Date: Monday, October 22, 2018
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Small vessel arteriopathy precedes the development of organ damage and tissue fibrosis in systemic sclerosis (SSc) and related disorders. It is currently considered that providing early vascular protection might result in a slower and milder progression of the disease. However, there is still no standard of care for this poorly understood process, besides symptomatic measures and treatment of complications. A major reason could be the lack of available tools for the routine assessment of the microcirculation at the clinic. In order to overcome this hurdle, we have launched a study addressing the utility of ultrasonography (US) in identifying robust outcome measures in patients with relevant SSc-like vasculopathy. Our first objective was to look for associations between US-based hemodynamic measures and features of vascular injury in a cohort of patients with Raynaud´s Phenomenon (RP).
26 real-life patients have been enrolled, 10 of which had primary RP (PRP) and 16 secondary RP (SRP), with 11p diagnosed with SSc. 5 of the patients with SRP had a past history of complications, and 10 had macroscopic alterations at the time of the study. All patients had a recent nailfold videocapillaroscopy (NVC) recording which had been pathologic in 15p. Of these, 10p had an SSc typical NVC pattern of lesions. Patients underwent a Duplex US evaluation of 6 arterial regions (cubital, radial, 1st, 2nd, and 3rd digital branches and the superficial palmar arch) at the non-dominant hand. Systolic peak (PS), end diastolic velocity (ED), maximum speed, resistance index and the PS to ED ratio (PS/ED) were registered. Global and specific health questionnaires were recorded as independent variables, and their association with the US data was established with non-parametric tests. An alpha value of 5% was considered significant.
Globally, no single US parameter discriminated between PRP and SRP. However, patients with anti CENP-B antibodies, history of RP-associated complications, concurrent macroscopic alterations and/or an SSc-type of NVC pattern of lesions showed significantly lower PS and/or ED, at least at one region, in particular at the cubital artery and the 2nd digital branch, while a decreased PS/ED at the palmar arch was associated to CENP-B antibodies and to a past history of complications. Interestingly, the SF36 domain of global health was lower in the SRP subgroup (p 0.035) and associated to a lower PS/ED at the cubital artery (p 0.019). Also associated to this hemodynamic parameter were SF36 social performance (p 0.037) and mental health (p 0.04) domains, while both the RP severity scale and number of episodes were negatively associated with the cubital artery PS values (p 0.002, p 0.019, respectively).
In this initial approach we have observed that Duplex US is able to distinguish patients with SSc-associated vasculopathy from those with milder RP. Our results point to reduced PS and PS/ED in the ulnar territory as potential outcome measures for further research.
To cite this abstract in AMA style:Pérez Esteban S, Naredo Sánchez E, Recuero Díaz S, Romero-Bueno FI, Herrero-Beaumont G, Sanchez-Pernaute O. A Role for Duplex Ultrasound of Hand Arteries in the Assessment of the Vasculopathy Associated to Systemic Sclerosis-like Diseases [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/a-role-for-duplex-ultrasound-of-hand-arteries-in-the-assessment-of-the-vasculopathy-associated-to-systemic-sclerosis-like-diseases/. Accessed November 26, 2020.
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