medical decision support medical decision support
Sign In

Nailfold Capillary Microscopic Profiles of Joyal et al in a Patient with Systemic Sclerosis

Purpose: To evaluate the capillaries in the finger nailfold of a patient with systemic sclerosis based on the criteria of Joyal et al.

Description

Joyal et al graded the severity of changes in nailfold capillaries seen in patients with systemic sclerosis. The authors are from the University of Montreal and University of Toronto in Canada.


Technique: nailfold capillary microscopy

 

Patient groups studied:

(1) S1 - skin involvement proximal to the metacarpo-phalangeal joint (major ARA criterion)

(2) S2 - 2 or 3 of the minor ARA criteria for systemic sclerosis (sclerodactyly, finger changes or bibasilar pulmonary fibrosis)

(3) S3 - 2 or more CREST criteria

 

Parameters:

(1) capillary telangiectasia

(2) capillary dilatation

(3) avascular areas (capillary loss)

 

Parameter

Finding

Code

capillary telangiectasia

absent

absent

 

present

present

capillary dilatation

normal (no dilatation)

0

 

1.1 to 1.9 times normal (less than 2 times)

1

 

2 to 4 times normal

2

 

> 4 times normal

3

avasuclar areas

none

A

 

rare

B

 

moderate

C

 

extensive

D

 

where:

• Venular telangiectasia are excluded.

• There was no specific code for capillary telangiectasia.

 

Telangiectasia

Dilatation

Avascular Areas

Profile

none

none

none

none

none

0 or 1

A or B

mild

none

1 to 3

B to D

moderate

present

1 to 3

B to D

severe

 

Performance:

• A moderate or severe profile showed a 94% sensitivity for S1 and S2 clinical groups and 70% for S3. A higher profile was associated with a higher disease severity score.

• Telangiectasia is seen in patients with higher disease severity scores.

• Capillary loss and loop enlargement are seen in patients with more severe organ involvement.


To read more or access our algorithms and calculators, please log in or register.

Specialty

Objective

ICD-10