Nailfold capillaroscopy as a non-invasive screening tool for early atherosclerosis in psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic autoimmune inflammatory disease associated with increased risk of atherosclerosis and cardiovascular morbidity. This study aimed to evaluate whether nailfold capillaroscopy (NFC) can facilitate early detection of subclinical atherosclerosis in PsA patients. This cross-sectional study included 120 PsA patients. All participants underwent detailed clinical and laboratory assessment, carotid intima–media thickness (CIMT) measurement, and NFC evaluation. Patients were categorized into atherosclerotic and non-atherosclerotic groups based on CIMT cutoff ≥ 0.8 mm. Thirty-six patients (30%) had subclinical atherosclerosis. Atherosclerotic patients had significantly longer disease duration (12.3 vs. 6.6 years, p < 0.001), higher body mass index (BMI) (29.0 vs. 26.3, p = 0.002), higher disease activity of psoriatic arthritis (DAPSA) scores (35.8 vs. 28.8, p = 0.033), and more frequent dyslipidaemia (p < 0.001) compared to non-atherosclerotic group. NFC abnormalities strongly associated with atherosclerosis included; capillary tortuosity (100% vs. 59.5%), capillary crossing (88.9% vs. 52.4%), microhaemorrhages (33.3% vs. 4.8%), and visible subpapillary venous plexus (100% vs. 45.2%) (all p < 0.001). CIMT correlated positively with BMI, lipid parameters, disease duration, DAPSA, tortuosity, and crossings, and negatively with high density lipoproteins. Capillary tortuosity at cut off value ≥ 11% had 100% sensitivity for identifying atherosclerosis in PsA patients. Subclinical atherosclerosis is common in PsA and is associated with higher disease activity and metabolic risk factors. NFC abnormalities, particularly tortuosity, crossings, and venous plexus visibility, may serve as simple, non-invasive biomarkers for early vascular risk detection in PsA patients.