumatic diseases (in general) and systemic sclerosis (in particular). Leading his translational research team, he aims to provide solutions for the complex problems faced by his patients.

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2025-06-09

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Nikolic RP, Larché M, Osman M. Capillaroscopy in Systemic Autoimmune Rheumatic Diseases: A Clinical Tool Linking Diagnosis and Pathogenesis. Can Rheumatol Today [Internet]. 2025 Jun. 9 [cited 2025 Jul. 17];2(1):5–15. Available from: https://canadianrheumatologytoday.com/article/view/2-1-Nikolic_et_al

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