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Introduction Nailfold videocapillaroscopy (NVC) represents a reliable, non-invasive tool for the diagnosis of several adult rheumatological diseases, and the assessment of peripheral microvascular abnormalities may serve as a potential biomarker of disease severity in these patients. Unfortunately, data on NVC findings and their clinical significance in paediatric patients remain limited. We aimed to compare NVC findings in children with primary Raynaud’s phenomenon (pRP) versus children with a definite diagnosis of connective tissue diseases (CTDs), and to identify potential associations between capillaroscopic features and specific disease characteristics, in order to assess their clinical significance.Material and Methods We conducted a cross-sectional, monocentric study evaluating consecutive children with pRP and those with CTDs—including juvenile systemic sclerosis (JSSc), dermatomyositis (JDM), and systemic lupus erythematosus (JSLE)—regardless of RP status. For each patient, 32 NVC images were acquired, and microvascular alterations were analysed and classified as either nonspecific or scleroderma patterns (early, active, late) by two independent observers. Six capillaroscopic features were examined: enlarged and giant capillaries, microhaemorrhages, microvascular disarray, capillary ramifications and loss of capillaries. A semiquantitative rating scale was adopted to score each capillaroscopic abnormality, and an average score was calculated.Results A total of 1600 NVC images from 50 subjects (30 females; mean age 16.4±4.0 years) were evaluated. Scleroderma pattern was significantly more frequent in JSSc versus pRP (p<0.001) and JDM (p<0.005). Differences in capillaroscopic alterations were observed only between pRP and JSSc for reduced capillary density (p<0.001) and presence of giants (p=0.01). Scleroderma pattern was associated with skin fibrosis (21/25 vs. 0/9; p<0.001), digital ulcers (8/25 vs. 0/9; p=0.07), and gastrointestinal involvement (17/25 vs. 1/9; p=0.006) ( table 1). A significantly higher avascular score was found in patients with interstitial lung disease (ILD) than in those without (0.69±0.51 vs. 0.44±0.38; p=0.048) (figure 1A). Indeed, patients with severe reduction of capillary density (<4 capillaries/mm) were more likely to have ILD (5/10 vs. 4/13; p=0.02). Neoangiogenesis was significantly associated with ILD in univariate analysis, as patients with CTD-ILD exhibited higher neoangiogenesis scores compared to those without lung fibrosis (1.85±0.65 vs. 1.10±0.50; p=0.03) (figure 1B); however, this association was not confirmed in the multivariate model (OR 2.5; 95%CI 0.7–8.8; p=0.15).Conclusions NVC is a valuable tool for differentiating pRP from early juvenile CTDs and may help risk stratification for organ involvement, particularly ILD. Future prospective studies should aim to validate these associations, and explore whether early capillaroscopic abnormalities can inform risk stratification or therapeutic decisions in the daily paediatric rheumatology practice.Abstract P.338 Figure 1Avascular scores in juvenile connective tissue diseases (JCTDs) patients with and without interstitial lung disease (ILD); (B) Neoangiogenesis scores in JCTDs patients with and without ILDAbstract P.338 Table 1Association between capillaroscopie features and organ involvement in juvenile connective tissue diseases (JCTDs)