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Introduction

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

The identification of predictive and prognostic tools allows early diagnosis and tailoring of the best treatment for a given patient. Nailfold capillaroscopy is recognized to have useful clinical applications in the assessment of children as well as adults with definite or suspected connective tissue diseases (CTDs) ([1-6]). Moreover, capillaroscopy is a feasible examination in children because it is noninvasive, rapid, relatively simple, and easy to perform and to repeat.

Documenting capillaroscopy examination with high-quality pictures is fundamental; good images are an essential support to the description of the capillary abnormalities, facilitating interpretation of medical reports. In recent years, improvements in methodology, including the increasing use of high-magnification video capillaroscopy, have led to increased interest and application of capillaroscopy in pediatric as well as adult practice. Capillaroscopy is especially applicable in pediatrics because children perceive the examination as a game. It should be stated that capillaroscopy is not always easy to perform in children, but a few useful tips can help to improve the quality of the examination. It is important that the child's hand is steady during the examination. Therefore, infants should be examined after a morning feeding when they are most likely to be asleep or at least settled. It is hard for children ages <5 years to stay still if they are not on a parent's lap, but they are rarely afraid of the examination. Children ages >5 years have fun if the examination and what appears on the screen are explained to them (Figure 1A). The tendency of capillary density to increase with age is a part of the maturation process. In older children and adolescents, this tendency is less obvious; in fact, in children ages >10 years, the number of capillaries (density) is similar to adults ([3-13]). The number of nonspecific loop abnormalities (i.e., tortuosity) increases with age, although it is well recognized that the interpretation of capillary loop morphology is subjective ([4, 5, 12, 13]). The loop dimensions vary with age; arterial and venous dimensions tend to rise with age. The total loop diameter increases with age, while the apical diameter remains almost stable ([3, 4]). However, further studies are required to establish reference ranges across different age groups. The association between subpapillary venular plexus visibility and growth and age is controversial ([5, 12-14]).

The quality of the capillaroscopy images is also influenced by the condition of the periungual region. Particularly in children, nail biting, recreational activities, nail varnish, recent nail/finger traumatic lesions, or infection can cause poor-quality images. Herein, we review the potential role of capillaroscopy in pediatrics.

Search strategy

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

In this review, searches were performed using the PubMed and Embase databases for all articles published from January 1950 to September 2012. This process was supplemented by manually searching bibliographies of these articles and previously published reviews. The results from all searches were combined and duplicate references were excluded. The following keywords were used in our search, and the Boolean operators “AND” and “OR” were used in combining more key words to increase the specificity and reduce the sensitivity of our search: “capillaroscopy” OR “nailfold capillaroscopy” AND “paediatric,” “children,” OR “adolescent” AND “juvenile systemic sclerosis” (SSc), “localized scleroderma,” “Raynaud's phenomenon” (RP), “juvenile dermatomyositis” (DM), “juvenile systemic lupus erythematosus” (SLE), “juvenile idiopathic arthritis” (JIA), OR “mixed connective tissue disease” (MCTD).

Capillaroscopy in healthy children

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

The first step in understanding capillaroscopy abnormalities is to recognize what a normal pattern is in healthy children. In newborns (1 or 2 days old), there is a primitive vessel network supplied by the arterioles and venules of the deeper layers, and capillary loops are not well defined ([7, 8]); then, from 1 to 4 weeks old, loops begin to sprout. Capillaries begin to elongate and project out; they are relatively evenly spaced, and arterial and venous limbs look the same ([7, 8]). Infants 1–6 months old show a rapid lengthening and formation of hairpin-shaped loops, with a differentiation of venous and arterial components. Children older than 6 months have a mature form of the microvascular network (Figures 1B–D). The nailfold capillaroscopic pattern in male and female children is similar ([7-11]).

Studies in the literature show that capillaroscopic parameters during childhood have been examined using different equipment and magnifications in a total of 1,244 children ([3-13]) (Table 1).

Table 1. Studies included in the review of capillaroscopy in pediatric rheumatic diseases and healthy children*
Author (ref.)No.Age range, yearsInstrument
  1. * NS = not stated; SSc = systemic sclerosis; DM = dermatomyositis; SLE = systemic lupus erythematosus; JIA = juvenile idiopathic arthritis; MCTD = mixed connective tissue disease; IgAV = IgA vasculitis (Henoch-Schönlein); KD = Kawasaki disease.

Healthy children   
Spencer-Green et al ([1])342.3–18.7Stereomicroscope
Herrick et al ([3])1106–15Video capillaroscope
Dolezalova et al ([4])172–18Stereomicroscope
Ingegnoli et al ([5])502–16Video capillaroscope
Maricq ([9])620.2–14Microscope
Baserga et al ([10])48NSVideo capillaroscope
Martino et al ([11])860.5–16Video capillaroscope
Cony et al ([12])800 to pubertyNS
Terreri et al ([13])3292.1–16.7Microscope
Whitson and Jones ([14])33913–17Stereomicroscope
Jayanetti et al ([18])103–14Video capillaroscope
Spencer-Green et al ([41])207–17Stereomicroscope
Scheja et al ([45])236–16Stereomicroscope
Huang et al ([56])36NSVideo capillaroscope
Raynaud's phenomenon   
Dolezalova et al ([4])93–14Stereomicroscope
Ingegnoli et al ([5])613–17Video capillaroscope
Duffy et al ([15])271.8–17.6Stereomicroscope
Pavlov-Dolijanovic et al ([17])2501–6Microscope
Jayanetti et al ([18])103–15Video capillaroscope
Navon et al ([19])116–15Microscope
Nigrovic et al ([26])1236–17Stereomicroscope
Gifford and Hines ([27])820–19NS
Juvenile SSc   
Spencer-Green et al ([1])910–25.6Stereomicroscope
Dolezalova et al ([4])3NSStereomicroscope
Ingegnoli et al ([5])89–14Video capillaroscope
Piotto et al ([6])45.7–17.7Microscope
Martini et al ([31])1530.3–15.6NS
Russo and Katsicas ([32])231–14NS
Localized scleroderma   
Spencer-Green ([1])105.4–18.2Stereomicroscope
Piotto ([6])208.8–15.4Microscope
Marzano ([37])126NSNS
Juvenile DM   
Spencer-Green et al ([1])322.5–34.9Stereomicroscope
Dolezalova et al ([4])8NSStereomicroscope
Ingegnoli et al ([5])87–18Video capillaroscope
Piotto et al ([6])307.1–14.3Microscope
Nussbaum et al ([40])111NS
Spencer-Green et al ([41])197–32Stereomicroscope
Silver and Maricq ([42])91.5–11Stereomicroscope
Rider and Atkinson ([43])116NS
Christen-Zaech et al ([44])611.09–15.2Video capillaroscope
Scheja et al ([45])85–11Stereomicroscope
Ostrowski et al ([46])800.2–8.9Video capillaroscope
Nascif et al ([47])13NSMicroscope
Smith et al ([48])602.2–21.3Video capillaroscope
Juvenile SLE   
Spencer-Green et al ([1])77.3–20.2Stereomicroscope
Dolezalova et al ([4])89–17Stereomicroscope
Ingegnoli et al ([5])345–17Video capillaroscope
Piotto et al ([6])3011.1–17.7Microscope
Ingegnoli ([55])3510–17Video capillaroscope
JIA   
Spencer-Green et al ([1])224.5–27Stereomicroscope
Dolezalova et al ([4])156–16Stereomicroscope
Ingegnoli et al ([5])553–16Video capillaroscope
Piotto et al ([6])606.8–16.2Microscope
Spencer-Green et al ([41])205–27Stereomicroscope
Juvenile MCTD   
Spencer-Green et al ([1])49.1–20.6Stereomicroscope
Dolezalova et al ([4])4NSStereomicroscope
Ingegnoli et al ([5])79–18Video capillaroscope
Piotto et al ([6])312.2–15.2Microscope
Scheja et al ([45])69–16Stereomicroscope
IgAV   
Dolezalova et al ([4])2NSStereomicroscope
Martino et al ([57])310.8–9NS
Zampetti et al ([58])323–16Video capillaroscope
KD   
Huang et al ([56])642.4–5Video capillaroscope
Turner's syndrome   
Coelho et al ([59])506–37Video capillaroscope
Diabetes mellitus   
Kaminska-Winciorek et al ([60])145NSVideo capillaroscope
image

Figure 1. Nailfold capillaroscopy in children. A, A young child having the examination. The capillaroscopy pattern in healthy children is characterized by hairpin-shaped capillaries and/or slightly tortuous loops at age 5 years (B), 10 years (C), and 16 years (D; magnification × 200).

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Box 1. Significance & Innovations

  • Nailfold capillaroscopy is especially applicable in pediatrics because it is noninvasive, rapid, and simple.
  • In juvenile Raynaud's phenomenon, positive antinuclear antibodies and capillaroscopy are the strongest predictors of development of connective tissue diseases.
  • In juvenile dermatomyositis, capillaroscopy is useful diagnostically and for evaluating disease activity and treatment response.

Capillaroscopy in children with RP

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

As in adult RP, antinuclear antibodies and capillaroscopy are the strongest predictors in distinguishing between primary RP and RP secondary to CTDs ([15-19]) (Figure 2A and B). The onset of RP is extremely rare in infants, but is reported more frequently in children and teenagers ([20-25]). The prevalence of RP increases with age; primary RP is frequently observed in the teenage population ([26]). Primary RP is more common than secondary RP; 70% of children with RP have primary RP and 80% of patients are female ([26]). The age at onset and age at diagnosis are not significantly different between primary and secondary cases and between female and male patients ([16, 26]).

image

Figure 2. Nailfold capillaroscopy patterns in juvenile Raynaud's phenomenon (RP) and in juvenile systemic sclerosis (SSc). A, Primary RP: a 14-year-old girl with negative autoantibodies and capillaroscopy characterized by hairpin-shaped capillaries and slightly tortuous loops. B, RP suspected secondary to SSc: a 14-year-old girl with positive antinuclear antibodies, normal physical examination, and capillaroscopy scleroderma pattern with enlarged loops and a giant capillary and slight decrease of the capillary density. C, Scleroderma pattern with enlarged loops, hemorrhages, and decrease of the capillary density with avascular areas in a 12-year-old girl with limited cutaneous SSc. D, Scleroderma pattern characterized by giant capillaries, hemorrhages, and a decrease of the capillary density with avascular areas in a 15-year-old girl with diffuse cutaneous SSc. Magnification × 200.

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The onset of RP in female children generally occurs around menarche, implying the influence of ovarian hormones in the pathogenesis ([27]). In both primary and secondary RP, monophasic color changes are more common than biphasic or triphasic changes ([26]). No seasonal or psychosocial factors have been shown to influence the reporting of RP symptoms, at least in older children ([28]). In children ages 12–15 years, a relationship with pain including in the arm/shoulder region has been reported ([28]). Pediatricians need to be aware that while RP is not uncommon (and is being increasingly recognized) in children and is usually benign primary (idiopathic) RP, RP may be the presenting feature of an underlying CTD. Capillaroscopy is a useful predictor; normal capillaries are reassuring, whereas abnormal capillaries as described below suggest an underlying disease (Figures 2A and B).

Capillaroscopy in juvenile SSc

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

Juvenile SSc is a rare systemic fibrosing disease with potentially life-threating complications affecting children before the age of 16 years. Foeldvari et al described clinical and serologic differences between younger and older children (disease onset younger or older than 10 years) ([29, 30]). Compared with 45 children with an onset of juvenile SSc between the ages of 10 and 16 years, 15 children with an onset before the age of 10 years were more likely to be male with a significantly higher mean modified Rodnan skin thickness score and decreased frequency of anticentromere antibodies. Patients with a disease onset at ages younger than 16 years were less likely to be anticentromere positive than patients with a disease onset between 20 and 40 years ([29]).

Capillaroscopy is a key investigation in the diagnosis of juvenile SSc ([1, 5, 31, 32]) (Table 1). Capillary abnormalities observed in juvenile and adult SSc are similar, and capillaroscopy reveals a wide range of capillary abnormalities in young patients. The scleroderma pattern is characterized by dilated loops, avascular areas, meandering loops, hemorrhages, giant capillaries, and neoangiogenesis (Figures 2C and D). The simultaneous presence of giant capillaries and avascular areas is present in >60% of children ([1, 31, 32]).

At the time of diagnosis, enlarged loops and avascular areas are the most frequent abnormalities. It has been reported that most children with nonspecific capillary abnormalities at the time of diagnosis of juvenile SSc develop a scleroderma pattern during the course of the disease ([32]). In children in whom a thorough capillaroscopy followup was performed, there was a trend toward the progressive reduction in the number of giant capillaries and enlarged loops and an increasing frequency of avascular areas over the years ([32]).

Capillaroscopy in localized scleroderma

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

In children, localized scleroderma can be severely debilitating. Lesions crossing joint lines can affect extremity growth and extracutaneous features (especially articular and neurologic) occur in a significant proportion of children. There are several recognized subtypes of localized scleroderma ([33]), including circumscribed morphea, linear scleroderma (including en coup de sabre and Parry-Romberg syndrome), generalized morphea, pansclerotic morphea, and mixed scleroderma (this term is used where combinations of different subtypes are present) ([34, 35]). In children as well as in adults, specific major nailfold capillary abnormalities have not been reported, although there have been no capillaroscopy studies specifically of childhood localized scleroderma ([1, 36-39]). If there is doubt whether scleroderma is localized or a part of SSc, then a scleroderma pattern on capillaroscopy will point toward SSc.

Capillaroscopy in juvenile DM

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

The capillaroscopic changes seen in juvenile DM are almost always present and are the most striking and anarchic of all the capillary patterns seen in CTDs (Figures 3A and B). These capillary abnormalities are sometimes so obvious that they are visible to the naked eye ([4-6, 40-43]). A juvenile DM scleroderma-like pattern is present from disease onset in almost all nailfolds, and it has dynamic features ([1, 40, 42, 44]). The earliest changes seen in the nailfold capillary bed consist of hemorrhages, which are followed by an extensive loss of capillaries in a wide band along the edge of the nailfold ([42, 45]).

image

Figure 3. Nailfold capillaroscopy patterns in juvenile dermatomyositis (DM) and in juvenile systemic lupus erythematosus (SLE). A and B, Scleroderma-like patterns with enlarged loops, giant capillaries, neoangiogenesis, hemorrhages, and decrease of the capillary density with avascular areas in juvenile DM. In juvenile SLE, nonspecific capillaroscopy patterns are found characterized by minor abnormalities such as tortuous loops with slightly decreased capillary density (C) or more obvious abnormalities such as enlarged, meandering, and ramified loops (D; magnification × 200).

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Nailfold capillaroscopy changes are associated with disease activity and chronicity ([40, 42, 44, 46, 47]). Cutaneous improvement is associated with the regeneration of capillaries ([48]). The most severe capillaroscopy changes (i.e., loss of capillaries, bushy and/or enlarged loops) are associated with a longer disease duration and untreated disease and with cutaneous but not musculoskeletal features ([44, 46, 48]).

Capillaroscopy may be a useful tool to monitor disease activity; continuing clinical activity is often characterized by continuing skin involvement and persistent nailfold capillary changes ([41, 44]). It was in children with DM that regression in capillaroscopy abnormalities paralleling clinical improvement was probably first reported ([42]). This was a key finding because it demonstrated that grossly abnormal nailfold capillaries were capable of remodeling, and that this remodeling was associated with clinical remission ([42]). Although abnormal findings on nailfold capillaroscopy are not included in the Bohan and Peter criteria for DM ([49, 50]), these data should be used to evaluate patients with juvenile DM ([51]).

Capillaroscopy in juvenile SLE

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

SLE is a chronic, multisystem, autoimmune disease of an unknown etiology. It is highly heterogeneous in its clinical presentation and a significant proportion of patients develop internal organ involvement. Although many diagnostic and treatment aspects are similar between childhood and adult SLE patients, there are special characteristics concerning juvenile SLE. Children with SLE have a more severe disease onset and clinical course compared with adult-onset SLE ([52-54]).

A wide variety of capillaroscopy changes have been reported in 40–90% of adult- and juvenile-onset SLE, but there is no specific pattern ([1, 4-6, 38, 55]) (Table 1). Juvenile SLE patients show capillaroscopy abnormalities characterized by increased tortuosity and a meandering of loops ([4, 5, 38]) (Figures 3C and D). The associations between disease activity and severity of the overall capillary patterns have been reported in both juvenile and adult SLE ([4, 5, 55]).

Capillaroscopy in JIA

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

JIA is a heterogeneous group of diseases characterized by arthritis of an unknown origin that persists for >6 weeks with an onset before the age of 16 years. Capillary density, size, and morphology do not differ from those in healthy children ([1, 6, 41]). Capillaroscopic appearances do not differ between the different JIA disease subgroups ([5]). Although some deviations from normal have been reported in the nailfold capillaries in JIA, for example, increased loop tortuosity and branched loops, they are less striking than those in the CTDs discussed above ([1, 4, 5]).

Capillaroscopy in other childhood diseases

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

There have been only a small number of studies examining the application of nailfold capillaroscopy in other childhood diseases, which we briefly describe below. Capillaroscopy has been demonstrated to be helpful in the assessment of pediatric MCTD ([1, 4-6, 45]). Nailfold capillary changes resembling a scleroderma-like pattern (i.e., decreased capillary density and dilatation of the venular branch) have been described in these patients ([1, 4-6, 45]).

Kawasaki disease is a generalized systemic vasculitis that affects children ages <5 years. Coronary arteries are involved in the majority of cases, and aneurysms are the major manifestation of the disease. A study of 64 children with Kawasaki disease reported capillary morphologic abnormalities both in the afebrile and convalescent phases of disease, including an increased diameter of the arterial and venous limbs, a higher intercapillary distance, and a decrease in the loop numbers ([56]).

IgA vasculitis (Henoch-Schönlein) is the most common vasculitis affecting children. The clinical features are a consequence of a systemic, small-vessel leukocytoclastic vasculitis, including cutaneous purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. The reported capillaroscopy abnormalities include increased tortuosity of the capillaries, edema and derangement of the microvascular network, which are abnormalities that do not completely regress during clinical remission ([57, 58]).

Nailfold capillaroscopy has also been applied in children with Turner's syndrome and diabetes mellitus. Turner's syndrome is a relatively common chromosome disorder caused by complete or partial X monosomy; a study of capillaroscopy reported hairpin-shaped or tortuous loops without any specific pattern ([59]). In children with type 1 diabetes mellitus, an increase in the capillary number and the presence of nonspecific loop abnormalities was reported to correlate with longer disease duration ([60]).

Discussion

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES

Nailfold capillaroscopy is a noninvasive tool that can be applied in children as well as in adults and it provides a unique window into the microcirculation. To date, there have been relatively few studies examining the application of nailfold capillaroscopy in children, but with the increasing use of capillaroscopy internationally, this is likely to change. The existing studies suggest that, in children as in adults, abnormal capillaroscopy predicts an underlying CTD. A key point in children is the application of capillaroscopy in juvenile DM; abnormal capillaroscopy is useful not only diagnostically but also potentially as a biomarker for disease activity and for treatment response, especially now that high-magnification video systems allow quantification of the capillary abnormalities. Application in other childhood diseases in which a microvascular component is suspected should provide new insights into their pathophysiology, natural history, and treatment responsiveness.

REFERENCES

  1. Top of page
  2. Introduction
  3. Search strategy
  4. Capillaroscopy in healthy children
  5. Capillaroscopy in children with RP
  6. Capillaroscopy in juvenile SSc
  7. Capillaroscopy in localized scleroderma
  8. Capillaroscopy in juvenile DM
  9. Capillaroscopy in juvenile SLE
  10. Capillaroscopy in JIA
  11. Capillaroscopy in other childhood diseases
  12. Discussion
  13. AUTHOR CONTRIBUTIONS
  14. Acknowledgments
  15. REFERENCES
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