Behçet’s March: A Possible Clinical Progress in Children Revealed by Nailfold Videocapillaroscopy

PURPOSE Behçet’s disease (BD) is a chronic multisystem vasculitis that may begin in childhood. Microvascular dysfunction is central to its pathogenesis, yet pediatric data are scarce. This study evaluated nailfold videocapillaroscopy (NVC) findings in children with BD using standardized methods and examined whether microvascular alterations differ between complete and incomplete forms. The research question was whether NVC can detect early endothelial changes indicating disease progression and serve as a diagnostic or monitoring tool. METHODS In this cross-sectional study, pediatric BD patients fulfilling the Pediatric Behçet’s Disease (PEDBD) criteria underwent NVC following the European Alliance of Associations for Rheumatology (EULAR) microcirculation protocol. Capillary density, morphology, and microhemorrhages were compared between complete and incomplete BD and with age-matched healthy reference data. Associations between NVC parameters and clinical or laboratory findings were analyzed. RESULTS Complete BD patients (n = 15, 40.5%) had significantly lower capillary density and higher apical loop width, tortuosity, dilatation, abnormal capillaries, and microhemorrhage scores than incomplete BD (n = 22, 59.5%). Compared with healthy peers, BD patients showed significantly lower capillary density, arterial and venous diameters, and capillary length but higher intercapillary distance and width. CONCLUSION Children with BD show early microvascular abnormalities, most evident in complete phenotype. These findings suggest progressive endothelial involvement. Therefore, we suggest that NVC may serve as a noninvasive adjunct or a future alternative for classification and monitoring in pediatric BD.