https://doi.org/10.4081/reumatismo.2026.2398
Nailfold videocapillaroscopy as a diagnostic clue in interstitial lung disease: differentiating idiopathic from autoimmune patterns in a Caucasian cohort
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Accepted: 2 July 2026
Published: 21 October 2026
Objective. Interstitial lung diseases (ILDs) include idiopathic pulmonary fibrosis (IPF) and autoimmune-related forms such as interstitial pneumonia with autoimmune features (IPAF) and connective tissue disease-associated ILD (CTD-ILD). Nailfold videocapillaroscopy (NVC) is well established in systemic sclerosis (SSc) but remains underused in ILD characterization. This study aimed to evaluate NVC findings in IPF, IPAF, and CTD-ILD.
Methods. This cross-sectional study included 67 Caucasian ILD patients (16 IPF, 13 IPAF, and 38 CTD-ILD, including 21 SSc-ILD). NVC was performed using a digital videocapillaroscope and scored semi-quantitatively (0–3) across six parameters (total score 0–18). Patterns were classified as normal, nonspecific abnormalities, or scleroderma pattern (early, active, or late). Continuous variables were analyzed with one-way analysis of variance and Bonferroni correction; categorical variables with χ² or Fisher’s exact test.
Results. The total NVC score increased progressively from IPF (3.2±1.4) to IPAF (4.5±3.2) and CTD-ILD (6.5±3.1; p=0.001). Capillary loss was the only item of NVC significantly different among groups (p=0.006), although all items showed a gradual increase across the spectrum. Scleroderma patterns were observed in 6.3% of IPF, 23.1% of IPAF, and 65.7% of CTD-ILD patients, particularly in SSc-ILD (95.2%). Notably, 81.3% of IPF patients showed nonspecific abnormalities, suggesting subtle microvascular involvement even in idiopathic disease.
Conclusions. NVC demonstrates potential discriminatory value between IPF and autoimmune-related ILD, especially SSc-ILD. The progressive increase in microvascular abnormalities observed from IPF to SSc-ILD suggests a possible contribution of immune-mediated microvascular involvement across different ILD phenotypes. These findings should be considered exploratory and warrant confirmation in larger prospective studies. NVC may represent a useful adjunct to serological and radiological assessment in ILD diagnostic pathways.
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CRediT authorship contribution
Daniele Vito Andrea Sabella, Marco Fornaro: conception and design of the study. Daniele Vito Andrea Sabella, Marco Fornaro, Laura Coladonato, Ester Boniello, Luciana Labate, Paola Piarulli, Anna Violante: patient recruitment and data collection. Daniele Vito Andrea Sabella: statistical analysis and draft of the manuscript. Marco Fornaro, Florenzo Iannone: critical revision of the manuscript for important intellectual content. All authors: data interpretation, review of the manuscript, and approval of the final version to be published. Florenzo Iannone is the guarantor of the study and takes responsibility for the integrity of the data and the accuracy of the analysis.
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