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Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration

Name: Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration
Creator: Gela Gunashvili
Published: 2026-11-04

Limited Cutaneous Systemic Sclerosis (ACA+)Early Scleroderma Pattern (CAPI-Score)Moderate

Images & measurements82

A 49-year-old woman with Limited Systemic Sclerosis and positive anti-centromeric antibodies. Two capillaroscopic examinations performed at a 6-month interval without immunosuppression, showing worsening of microangiopathy.

AuthorGela Gunashvili

Added to Capillaroscopy.comNovember 4, 2026

Clinical context

The patient has presented with symmetrical Raynaud’s phenomenon for 5 years and has been diagnosed with limited systemic sclerosis (SSc). She was previously treated with methotrexate and hydroxychloroquine; however, these medications were discontinued due to intolerance. Currently, she is taking only Nifedipine and Euthyrox (for hypothyroidism). She reports periodic swelling of the fingers and skin mottling. Her medical history includes two episodes of digital ulceration.

Capillaroscopy

The initial capillaroscopic examination revealed an early-stage scleroderma pattern, characterized by preserved capillary density (7.22/mm), a small number of giant capillaries (7%), moderate hemorrhages, and the absence of avascular zones. Upon re-evaluation, findings included an increase in giant capillaries (8.7%)—along with an increase in their mean loop diameter (60.5 to 70.4 µm), a reduction in capillary density (6.16/mm), an increase in dilated forms, the appearance of focal avascular zones, the emergence of isolated signs of neoangiogenesis, and an increase in hemorrhages. The CSURI index remained at elevated levels. Overall, the microangiopathy showed moderate progression. Note for interpretation: The latest capillaroscopic image was assessed by the software as an “active” pattern (with 87.8% probability). However, according to the “2024 CAPI-SCORE Objective pattern decision” criteria (density >5/mm, giant <10%, anomalous <5%), the pattern is classified as an “early” form, albeit one progressing toward an “active” stage.

Key Capillaroscopic Findings

Capillary density (N/mm): 7.22 → 6.16 (−14.7%)
Normal capillaries (%): 39.1% → 28.9%
Giant capillaries: 7% → 8.7%
Hemorrhages: 0.37/mm → 0.73/mm (+97%)
Enlarged capillaries (%): 49.8% → 59.7%
Early form progressing toward an active stage; active software prediction at follow-up (87.8%)

Initial study · 6 May 2026

Follow-up study · 28 October 2026

Longitudinal Capillaroscopic Comparison

6 May 2026 → 28 October 2026

Capillary density (N/mm)7.22→6.16 (−14.7%)

Normal capillaries (%)39.1%→28.9%

Giant capillaries (%)7%→8.7%

Hemorrhages (N/mm)0.37→0.73 (+97%)

Enlarged capillaries (%)49.8%→59.7%

Mean giant capillary loop diameter (µm)60.5→70.4

2 capillaroscopies

The study, field by field

Images & measurements

Explore the fields from each finger and open any image for a closer look. Measurements describe the complete examination at each visit.

Contributed by Gela Gunashvili for educational publication on Capillaroscopy.com. For reuse permissions, contact the rights holder.

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Initial study · 6 May 2026

Early-stage scleroderma pattern with preserved capillary density (7.22/mm), a small number of giant capillaries (7%), moderate hemorrhages, and no avascular zones.

Recorded measurements

Capillary density: 7.22capillaries/mm
Enlarged capillaries: 49.76%
Giant capillaries: 7.04%
Hemorrhages: 0.37/mm

Values from the saved analysis: density and hemorrhages per total analyzed length; percentages of the total capillary count. These are not measurements of an individual image and may differ from averages across fields.

Left index finger

6 images

Nailfold capillaroscopy: left index finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left index finger, field b.

Nailfold capillaroscopy: left index finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left index finger, field c.

Nailfold capillaroscopy: left index finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: left index finger, field d.

Left middle finger

5 images

Nailfold capillaroscopy: left middle finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left middle finger, field b.

Nailfold capillaroscopy: left middle finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left middle finger, field c.

Nailfold capillaroscopy: left middle finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: left middle finger, field d.

Left ring finger

6 images

Nailfold capillaroscopy: left ring finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left ring finger, field b.

Nailfold capillaroscopy: left ring finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left ring finger, field c.

Nailfold capillaroscopy: left ring finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: left ring finger, field d.

Left little finger

4 images

Nailfold capillaroscopy: left little finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left little finger, field b.

Nailfold capillaroscopy: left little finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left little finger, field c.

Nailfold capillaroscopy: left little finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: left little finger, field d.

Right index finger

5 images

Nailfold capillaroscopy: right index finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right index finger, field b.

Nailfold capillaroscopy: right index finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right index finger, field c.

Nailfold capillaroscopy: right index finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: right index finger, field d.

Right middle finger

5 images

Nailfold capillaroscopy: right middle finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right middle finger, field b.

Nailfold capillaroscopy: right middle finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right middle finger, field c.

Nailfold capillaroscopy: right middle finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: right middle finger, field d.

Right ring finger

6 images

Nailfold capillaroscopy: right ring finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right ring finger, field b.

Nailfold capillaroscopy: right ring finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right ring finger, field c.

Nailfold capillaroscopy: right ring finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: right ring finger, field d.

Right little finger

5 images

Nailfold capillaroscopy: right little finger, field b. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right little finger, field b.

Nailfold capillaroscopy: right little finger, field c. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right little finger, field c.

Nailfold capillaroscopy: right little finger, field d. Initial study · 6 May 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: right little finger, field d.

Follow-up study · 28 October 2026

6-month interval

Moderate progression of microangiopathy, with reduced capillary density (6.16/mm), increased giant capillaries (8.7%), focal avascular zones, isolated signs of neoangiogenesis, and increased hemorrhages.

Recorded measurements

Capillary density: 6.16capillaries/mm
Enlarged capillaries: 59.66%
Giant capillaries: 8.68%
Hemorrhages: 0.73/mm

Left index finger

4 images

Nailfold capillaroscopy: left index finger, field d. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: left index finger, field d.

Nailfold capillaroscopy: left index finger, field c. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left index finger, field c.

Nailfold capillaroscopy: left index finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left index finger, field b.

Left middle finger

5 images

Nailfold capillaroscopy: left middle finger, field c. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left middle finger, field c.

Nailfold capillaroscopy: left middle finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left middle finger, field b.

Nailfold capillaroscopy: left middle finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: left middle finger, field a.

Left ring finger

7 images

Nailfold capillaroscopy: left ring finger, field c. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: left ring finger, field c.

Nailfold capillaroscopy: left ring finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left ring finger, field b.

Nailfold capillaroscopy: left ring finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: left ring finger, field a.

Left little finger

4 images

Nailfold capillaroscopy: left little finger, field d. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: left little finger, field d.

Nailfold capillaroscopy: left little finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: left little finger, field b.

Nailfold capillaroscopy: left little finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: left little finger, field a.

Right index finger

5 images

Nailfold capillaroscopy: right index finger, field c. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right index finger, field c.

Nailfold capillaroscopy: right index finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right index finger, field b.

Nailfold capillaroscopy: right index finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: right index finger, field a.

Right middle finger

6 images

Nailfold capillaroscopy: right middle finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right middle finger, field b.

Nailfold capillaroscopy: right middle finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: right middle finger, field a.

Nailfold capillaroscopy: right middle finger, field d. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field D
Nailfold capillaroscopy: right middle finger, field d.

Right ring finger

5 images

Nailfold capillaroscopy: right ring finger, field c. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right ring finger, field c.

Nailfold capillaroscopy: right ring finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right ring finger, field b.

Nailfold capillaroscopy: right ring finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: right ring finger, field a.

Right little finger

4 images

Nailfold capillaroscopy: right little finger, field c. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field C
Nailfold capillaroscopy: right little finger, field c.

Nailfold capillaroscopy: right little finger, field b. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field B
Nailfold capillaroscopy: right little finger, field b.

Nailfold capillaroscopy: right little finger, field a. Follow-up study · 28 October 2026. Limited Systemic Scleroderma (ANA-Centromeric+) with Capillaroscopic Deterioration. — Field A
Nailfold capillaroscopy: right little finger, field a.

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