2026 SIR临床实践指南：甲襞视频毛细血管镜检查报告

Abstract

Objective

In clinical practice, standardised reporting of nailfold videocapillaroscopy (NVC) findings is lacking, making the interpretation and comparison of results difficult. We aimed to achieve a national consensus on how to describe NVC findings in routine clinical practice.

Methods

A web-based Delphi consensus study was conducted among members of the Study Group on Capillaroscopy and Microcirculation in Rheumatic Diseases of the Italian Society of Rheumatology (CAPSIR). The study was based on items derived from a previous systematic review and international consensus by the EULAR Study Group on Microcirculation in Rheumatic Diseases (SG_MC/RD).

Results

A total of 40 items were proposed during the Delphi process, which was completed by 52 participants from different Italian regions. An agreement was reached on 23 items covering different aspects of the NVC examination: general aspects (2 items), description of the fingers examined (3 items), possible confounding factors (2 items), device description (2 items), image quality (1 item) and details of the NVC examination (13 items). Sixteen of these were considered mandatory for inclusion in the NVC practice report, and 7 were considered optional.

Conclusion

The proposed NVC checklist covers 23 relevant issues in clinical practice, including 16 mandatory items grouped into five categories. This national consensus will improve the reproducibility and generalisability of NVC reporting in daily clinical practice. Furthermore, the outcomes of this NVC consensus process will inform the next European web-based Delphi consensus study, to be conducted among the member countries of the EULAR SG_MC/RD.

Keyword capillaroscopy, microcirculation, Raynaud's phenomenon, rheumatic diseases

Clinical practice guidelines for reporting nailfold videocapilarscopy / F. Ingegneti al.

Affiliations: see page 6. Francesca Ingegnoli', MD Debora Pireddu', MD Elena Platania, MD Rossella De Angelis, MD Alessia Alunno, MD, PhD Alarico Ariani, MD Simone Barsotti, MD Veronica Batani', MD Laura Belloli, MD Alessandra Bezzi', MD Silvia Laura Bosello, MD Fabio Cacciapaglia, MD Stefania Laura Calvisi, MD Phd Nicoletta Carlo-Stella, MD Francesco Carubbi, MD Ilaria Cavazzana', MD Veronica Codullo', MD Michele Colaci', MD Martina Cornalba, MD Giovanna Cuomo, MD Ginevra De Marchi', MD Alessandra Della Rossa', MD Marco Di Battista', MD Evy Di Ruscio, MD Paola Faggioli, MD Marta Favero, MD Roberta Foti, MD Francesco Girelli, MD Dilia Giuggioli', MD Serena Guiducci', MD Emanuele Gotelli, MD, PhD Vittorio Grosso, MD Elvis Hysa', MD Annamaria Iuliano', MD Francesca Lalli, MD Lorenzo Leveghi, MD Emiliano Marasco, MD Gianna Mennillo', MD Gianna Moroncini, MD Greta Pellegrino, MD Carlo Perricone', MD Carmen Pizzorni, MD, PhD Emanuela Praino, MD Laura Quarta, MD Véronique Laure Ramoni, MD Leonardo Santo, MD Carlotta Schenone, MD Marco Sebastiani, MD Lucia Serafino, MD Teodora Serban, MD Paolo Stobbione, MD Alberto Sulli', MD Simona Truglia', MD Vanessa Smith', MD, PhD Maurizio Cutolo®, MD Valeria Riccieri®, MD Chemulee Gotelli, MD, PhD Vittorio Grosso, MD Elvis Hysa', MD Annamaria Iuliano', MD Francesca Lalli, MD Lorenzo Leveghi, MD Emiliano Marasco, MD Gianna Mennillo', MD Gianna Moroncini, MD Greta Pellegrino, MD Carlo Perricone', MD Carmen Pizzorni, MD, PhD Emanuela Praino, MD Laura Quarta, MD Véronique Laure Ramoni, MD Leonardo Santo, MD Carlotta Schenone, MD Marco Sebastiani, MD Lucia Serafino, MD Teodora Serban, MD Paolo Stobbione, MD Alberto Sulli', MD Simona Truglia', MD Vanessa Smith', MD, PhD Maurizio Cutolo®, MD Valeria Riccieri®, MD Chemulee Gotelli, MD, PhD Vittorio Grosso, MD Elvis Hysa', MD Annamaria Iuliano', MD Francesca Lalli, MD Lorenzo Leveghi, MD Emiliano Marasco, MD Gianna Mennillo', MD Gianna Moroncini, MD Emiliano Marasco, MD Gianna Mennillo', MD Carlo Perricone', MD Gina Mennocrini, MD, PhD Emanuela Praino, MD Laura Quarta, MD Véronique Laure Ramoni, MD Leonardo Santo, MD Laura Quarta, MD Véronique Laure Ramoni, MD Leonardo Santo, MD Gina Serafino, MD Teodora Serban, MD Paolo Stobbione, MD Alberto Sulli', MD Simona Truglia', MD Vanessa Smith', MD, PhD Maurizio Cutolo®, MD Valeria Riccieri®, MD Deva Litercieri®, MD Valeria Riccieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®, MD Valeria Rencieri®,

Introduction

Nailfold videocapilaroscopy (NVC) is an easy-to-use, safe and non-invasive technique that has become an integral part of the imaging armamentarium in rheumatology research and clinical practice over the years (1, 2). Nowa-days, rheumatologists are familiar with NVC, and the level of knowledge and availability of NVC is higher than other techniques for assessing microvascular involvement in systemic autoimmune rheumatic diseases (3-5).

Moreover, the role of NVC in the differential diagnosis of Raynaud's phenomenon (RP), early diagnosis and monitoring of systemic sclerosis (SSc), as well as scleroderma spectrum disorders is well established (6). As evidence of this, abnormal capillaroscopic findings were formally included in the 2013 ACR-EULAR classification criteria for SSc(7).

In the last ten years, the EULAR Study Group on Microcirculation in Rheumatic Diseases (SGMC/RD) has been active in standardising different phases of this technique, such as the nomenclature to be used in daily practice and research (8, 9), the items relevant for reporting in clinical research (10), and organizing several international face-to-face and online training courses.

Increased use in clinical practice has corresponded with major technical advances in image resolution and analysis. In addition, a patient infographic explaining the meaning and advantages of NVC has been developed in several languages, and it is available for free download from the ERN ReConnet (European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases) website (11).

In Italy, the NVC training program is part of the curriculum for rheumatology trainees, and in 2020 the steering committee of the Italian Society of Rheumatology (SIR) approved the Study Group (SG) on Capillaroscopy and Microcirculation in Rheumatic Diseases (CAPSIR), which soon started its first project to obtain an overview of the use of NVC and identify potential unmet needs in Italian rheumatology centres (4).

Reporting methods were heterogene-

Despite all these advances, there was no unanimous way of reporting in Italian centres, even though complete and accurate reporting is essential for comparing results. Based on these findings, in November 2024, CAPSIR_SG members proposed a national Delphi consensus to develop an agreed NVC report.

Methods

Delphi process

The CAPSIR Steering Committee oversaw the management of the Delphi process. The study was exempt from Institutional Review Board (IRB) ap-proval since there was no research involving patient samples or data.

The Delphi exercise was conducted online (Google Forms) from January to April 2025.

The national experts in the field of nVC were recruited among the members of the CAPSIR SG and invited to participate in this Delphi exercise. The experts were all members of the SIR. A total of 132 experts, included in the CAPSIR SG mailing list, were invited by e-mail to participate in this Delphi exercise. At least three reminders were sent. Experts who did not complete the first round were not invited to any of the subsequent Delphi rounds.

For all Delphi rounds, a deadline for submitting responses was set and communicated in the invitation. During this period, automated reminders were sent to participants who had not yet provided their ratings for each Delphi statement.

Importantly, a glossary summarising NVC terminology in line with the EULAR nomenclature (8) has been included to summarise NVC terminology and to ensure standardisation of the final results (Table I). It should also be noted that when limb capillary dilations are present in NVC analyses, operators have to use the appropriate software to properly evaluate the diameters.

Clinical practice guidelines for reporting nailfold videocapilariscopy / F. Ingegnoli et al.

Statistical analysis

The CAPSIR Steering Committee first reviewed the results of a systematic literature review (SLR) that had previously been conducted with the aim of identifying reporting items for NVC (10). In the previous SLR, references were retrieved using an initial search strategy in Medline via PubMed, Embase and Scopus (10). The objective of this strategy was to identify all studies in which NVC was performed on a population of adults and children with rheumatic musculoskeletal diseases (10). In this SLR (10), 319 studies were analysed, revealing three main topics: 1) patient preparation (21 items); 2) device technical description (6 items); and 3) examination details (19 items). The CAPSIR Steering Committee agreed on the three topic categories to be addressed: patient preparation, instrument description and capillaro-scopic parameters. They also finalised the preliminary list of statements, comprising 11, 8 and 21 items respectively. In the first round, participants were asked to consider the items previously identified, to focus on new items that may have been omitted, and to clarify items that may be ambiguous. The second round was based on the results of the first round, and in the third-round, participants reviewed the responses to each item from the second round, including basic summary statistics for each question, and were asked to rate the items again. In each round, they were asked to rate the level of appropriateness of each item on a scale from 1 (extremely inappropriate) to 9 (extremely appropriate). To achieve agreement, the median of the responses for each item had to be ≥7, and 1/3 or fewer of the participants had to be in the range 1-3 (12). Items on which no agreement was reached were excluded. The CAP-SIR Steering Committee evaluated the results and comments from all the Delphi rounds, amending the newly proposed statements as necessary.

Results

Delphi participants

Sixty-one experts responded to the in- vitation to participate, representing all Italian regions. There were more fe-

|NVC parameters|NVC parameters|NVC parameters| |---|---|---| |Terminology|Definition|Definition| |Density|The number of capillaries/mm of distal row|≥7 capillaries/mm: normal density <7 capillaries/mm: lowered density| |Dimension|Diameter of the apical limb of the capillary|<20 µm: normal diameter ≥20 and ≤50 µm: dilated >50 µm: giant capillary| |Morphology|1) Normal: hairpin-shaped capillary 2) Non-specific variations: tortuous capillary (the limb bends but does not cross), or crossing (the limbs cross once or twice) 3) Abnormal shapes: bushy (capillary with small buds instead of branches capillary) and/or ramified capillary (capillary with branched limb) and/or crossed with more than 3 twisted, neoangiogenesis|| |Microhaemorrhages|Pericapillary microhaemorrhages|| |Venous Plexus|Visibility of the subpapillary venous plexus|| |Architecture|Architecture of the capillary network||

||Round 1|Round 3| |---|---|---| |Experts invited, No.||| |Experts participated, No.|61|52| |Gender (Female-Male)|39-22|33-19| |Italian region represented||| |- Northwest*|23 (37.7%)|20 (38.4%)| |- Northeast°|8 (13.1%)|8 (15.4%)| |- Centre§|14 (23%)|12 (23.1%)| |- South and islands|16 (26.2%)|12 (23.1%)| |Specialty||| |- Rheumatology|51 (83.6%)|44 (84.6%)| |Primary practice setting||| |- Public hospital|23 (37.7%)|20 (38.5%)| |- University hospital|29 (47.6%)|25 (48.1%)| |- IRCSS°|6 (9.8%)|5 (9.6%)| |- Private practice|3 (4.9%)|2 (3.8%)| |NVC experience of respondents||| |- more than 10 years|40 (65.6%)|34 (65.4%)| |- 5-10 years|15 (24.6%)|12 (23.1%)| |- less than 5 years|6 (9.8%)|6 (11.5%)| |- No experience|0|0|

Experts who completed the survey in full in the previous round were invited to subsequent rounds.

* Valle d'Aosta, Liguria, Lombardy, Piedmont.

ªTrentino-Alto Adige, Veneto, Friuli-Venezia Giulia, Emilia-Romagna.

$^{9}$Tuscany, Umbria, Marche, Lazio.

^Abruzzo, Molise, Campania, Apulia, Basilicata, Calabria, Sicily.

^°IRCSS Institute of Hospitalisation and Scientific Care.

male (39, 64%) than male (22, 36%) panelists. Patient care settings were diverse, with 29 (47.6%) experts working in academic institutions and 23 (37.7%) in public hospitals. They were predominantly rheumatologists (51, 83.6%) who were familiar with NVC (65.6% reported using NVC in routine clinical practice for more than 10

In the second round, 52 of the panelists. Patient care settings were diverse, with 29 (47.6%) experts working in academic institutions and 23 (37.7%) in public hospitals. They were predominantly rheumatologists (51, 83.6%) who were familiar with NVC (65.6% reported using NVC in routine clinical practice for more than 10

years). In the second round, 52 of the 61 experts responded (response rate, 85.24%), and in the third round, all 52 participants responded (Table II).

Delphi results

The Delphi workflow is shown in Figure 1. After three rounds of voting, several items were rephrased, deleted

Clinical practice guidelines for reporting nailfold videocapillariscopy / F. Ingegnoli et al.

or merged. The process started with 40 items and resulted in a final list of 23. Based on participants' suggestions, items were grouped into five main categories (i.e., general items, anatomical area, contextual factors, equipment, images and NVC parameters) rather than three (i.e., patient preparation, device description and examination details). The results consisted of 16 mandatory (i.e., essential to be reported in the NVC report) and 7 optional items (Fig. 2). The English and Italian versions of the final consensus report of the NVC are shown in Figure 2 and Supplementary Figure S1, respectively. In particular, in the first round, three items not explicitly related to NVC but to general good clinical practice were requested for inclusion in the reporting checklist: reason for request, indications for other tests and timing of NVC repetition (Table III).

Participants also agreed on the importance of clearly stating where NVC will be performed: on both hands, or which finger is excluded and why. Although some other aspects may be important to report in clinical research studies (10), there was no consensus on their relevance for inclusion in a medical report in routine practice (Supplementary Table S1).

Two contextual factors were considered important as potential confounders, namely the presence of nail polish (or artificial or gel nail polish) and the presence of periungual lesions for various reasons (finger trauma or nail biting, self-mutilation of cuticles, manicure, manual work or hobbies). Technical characteristics of the NVC instrument, such as model, brand and magnification, which may affect the accuracy of the NVC examination, have to be included in the report. As NVC is an imaging technique, it is important to report details of the image quality (e.g., excellent, good, poor) and the possible reasons if the quality is not acceptable (fibrosis, local trauma, dirty, blurred, oedema).

Finally, capillary density, morphology and dimensions, all standardized NVC parameters useful in deriving the overall pattern, achieved the agreement reported in Table III. Participants also

![graph TD\n A1[The CAPSIR Steering Committee agreed on the items identified in a previous SLR for the Delphi consensus] --> A2[patient preparation]\n A1 --> A3[device description]\n A1 --> A4[NVC details]\n A2 -->|11 Likert scale items| A2\n A2 -->|7 eliminated 3 revised* 2 added| A2\n A3 -->|8 Likert scale items| A3\n A3 -->|3 eliminated 2 revised*| A3\n A4 -->|21 Likert scale items| A4\n A4 -->|5 eliminated 3 revised 5 added| A4\n A5[patient preparation] -->|5 Likert scale items| A5\n A5 -->|2 eliminated| A5\n A6[device description] -->|4 Likert scale items| A6\n A6 -->|2 eliminated| A6\n A7[NVC details] -->|21 Likert scale items| A7\n A7 -->|3 eliminated| A7\n A8[patient preparation] -->|5 Likert scale items| A8\n A8 -->|2 eliminated| A8\n A9[device description] -->|4 Likert scale items| A9\n A9 -->|2 eliminated| A9\n A10[NVC details] -->|21 Likert scale items| A10\n A10 -->|3 eliminated| A10\n A11[patient preparation] -->|3 Likert scale items| A11\n A11 -->|2 Likert scale items| A11\n A12[device description] -->|2 Likert scale items| A12\n A12 -->|18 Likert scale items| A12\n](1/parseimages/figurefefb6510900143f2aacf84edcf531d85_0_5.png) *Two items have been merged.

agreed to include three further optional items, such as: capillary bed architecture, blood flow characteristics and venular plexus visibility. Full agreement was reached to report the overall pattern according to the standardized EULAR nomenclature as the conclusion of the report (Table III).

Discussion

CAPSIR_SG participants have produced the first national checklist focusing on the reporting findings of NVC in daily clinical practice. The target audience of this project is all Italian healthcare professionals who perform and report NVC in rheumatic diseases. This simple and practical checklist will ensure transparent and comprehensive NVC reporting and it is an attempt to standardise and homogenise NVC reporting.

The overarching principles of NVC examinations, as validated by the EU-LAR nomenclature, were accepted a priori, such as the number and fingers to be examined. Ideally, all 8 fingers (excluding the thumbs) should be examined to capture the heterogeneity in appearance that is common between and within the nailfolds (6, 8, 13).

As this format is intended to be used in a real-world scenario, two general items were requested to be added to the checklist, such as the reason for the request and indications for other tests and the timing of the repeat NVC. The majority of CAPSIR_SG participants felt it was important to include these to emphasise the importance of NVC in the diagnosis and monitoring of scleroderma spectrum disorders.

In recent years, several NVC systems with different magnifications and performance have been introduced to the market (14-16). For this reason, the participants agreed to report device characteristics and magnification. By contrast, there was no consensus on items related to capillaroscopists' experience. This was primarily due to the lack of an agreed method for reporting and assessing such experience. However, the ongoing EULAR online courses on NVC and microcirculation will soon help participants report NVC findings correctly, culminating in a final examination to assess acquired competency. With clinicians concerned about increased administrative duties and cost-containment pressures, the importance of a time-

Clinical practice guidelines for reporting nailfold videocapillariscopy / F. Ingegnoli et al.

 consuming reporting checklist cannot be overstated. Furthermore, according to Italian legal guidelines, any clinical report must be easily understandable for patients and general practitioners

alike. Against this background, it was considered more practical and feasible in the first round to categorise non-specific capillary variations, abnormally shaped capillaries, and dilated

capillaries as absent, rare (less than 33% capillary alterations per mm), frequent (between 33% and 66% of capillary alterations per mm) or very frequent (more than 66% capillary alterations per mm) (17), rather than counting the number per mm (8).

Only for giant capillaries was there agreement to report both measures. For a capillary to be defined as 'giant', its apical diameter must exceed 50 micro-metres. By definition, giant capillaries are absent in the 'late' pattern; they are merely dilations of neoangiogenic loops. Other parameters measured per mm were eliminated in the first Delphi round.

Since what we see during NVC is the column of red blood cells within the capillary walls, contextual factors that may influence capillary visibility (and thus alter the final NVC report) were considered (10). However, only factors directly disturbing the observation of the periungual area, such as recent manicure (18) or traumatic lesions, reached the consensus. On the contrary, there was no consensus on other issues such as environmental conditions, pre-test acclimatisation, hydration (19), avoidance of caffeine and nicotine (20).

Although a description of peripheral blood flow intensity was introduced as an optional item in the second round, this is a difficult parameter to evaluate without a proper automated system. Furthermore, the examination is operator-dependent and susceptible to short-term variations. The final checklist consists of 23 items (16 mandatory and 7 optional) grouped into 5 categories to provide standardized information about the NVC examination.

One of the most important factors is still capillary diameter, as progressive dilation of over 30 microns is considered an early sign of capillary damage. Over time, this may evolve into giant capillaries measuring over 50 microns in a large percentage of patients with RP and antinuclear antibodies. The latter is essential for making a differential diagnosis of RP secondary to connective tissue diseases (21, 22).

This reporting format is easy to use, comprehensive and appropriate, and

Clinical practice guidelines for reporting nailfold videocapillariscopy / F. Ingegnoli et al.

|Items|Level of appropriateness|Median|Agreement||| |---|---|---|---|---|---| |Items|1-3|Median|Agreement|4-6|7-9| |General items|||||| |Reason for NVC request|0|5 (9.6%)|47 (90.4%)|9|Yes| |Indications for other tests or when to repeat NVC|0|2 (3.8%)|50 (96.2%)|9|Yes| |Anatomical area|||||| |Indicate if NVC is performed on both hands|2 (3.8%)|4 (7.7%)|46 (88.5%)|9|Yes| |Number of fingers examined|3 (5.8%)|7 (13.5%)|42 (80.7%)|8|Yes| |Reason for finger exclusion|2 (3.8%)|3 (5.8%)|47 (90.4%)|9|Yes| |Contextual factors|||||| |Remove nail polish or artificial or gel nails|5 (8.2%)|10 (16.4%)|46 (75.4%)|7|Yes| |Indicate the presence of periungual lesions and their causes (e.g., finger trauma, nail biting, self-mutilation of cuticles, manicure, manual work or hobbies)|0|2 (3.8%)|50 (96.2%)|9|Yes| |Equipment|||||| |Device model, brand|11 (21.1%)|11 (21.1%)|30 (57.8%)|7|Yes| |Magnification|4 (7.7%)|4 (7.7%)|44 (84.6%)|9|Yes| |Images|||||| |Image quality (excellent, good, poor) and, if poor, possible reasons (fibrosis, local trauma, dirty, blurred, oedema).|0|1 (1.9%)|51 (98.1%)|9|Yes| |NVC parameters|||||| |No. of capillary/mm (median of both hands)|6 (11.5%)|7 (13.5%)|39 (75%)|8|Yes| |Hairpin-shaped capillaries§ (absent, rare, frequent, very frequent) very frequent)|3 (5.8%)|5 (9.6%)|44 (84.6%)|9|Yes| |Non-specific $variations^{§}$|4 (7.7%)|4 (7.7%)|44 (84.6%)|9|Yes| |(absent, rare, frequent, very frequent)|0|1 (1.9%)|51 (98.1%)|9|Yes| |(absent, rare, frequent, very frequent)|0|0|52 (100%)|9|Yes| |Dilated capillaries§|0|0|48 (92.4%)|9|Yes| |(absent, rare, frequent, very frequent)|2 (3.8%)|2 (3.8%)|48 (92.4%)|9|Yes| |No. of giant capillaries/mm|0|1 (1.9%)|51 (98.1%)|9|Yes| |Giant capillaries§|0|1 (2%)|51 (98.1%)|9|Yes| |(absent, rare, frequent, very frequent)|2 (3.8%)|2 (3.8%)|48 (92.4%)|9|Yes| |Microhaemorrhages§|0|1 (2%)|51 (98%)|9|Yes| |(absent, rare, frequent, very frequent)|2 (3.8%)|8 (15.4%)|42 (80.8%)|8|Yes| |Venular plexus visibility (visible, not visible)|3 (5.8%)|9 (17.3%)|40 (76.9%)|8|Yes| |Report the NVC pattern according to EULAR definitions (8)*|0|0|52 (100%)|9|Yes|

$^{4}$Using the Delphi method, participants voted on the appropriateness of reporting these parameters both per mm (according to the EULAR consensus) and as absent, rare, frequent, or very frequent (according to pragmatic daily practice). Only for giant capillaries was there agreement to report both measures. Other parameters were eliminated in the first round.

^ To define a capillary dilation as ‘giant’ (i.e., greater than 50 micrometres in diameter), the diameter at the apex must be measured and reported. By definition, giant capillaries are absent in the ‘late’ pattern; they are simply dilated neoangiogenic loops.

we believe it will be widely adopted in Italy, thereby improving the interpretability and reproducibility of NVC reporting.

The results of this current national NVC consensus will form the basis of the next European web-based Delphi consensus, which will be launched among the member countries of the EULAR Study Group on Microcirculation in Rheumatic Diseases and will be available in several languages.

Affiliations

$^{1}$Clinica Reumatologica, Dipartimento di Reumatologia e Scienze Mediche, ASST Gaetano Pini-CTO, Milano; $^{2}$Dipartimento di Scienze Cliniche e di Comunità, Dipartimento di Eccellenza 2023-2027, Università degli Studi di Milano; $^{3}$Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome; $^{4}$Rheumatology Clinic, Polytechnic University of Marche,

Department of Clinical and Molecular Science, Jesi, Ancona; $^{5}$Department of Life, Health and Environmental Sciences, University of L'Aquila; Internal Medicine and Nephrology Division, Avezzano-Sulmona-L'Aquila Local Health Authority 1, San Salvatore Hospital, L'Aquila; $^{6}$Department of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliera Universitaria di Parma; $^{7}$Ambulatorio di Reumatologia, Ospedale Versilia, ASL Toscana

Clinical practice guidelines for reporting nailfold videocapillariscopy / F. Ingegnoli et al.

Nord Ovest, Lido di Camaiore, Lucca; $^{8}$Unità di Immunologia, Reumatologia, Allergologia e Malattie Rare, IRCCS San Raffaele, Milano; $^{9}$Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan; $^{10}$SS Reumatologia, Medicina Interna e Reumatologia, ASL Romagna, Ospedale Infermi, Rimini; $^{11}$Rheumatology Division, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome; $^{12}$Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari Aldo Moro, Bari; Rheumatology Service, Internal Medicine Unit, F. Miuli General Hospital, Acquaviva delle Fonti, Department of Medicine and Surgery, LUM G. De Gennaro, Casamassima, Bari; $^{13}$Casa di Cura Beato Palazzolo, Bergamo; $^{14}$Istituto Clinico Beato Mateo, Vigevano; $^{15}$Rheumatology and Clinical Immunology, ASTS Spedali Civili of Brescia; $^{16}$Department of Clinical and Experimental Sciences, University of Brescia; $^{16}$Department of Digital Pavia; Division of Rheumatology, Fondazione IRCCS Policinico San Matteo, Pavia; $^{17}$Department of Clinical and Experimental Medicine, University of Catania; $^{18}$Department of Precision Medicine, University of Campania, Luigi Vanvitelli University, Naples; $^{19}$Clinica di Reumatologia, Azienda Sanitaria Universitaria Friuli Centrale, Udine; $^{20}$Department of Rheumatology, University of Pisa; $^{2}$UOC Reumatologia, ASST Ovest Milanese, Legnano, Milano; $^{23}$Internal Medicine 1, Ca'Foncello University Hospital, AULSS2, Treviso; $^{23}$Division of Rheumatology, AOU Pollicinico G. Rodolico San Marco, Catania; $^{24}$UOS Reumatologia, Ospedale GB Morgagni-Perantoni di Forli; $^{25}$Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Modena; $^{26}$Department of Experimental and Clinical Medicine, University of Florence; Department of Internal Medicine, Division of Rheumatology AOUC, Florence; $^{27}$Laboratory of Experimental Rheumatology and Academic Division

of Clinical Rheumatology, Department of Clinical Medicine and Medical Specialities (Di.M.I). IRCCS Ospedale Policlinico San Martino, University of Genova; $^{28}$SS Reumatologia, UOC Medicina Interna, Ospedale Michele Pietro Ferrero, ASL CN2, Verduno; $^{29}$UOC Reumatologia, AO San Camilio-Forlanini, Roma; $^{30}$Rheumatology, Department of Medicine and Surgery, University of Perugia; $^{31}$Rheumatology Unit, Hospital S. Chiara, Trento, $^{32}$Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Rome; $^{33}$Reumatologia, Ospedale San Carlo, Potenza; $^{34}$Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona; $^{35}$Department of Rheumatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan; $^{36}$Dpartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano; $^{37}$U.O.S.V.D. Reumatologia e Rischio Oncologico, P.O. Mons. R. Dimiccoli Barletta, ASL BT Andria; $^{38}$U.O. Reumatologia, Ospedale Antonio Galateo, San Cesario, Lecce; $^{39}$UOC Medicina Interna Lodi, ASST di Lodi, Ospedale Maggiore di Lodi; $^{40}$S.C. Reumatologia, Ospedale La Colletta, ASL3 Genovese, Arenzano; $^{41}$Rheumatology Unit, AUSL Piacenza; Department of Medicine and Surgery, University of Parma; $^{42}$UOS Reumatologia, PO San Paolo, Bari; $^{43}$SSD Reumatologia Azienda Sanitaria Osperadilera S.S. Antonio e Biagio e C. Arrigo, Alessandria, Italy; $^{44}$Department of Rheumatology and Department of Internal Medicine, Ghent University Hospital, University of Ghent, Unit for Molecular Immunology and Inflammation, Flemish Institute for Biotechnology, Inflammation Research Centre, Ghent, Belgium.

Acknowledgements

*These authors are members of the European Reference Network (ERN) on Rare and Complex Connective Tissue Diseases (ReCONNET).

We wish to thank the EULAR Study Group on Microcirculation in Rheumatic Diseases for continuous support. V. Smith is a Senior Clinical Investigator of the Research Foundation – Flanders (Belgium) (FWO) [grant numbers 1802920N and 1802925N].

References

1. CUTOLO M, SMITH V: Detection of microvascular changes in systemic sclerosis and other rheumatic diseases. Nat Rev Rheumatol 2021; 17: 665-77. https://doi.org/10.1038/s41584-021-00685-0

https://doi.org/10.1038/nrrheum.2017.95

3. INEGNOLFI F, UGHNI N, DINSDALE G et al.: An international Survey on non-iNvaSive tecHniques to assess the mlrocirculation in patients with Raynaud's phenomenon (SUNSHINE survey). Rheumatol Int 2017; 37: 1879-90.

4. INEGNOLFI F, CORNALBA M, DE ANGELIS R et al.: Nailfold capillaroscopy in the rheumatological current clinical practice in Italy: results of a national survey. Reumatismo 2022; 74(3). https://doi.org/10.4081/reumatismo.2022.1508

5. GRACTIA TELLO B, RAMOS IBANEZ E, FANLO MATEO P et al.: The challenge of comprehensive mailfold videocapillaroscopy practice: a further contribution. Clin Exp Rheumatol 2022; 40: 1926-32. https://doi.org/10.55563/clinexprheumatol/6usce8

6. SMITH V, ICKINGER C, HYSA E et al.: Nail- fold capillaroscopy. Best Pract Res Clin Rheumatol 2023; 37: 101849. https://doi.org/10.1016/j.berh.2023.101849

7. VAN DEN HOOGEN F, KHANNA D, FRANSEN J et al.: 2013 classification criteria for systemic sclerosis. an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 2013; 65: 2737-47.

https://doi.org/10.1002/art.38098

8. SMITH V, HERRICK AL, INGEGNOLI F et al.: Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev 2020; 19: 102458.

9. CUTLOO M, MELSENS K, HERRICK AL et al.: Reliability of simple capillaroscopic definitions in describing capillary morphology in rheumatic diseases. Rheumatology (Oxford) 2018; 57: 757-9.

https://doi.org/10.1093/rheumatology/kex460 10. INGEGNOLFI F, HERRICK AL, SCHIOPPO T et al.: Reporting items for capillaroscopy (Oxford)

eases: a systematic review and international Delphi consensus. Rheumatology (Oxford) 2021; 60: 1410-8. https://doi.org/10.1093/rheumatology/keaa457

11. ERN RECONNET: Infographic on Videocapilaroscopy. 2024 [cited; https://reconnet.ernet.eu/2024/09/06/ern-reconnet-infographic-on-ideocapilaroscopy/].

12. FITCH K, BERSTEIN S, AGUILAR M et al. (Eds): The RAND/UCLA Appropriateness Method User's Manual. RAND, 2001.

13. DINSDALE G, ROBERTS C, MOORE T et al.: Nailufad capillaroscopy-how many fingers should be examined to detect abnormality? Rheumatology (Oxford) 2019; 58: 284-8. https://

Clinical practice guidelines for reporting nailfold videocapillariscopy / F. Ingegnoli et al.

doi.org/10.1093/rheumatology/key293 14. HERRICK AL, BERKS M, TAYLOR CJ: Quantitative nailfold capillaroscopy-update and possible next steps. Rheumatology (Oxford) 2021; 60: 2054-65. https://doi.org/10.1093/rheumatology/keab006 15. WILDT M, WUTTGE DM, HESSELSTRAND R, SCHEJA A: Assessment of capillary density in systemic sclerosis with three different capillaroscopic methods. Clin Exp Rheumatol 2012; 30: (Suppl. 71): S50-4. 16. BERKS M, DINSDALE G, MARJANOVIC E, MURRAY A, TAYLOR C, HERRICK AL: Comparison between low-cost USB nailfold capillaroscopy and videocapillaroscopy: a pilot study. Rheumatology (Oxford) 2021; 60: 3862-7. https://

doi.org/10.1093/rheumatology/keaa723 14. SULLI A, SECCHI ME, PIZZORNI C, CUTO-LO M: Scoring the nailfold microvascular changes during the capilarscopic analysis in systemic sclerosis patients. Ann Rheum Dis 2008; 67: 885-7. https://doi.org/10.1136/ard.2007.079756 18. SHENAVANDEH S: Does the use of nail cos-metics interfere with the reporting of nailfold capillaroscopy? Clin Rheumatol 2023; 42: 1307-13. https://doi.org/10.1007/s10067-023-06503-0 19. SHEIKH ASF, WILKINSON J, MACIVER I et al.: The influence of hydration and heating on visualisation of nailfold capillaries in pa- patients with systemic sclerosis. Microvasc Res 2021; 136: 104170.

https://doi.org/10.1016/j.mvr.2021.104170 20. KIM KM, LEE DJ, JOO NS: Reduction of the nail-fold capillary blood velocity in cigarette smokers. Korean J Fam Med 2012; 33: 398-405. https://doi.org/10.4082/kjfm.2012.33.6.398 21. PACINI G, POGNA A, PENDOLINO M et al.: Understanding the value of non-specific abnormal capillary dilations in presence of Raynaud's phenomenon: a detailed capillaroscopic analysis. RMD Open 2022; 8. https://doi.org/10.1136/rmdopen-2022-002449 22. TROMBETTA AC, SMITH V, PIZZORNI C et al.: Quantitative Alterations of Capillary Diame-ter Have a Predictive Value for Development of the Capillaroscopic Systemic Sclerosis Pattern. J Rheumatol 2016; 43: 599-606. https://doi.org/10.3899/jrheum.150900

https://doi.org/10.3899/jrheum.150900

20. KIM KM, LEE DJ, JOO NS: Reduction of the nail-fold capillary blood velocity in cigarette smokers. Korean J Fam Med 2012; 33: 398-405. https://doi.org/10.4082/kjfm.2012.33.6.398 21. PACINI G, POGNA A, PENDOLINO M et al.: Understanding the value of non-specific abnormal capillary dilations in presence of Raynaud's phenomenon: a detailed capillaroscopic analysis. RMD Open 2022; 8. https://doi.org/10.1136/rmdopen-2022-002449 22. TROMBETTA AC, SMITH V, PIZZORNI C et al.: Quantitative Alterations of Capillary Diame-ter Have a Predictive Value for Development of the Capillaroscopic Systemic Sclerosis Pattern. J Rheumatol 2016; 43: 599-606. https://doi.org/10.3899/jrheum.150900

20. KIM KM, LEE DJ, JOO NS: Reduction of the nail-fold capillary blood velocity in cigarette smokers. Korean J Fam Med 2012; 33: 398-405. https://doi.org/10.4082/kjfm.2012.33.6.398 21. PACINI G, POGNA A, PENDOLINO M et al.: Understanding the value of non-specific abnormal capillary dilations in presence of Raynaud's phenomenon: a detailed capillaroscopic analysis. RMD Open 2022; 8. https://doi.org/10.1136/rmdopen-2022-002449 22. TROMBETTA AC, SMITH V, PIZZORNI C et al.: Quantitative Alterations of Capillary Diame-ter Have a Predictive Value for Development of the Capillaroscopic Systemic Sclerosis Pattern. J Rheumatol 2016; 43: 599-606. https://doi.org/10.3899/jrheum.150900