Qualitative and quantitative assessment of nailfold capillaries by capillaroscopy in healthy volunteers

Background: Nailfold capillaroscopy (NVC) is a diagnostic tool particularly useful in the differential diagnosis of rheumatic and connective tissue diseases. Although successfully applied since many years, little is known about prevalence and distribution of NVC changes in healthy individuals. Probands and methods: NVC was performed in 120 individuals (57 men and 63 women; age 18 to 70 years) randomly selected according to predefined age and sex strata. Diseases associated with NVC changes were excluded. The nailfolds of eight fingers were assessed according to standardized procedures. A scoring system was developed based on the distribution of the number of morphologically deviating capillaries, microhaemorrhages, and capillary density. Results: Only 18 individuals (15%) had no deviation in morphology, haemorrhages, or capillary density on any finger. Overall 67% had morphological changes, 48% had microhaemorrhages, and 40% of volunteers below 40 years of age and 18% above age 40 had less than 8 capillaries/mm. Among morphological changes tortous (43%), ramified (47%), and bushy capillaries (27%) were the most frequently altered capillary types. A semiquantitative scoring system was developed in such a way that a score above 1 indicates an extreme position (above the 90th percentile) in the distribution of scores among healthy individuals. Conclusions: Altered capillaries occur frequently among healthy individuals and should be interpreted as normal unless a suspicious increase in their frequency is determined by reference to the scoring system. Megacapillaries and diffuse loss of capillaries were not found and seem to be of specific diagnostic value.