Yasser El Miedany1, Sherif Ismail2, Mary wadie fawzy3, Ulf Müller-Ladner4, Roberto Giacomelli5, Vasiliki Liakouli6, W Hermann7, Nihal Fathy8, Maha El Gaafary9, Nermin A Fouad10, Sally Saber11, Mohammed Hassan Abu-Zaid12

1Canterbury Christ Church University, Rheumatology, London, United Kingdom
2Department of Rheumatology and Rehabilitation, National Research Center, Cairo, Egypt
3Department of Internal Medicine, Cairo University, Cairo, Egypt
4Department of Rheumatology and Clinical Immunology, Justus-liebig University of Giessen, Campus Kerckhoff, Giessen, Germany
5Clinical Unit of Rheumatology and Clinical Immunology, University of Rome, Rome, Italy
6Department of Biotechnological and Applied Clinical Sciences, University of L'aquila, Unit of Rheumatology, L'Aquila, Italy
7Kerckhoff-klinik Gmbh, Benekestr, Abteilung Für Rheumatologie Und Klinische Immunologie, Bad Nauheim, Germany
8Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
9Ain Shams University, Community and Public Health, Cairo, Egypt
10Rheumatology and Rehabilitation, Fayoum University, Fayoum, Egypt
11Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
12Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt

Keywords: Clinical practice, microcirculation, nailfold capillaroscopy, recommendations.


Objectives: Based on the mainstream adoption of nailfold capillaroscopy as an investigative tool for rheumatologists, this work was carried out by a panel of experts in the field of capillaroscopy and microcirculation to issue a consensus view on capillaroscopic image acquisition and analysis standardization.

Patients and methods: After the key clinical questions were identified by the core team, a systematic review of the published research was carried out focusing on variable capillaroscopic techniques, definitions, and characteristics, including capillary density (number of capillaries), capillary morphology (shape of each capillary), capillary dimensions (width of apical, arterial, and venous limb of the capillary), and the presence of hemorrhages. The expert panel attained a consensus and developed recommendations for the standardization of capillaroscopy in clinical practice. These included recommendations for normality and abnormality and the different capillaroscopic patterns. It also involved recommendations for scoring systems, reliability, and reporting.

Results: A panel of 11 experts participated in the two rounds with a response rate of 100%. A total of nine recommendations were obtained. The agreement with the recommendations (a score of 7-9) ranged from 81.8 to 90.9%. A consensus (i.e., ≥75% of respondents strongly agreed or agreed) was reached on all the clinical standards.

Conclusion: This work highlighted the main NFC indications, the technical equipment that should be used, how to carry out the procedure, standardization of the terminology of the parameters, and the interpretation of NFC findings. An evidence-based consensus incorporating the advice and experience of a diverse international expert panel was reached.

Citation: Miedany YE, Ismail S, Fawzy MW, Ladner UM, Giacomelli R, Liakouli V, et al. Towards a consensus on the clinical applications and interpretations of the nailfold capillaroscopy standards in clinical practice: An initiative by the Egyptian Society of Microcirculation. Arch Rheumatol 2023;38(3):451-460.

Ethics Committee Approval

The study protocol was approved by the Tanta University Ethics Committee (date: 16.08.2021, no: 34842/8/21). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea: Y.E.M., S.I., M.F., M.A.Z.; Design and data processing: M.E.G.; Literature review: Y.E.M., N.F., N.F., S.S. Analysis interpretation, writing the article, critical review, referencing: All authors.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.