Capillaroscopy

Capillaroscopy is a diagnostic test used in rheumatology, dermatology, physiatry, neurology and many other branches of medicine to analyse microcirculation at the capillary level in detail and at high resolution.

A capillaroscope is a device with which we directly visualise the microcirculation. In rheumatology there are a number of diseases that affect the microcirculation (capillaries, arterioles and venules). The capillaroscope makes it possible to visualise the microcirculation safely, painlessly and very precisely, down to the level of individual capillaries, some of the blood cells as they pass through the narrow capillary network, and changes in the capillary walls.

The most common reason for capillaroscopy is a change in the colour of the fingers that occurs spontaneously or is provoked by stress, cold or medicines. This colour change is called Raynaud's phenomenon, and it is characterised by colour changes in the fingers, toes, ears or nipples. In Raynaud's phenomenon the colour changes from blue and white to red. The duration of Raynaud's phenomenon varies; it is often painful, but not every time and not for everyone. There is primary Raynaud's phenomenon, but also a secondary form in inflammatory rheumatic diseases.

Systemic sclerosis is an autoimmune, inflammatory rheumatic disease of unknown origin in which several tissues and organs undergo changes. With capillaroscopy we can see changes typical of systemic sclerosis, whether early and initial, active or late. Other diseases, such as mixed connective tissue disease (MCTD), overlap syndromes of several rheumatic diseases, collagenoses and psoriatic arthritis, can also show changes in the microcirculation.

We describe the changes we see using various categories, most often as early fibrotic reactions, capillary collapse, dilatation, extravasation of red blood cells, microvascular haemorrhages, arborisation of capillaries, changes in permeability, angiogenesis, necrosis and diffuse changes. Besides the skin, systemic sclerosis affects many other organs, such as the kidneys, lungs, gastrointestinal system and others.

It is important to monitor people with microcirculatory changes over the long term, regularly, systematically and consistently. Capillaroscopy is a safe, non-invasive and painless method that can detect changes in the microcirculation at the base of the nail early. Together with the clinical picture and laboratory results, this makes it possible to establish the correct diagnosis, start treatment as early as possible and avoid local and systemic damage.