Nailfold capillaroscopy is a valuable diagnostic tool for evaluating microvascular changes, particularly in rheumatic and autoimmune diseases such as systemic sclerosis, mixed connective tissue disease, systemic lupus erythematosus and dermatomyositis. By visualising capillary morphology at the nailfold, capillaroscopy aids in distinguishing primary Raynaud’s phenomenon from secondary and detecting early vascular involvement in systemic autoimmune diseases. Despite its utility, interpreting capillaroscopic findings presents significant challenges, including distinguishing normal variations from pathological changes, identifying subtle early abnormalities and accounting for secondary causes of capillary changes. There may be pitfalls in capillaroscopic interpretation, such as overestimating normal variations, overlooking early-stage systemic disease changes, misclassifying capillary patterns and over-relying on findings without integrating clinical and serological data. Strategies to avoid these errors include proper training in nailfold capillaroscopy, regular follow-up for evolving patterns and a comprehensive approach incorporating clinical, serological and imaging findings. By addressing these challenges, rheumatologists can maximise the diagnostic potential of capillaroscopy, improve early detection of systemic diseases and guide effective management strategies.