Fast-track capillaroscopic progression in systemic sclerosis: a case-based review of active pattern emerging within 3 months of raynaud's phenomenon onset

Abstract

Nailfold videocapillaroscopy typically shows a gradual progression through early, active, and late scleroderma patterns over years in systemic sclerosis. Rapid evolution directly to active pattern within months of Raynaud's phenomenon onset is rarely documented. We report a 39-year-old non-smoking Caucasian woman who developed Raynaud's phenomenon in April 2025. Nailfold videocapillaroscopy performed three months later revealed an active scleroderma pattern characterized by multiple megacapillaries, microhemorrhages, and reduced capillary density, bypassing the typical early pattern phase. Antinuclear antibodies were positive at 1:320 with centromere pattern. The patient met the criteria for early systemic sclerosis (SSc) in accordance with LeRoy and Medsger, and showed high risk for progression to definite systemic sclerosis. This case demonstrates that rapid progression to active scleroderma pattern can occur within three months of Raynaud's onset, challenging the conventional understanding of capillaroscopic evolution timing. Early capillaroscopy in recent-onset Raynaud's phenomenon may identify patients at accelerated risk for systemic sclerosis development, with important implications for monitoring and early intervention strategies.

Keywords: Active scleroderma pattern; Early diagnosis; Early systemic sclerosis; LeRoy criteria; Nailfold videocapillaroscopy; Raynaud's phenomenon.