**5. Nailfold capillaroscopy in noninfectious vasculitides**

Vasculitides evolve by inflammation of vessels, which include capillaries. NFC can, then, provide valuable information on the approach of patients with vasculitis. Although scarce research has been made in this field, a recent systematic review, following Chapel-Hill nomenclature, puts in evidence that NFC is more useful in small than in large vessel vasculitides [39, 40]. However, as large vessel vasculitides also involve microcirculation, the presence of NFC changes in these disorders cannot be excluded. Besides, NFC can also give important information about organ involvement and disease activity [41, 42].

The microangiopathy in vasculitides reveals several and heterogeneous NFC changes, but generally nonspecific, when compared to scleroderma pattern. Increased tortuosity; microhemorrhages; enlarged, bushy, and bizarre capillaries; and architectonic disarrangement are the most frequent findings [39]. In some cases, however, the described NFC abnormalities include capillary dilation and reduced density, which are usually associated with scleroderma spectrum diseases. Whether a deep capillary damage is due to primary vasculitis or if there is a possible overlap of cases with scleroderma-related disorders is yet to be clarified.

#### **5.1 Large vessel vasculitis**

A recent study revealed that in Takayasu arteritis (TA) capillaries are affected due to hypoperfusion [43]. NFC abnormalities found were reduced capillary length and venous limb diameter and tortuosity, but, in hands with subclavian involvement, these changes were more severe. Capillary diameter was then considered as an example of subclavian artery stenosis alteration due to disease progression.

**181**

**Figure 13.**

*Hospital Curry Cabral.*

*The Impact of Nailfold Capillaroscopy in the Approach of Microcirculation*

In polyarteritis nodosa, NFC can be normal in the absence of Raynaud's phenomenon [19]. Yet, in its presence, changes include reduced capillary density, microhemorrhages, and edema. When digital ischemia is present, important edema, capillary flow sludge, and multiple hemorrhages can be seen (**Figure 13**). Only one study about Kawasaki disease and NFC was found and it involved 64 pediatric patients [44]. Microcirculation abnormalities found included reduced density, dilation of arterial and venous limb diameters, higher intercapillary

distance, and abnormal loops. The latter two were related to disease activity, as they improved from postacute to convalescent phase. Blood velocity was associated with

Microcirculation abnormalities of granulomatosis with polyangiitis, formerly Wegener's granulomatosis, were described in one study involving 12 patients [45]. The main NFC changes detected were avascular areas; crossed and bushy capillaries; and microhemorrhages. No relationship was established with disease activity or

No valuable information was found about NFC in microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis-former Churg-Strauss vasculitis.

NFC changes in cryoglobulinemic vasculitis were disclosed in one study with 29 patients, of which 28 had hepatitis C infection [41]. Microcirculation abnormalities detected were tortuosity, altered orientation, shortened capillaries, and neoangiogenesis (**Figure 14**). No relation was found with disease activity, but glomerulone-

IgA vasculitis (IAV), formerly called Henoch-Schönlein purpura, rarely affects adults and studies about NFC changes have been performed in small samples of patients in pediatric age [46–48]. The NFC changes in IAV are conflicting, including density reduction, increased capillary length, loop dilatation, persistent edema,

*Polyarteritis nodosa. This patient presents with capillary slow flow sludge (dashed arrow), reduced capillary density, but also enlarged capillaries (black dot) (4th finger of the left hand). Images were taken using Videocap biomicroscope, version 3.0, magnification ×200. Courtesy of Nailfold Capillaroscopy Clinic of* 

• Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis

*DOI: http://dx.doi.org/10.5772/intechopen.90525*

**5.2 Medium vessel vasculitis**

increased coronary artery diameter.

• Immune complex small vessel vasculitis

phritis was associated with a higher score of NFC alterations.

**5.3 Small vessel vasculitis**

its clinical aspects.

We found no data about nailfold capillaroscopy in giant cell arteritis.
