Capillary Microvascular Dysfunction in Rheumatoid Arthritis: The Promising Role of Nailfold Videocapillaroscopy—A Narrative Review

Arthritis (RA) is characterized by immune-mediated chronic inflammation and endothelial dysfunction, ultimately resulting in clinically overt cardiovascular complications. As a prototypical disease of microvascular dysfunction, RA represents an ideal model to study microvascular alterations. The dermal capillary network offers an easily accessible window to the peripheral microcirculation, whose function can be easily assessed using Nailfold videocapillaroscopy (NVC) or laser techniques. Whereas the clinical significance of structural alterations is not always clear, functional abnormalities may provide more direct insight into the dynamic status of the microvasculature and endothelial integrity. The present narrative review aims to provide an integrative overview of available studies evaluating functional abnormalities of the dermal microcirculation in RA, with particular emphasis on the emerging role of NVC as a dynamic vascular assessment tool. Several studies in RA have assessed the structure and morphology of the peripheral microvasculature using NVC, but far fewer data exist on functional alterations assessed with this method. The study of functional alterations of the dermal microvascular network in RA has largely been based on laser techniques, which consistently point towards altered microvascular reactivity. By contrast, functional NVC-related approaches remain limited, despite their potential ability to simultaneously assess structural and dynamic capillary abnormalities in vivo. Available evidence supports that NVC may be reframed as a promising functional vascular biomarker in RA. However, the available literature is characterized by small sample sizes, predominantly cross-sectional designs, and methodological heterogeneity, highlighting the need for standardized prospective studies.