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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2003 May;62(5):444–449. doi: 10.1136/ard.62.5.444

Nailfold capillary microscopy in healthy children and in childhood rheumatic diseases: a prospective single blind observational study

P Dolezalova 1, S Young 1, P Bacon 1, T Southwood 1
PMCID: PMC1754542  PMID: 12695158

Abstract

Objectives: To develop an objective method of nailfold capillaroscopy (NFC), applicable to a wide age range of paediatric patients. To compare the morphological characteristics of the nailfold capillaries in different rheumatology patient groups and controls.

Methods: A colour digital video camera attached to a stereomicroscope was used to capture nailfold capillary images. Computerised image processing was used to analyse and store data. Subsequent quantitative and qualitative morphological analysis was performed in the following paediatric patient and control groups: 18 children with connective tissue diseases (CTD: juvenile dermatomyositis, systemic sclerosis, and undifferentiated connective tissue disease), eight with systemic lupus erythematosus, nine with primary Raynaud's disease, three with primary vasculitis, 15 with juvenile idiopathic arthritis, 17 healthy children and 20 healthy adults. Images were analysed by a single assessor who was unaware of the patient details.

Results: The NFC technique was simple to perform and gave reproducible results, although some intra- and intersubject variation was noted. Capillary density and width was age related, with younger children having fewer and wider capillaries than older children and adults. Linear capillary density was significantly higher in healthy adults (mean (SD) 8.6 (1.6) capillaries/mm) compared with healthy children (HC 6.9 (0.9) capillaries/mm). The group with CTD had the most abnormal findings, with lower linear density (4.9 (1.7) capillaries/mm) and increased capillary loop width (10.7 (7.3) mm) compared with HC (3.5 (1.7) mm). In addition, 11/18 (61%) patients in the CTD group had more than two definitely abnormal capillaries in at least two nailfolds, an abnormality not seen in other subjects. Two qualitative measures, the degree of avascularity and general disarrangement of capillary pattern, were more commonly observed in the CTD group than in HC. The proportion of tortuous capillaries did not differ significantly between study groups.

Conclusions: This study is unique in measuring objective quantitative and qualitative parameters of the nailfold vasculature across a wide spectrum of age and disease. Differences in capillary morphology and frequency in children with CTD compared with other paediatric diseases and healthy controls were demonstrated. In the clinical situation, an assessment of the general degree of disarrangement may offer a fast tool for assessment of the nailfold vasculature which correlates well with NFC data.

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Figure 1.

Figure 1

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Nailfold capillary morphology: (A) normal capillaries, healthy adult; (B) normal capillaries, healthy 2 year old child; (C) abnormal capillaries, 15 year old boy with JDMS. a, Capillary width in a giant capillary; b, tortuous loop, c, avascular area.

Figure 2.

Figure 2

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Linear capillary density. Capillaries/mm—number of capillaries per 1 mm of end capillary row. Healthy adults had significantly increased capillary density compared with healthy children (p<0.01). Patients with CTD also had significantly reduced capillary density compared with healthy children (p<0.001).

Figure 3.

Figure 3

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Variation of linear capillary density with age. In a normal population, linear capillary density varies directly with age.

Figure 4.

Figure 4

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Capillary loop width in health and disease. mm screen—mean width of the three widest capillaries in millimetres of the screen. 1 mm screen = 15.15 actual µm. Children with CTD had wider capillaries than normal control children (p<0.05).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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