Could nailfold videocapillaroscopy (NVC) be useful to assess disease activity in patients with systemic sclerosis, as well as for diagnostic and staging purposes? The results of a new cross-sectional study suggest they can. NVC and automated image analysis was used to assess all eight fingers of 107 patients with systemic sclerosis. The NVC findings correlated closely with disease activity scores obtained using the European Scleroderma Study Group (ESSG) composite index, the current gold standard for assessing disease activity in patients with systemic sclerosis. The presence of ≥6 microhaemorrhages or microthromboses (or the presence of 3–5 microhaemorrhages or microthromboses and ≥3 giant capillaries) on NVC identified the 41 patients with moderate to high disease activity (ESSG index ≥3.0) with sensitivity of 95.1%, specificity of 84.8% and accuracy of 88.7%. The researchers call for longitudinal studies to assess the sensitivity of this quick and easy assessment technique to changes in disease activity over time.