Nail Fold Capillaryscopy (NFC)

Abnormal microangiopathiy of nailfold often occurs in systemic rheumatic diseases. Nailfold Capillaryscopy (NFC) is easily performed test which which examine nailfold capillary architecture by microscope. Although not truly specific, NFC is non-invasive, simple, repeatable, highly sensitive, safe and inexpensive method used in distinguishing primary and secondary Raynaud.

When to perform NFC? ( Indications)

People having Primary Raynaud ‘s ( Raynaud’s disease) or Secondary Raynaud’s ( Raynaud’s Phenomenon). Signs and symptoms include:
-cold fingers and toes
-color changes in fingers/skin ( especially blue or white)in response to cold or stress( emotional)
-numb, prickly feeling or stinging pain upon warming or stress relief
-underlying rheumatic diseases

How the test is done? (Method)

During a nailfold capillaroscopy, the doctor places a drop of oil on the patient’s nailfold – the skin at the base of the fingernail. The doctor will then examine the nailfold under a microscope to look for abnormalities of the capillaries. If the capillaries are enlarged or abnormal, this may indicate that the patient has a connective tissue disease.
There may be finger to finger variation in findings.
Fingers affected by recent trauma are not analyzed.

How do we know if the result is normal or abnormal?

Normal findings:
-Thin, uniform, evenly spaced, symmetrical in distribution
-Capillaries have hair pin appearance
-Normal seen in: Fibromyalgia, Osteoarthrirtis, Gout, Eosinophillic fasitis, primary Raynaud
-Minor vessels and a few avascular area commonly seen in normal

Abnormal findings:
-Avascular dropouts, giant loops, bizarre capillaries, tortuousity, hemmorage of capillaries
-Dropouts indicated Scleroderma
– Seen in primary Raynaud, Scleroderma, SLE, Mixed Connective Tissue Diseases( MCTD), Dermatomyositis, CREST syndrome

Why to do NFC? (Advantage of doing NFC)

The extent of capillary lesions may correlate with the severity of end organ damage and survival rate.

Is it time consuming? What about the cost? (Cost and time)

Inexpensive, procedure takes 10-15 minutes using a hand held microscope.