Background/Purpose: Systemic sclerosis (SSc) is a complex autoimmune disorder. To date, no comparative multi-modal imaging data exist for precursor patients, those with Raynaud’s phenomenon (RP) fulfilling the 2001 LeRoy and Medsger criteria1 for early SSc but without clinical skin thickening, compared to healthy controls.

Methods: This prospective cross-sectional study included unselected RP patients (n=20) fulfilling LeRoy’s criteria (RP plus SSc-specific antibodies, RP plus scleroderma pattern, or RP plus both) of the Ghent University (hospital) Raynaud’s clinic. Age-, sex-, and BMI-matched healthy controls (HC) (n=20) were recruited for baseline comparison. Dermal thickness (DT) was measured using high-frequency ultrasound (HFUS, 18 MHz) at 17 anatomical sites, a reliable technique, as described by our previous findings2. Nailfold videocapillaroscopy (NVC ×200 magnification) was evaluated qualitatively and quantitatively using standardized Scleroderma Clinical Trial Consortium (SCTC)/ European Alliance of Associations for Rheumatology (EULAR) Study Group on Microcirculation in Rheumatic Diseases consensus definitions. Peripheral blood perfusion (PBP) was assessed by laser speckle contrast analysis (LASCA) in the volar aspect of both hands under standardized conditions, as described previously3. Exploratory statistical analysis included Student T-test, Wilcoxon, and Fischer exact tests for between-group comparisons as appropriate.

Results: RP patients showed no evidence of SSc-related organ involvement4, except for gastro-oesophageal reflux without oesophageal dilatation on high-resolution computerised tomography (HRCT) (Table. 1). HFUS revealed no clinically meaningful differences in DT between groups (all p > 0.05) (Figure. 1A). LASCA showed significantly reduced volar fingertip PBP in RP patients compared to HC (all p < 0.005) (Figure. 1B). Baseline NVC showed significantly lower capillary density in RP patients across all 8 fingers (all p < 0.05). RP patients exhibited higher frequencies of giant capillaries (5–21% vs 0%) and microhaemorrhages (32–35% vs 0–5%, p < 0.05), with no significant differences in abnormal shapes (Figure. 2). Early and active scleroderma patterns were observed exclusively in RP patients.

Conclusion: In RP patients meeting the LeRoy’s criteria for early SSc, functional and structural microvascular abnormalities are detectable before skin or organ involvement. In line with the clinical absence of skin thickening in both the RP as well as in the HC groups, HFUS was indiscriminatory. Future longitudinal studies will be needed to determine at what point HFUS detects discriminatory changes compared to HC. References:1. LeRoy et al. J Rheumatol. 20012. Cutolo et al. Clin Exp Rheumatol. 20253. Willems et al. Diagnostics. 20234. Vanhaecke et al. Rheumatology (Oxford). 2022

Table 1. Baseline characteristics of study population

Figure 1. High frequency ultrasound (HFUS) and laser speckle contrast analysis (LASCA) findings in Raynaud’s patients versus healthy controls at baseline

Figure 2. Multi-panel image showing nailfold videocapillaroscopy (NVC) findings in Raynaud’s phenomenon (RP) patients (purple bars) vs healthy controls (green bars) at baseline. Significant p-values are graphically reported with the red outlines.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/multimodal-imaging-evaluation-of-patients-with-raynauds-phenomenon-meeting-the-criteria-for-early-systemic-sclerosis-according-to-leroy-versus-healthy-controls-a-prospective-cross-sectional-stu/