PMC9897177_01
Nailfold videocapillaroscopy (NVC) showing the capillaries of eight fingers, excluding the thumbs, across both hands. (a) NVC image at the time of SSc diagnosis, before initiation of treatment. Enlarged capillaries, giant capillaries and haemorrhages are present. (b) Images after 1 year of treatment with selexipag and macitentan. Enlarged capillaries, giant capillaries and haemorrhages appear worse than those at the initial examination. (c) Three years after initiation of treatment, with the addition of riociguat as a triple therapy approach. Although some vasodilatation remains, the giant capillaries have disappeared and haemorrhage has improved. (d-f) Magnified images of the right ring finger at each stage. (d) Early pattern: multiple giant capillaries are present, and eight nailfold capillaries can be observed at intervals of 1 mm. (e) Active pattern: half of the nailfold capillaries are giant capillaries. A decrease in nailfold capillary density can be observed, with only six nailfold capillaries at 1 mm intervals. (f) Early pattern: enlarged capillaries have improved, and most of the giant capillaries have disappeared. The nailfold capillary density also appears to have improved, with seven capillaries observed at intervals of 1 mm. L2: left index finger; L3: left middle finger; L4: left ring finger; L5: left little finger; R2: right index finger; R3: right middle finger; R4: right ring finger; R5: right little finger
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NVC testing was performed on eight fingers, excluding the thumb, and each finger was assessed on two images on either side of the centre. NVC showed enlarged capillaries, giant capillaries and haemorrhages (Fig. 1a and d). One year after initiation of treatment, the NVC showed worsening of the previous vasodilatation and haemorrhages (Fig. 1b and e). NVC performed at the 3-year follow-up showed that the vascular findings had normalized (Fig. 1c and f).