Background/Purpose: Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by initial vascular injuries and resultant fibrosis of skin and certain internal organs. Evidence has shown that vascular impairment in SSc may be a sign of endothelial dysfunction involving both microvascular and macrovascular systems. Ultrasound assessment of brachial artery endothelial-dependent flow-mediated dilation (FMD) is a noninvasive instrumental evaluation that is routinely performed as an index of macrovascular function. We evaluated the association of FMD with clinical features of SSc to assess the possible contribution of endothelial dysfunction to the developmental process of clinical features associated with this disease.

Methods: Twelve healthy controls and thirty-five consecutive patients with SSc (mean age 53 ± 17 years and 57 ± 11 years, respectively) were studied. In patients, clinical symptoms, such as swollen fingers, nailfold bleeding (NFB), pitting scars, digital ulcers, and Raynaud’s phenomenon, were meticulously recorded. Eighteen patients had limited cutaneous SSc (lcSSc) and 17 had diffuse cutaneous SSc (dcSSc). Ultrasound assessment of FMD was performed on all patients. Correlation between FMD value (%FMD) and various typical symptoms, disease duration, and subtype of SSc was studied.

Results:  There was significant decrease in %FMD in patients compared to healthy controls (5.72% versus 7.71%, respectively; p = 0.041). Especially, lcSSc patients had significantly lower %FMD values than healthy controls (5.25% versus 7.6%, p = 0.016), while the levels in dcSSc patients (6.8%) were comparable to those of healthy controls. Furthermore, in lcSSc patient group, patients with decreased %FMD had much longer disease duration than those with normal %FMD (p = 0.0088), while the age of these two patient groups was comparable. As for clinical symptoms, lcSSc patients with decreased %FMD showed much higher prevalence of digital ulcers and elevated RVSP than those with normal %FMD (for each; 75% versus 10%, p = 0.040). In addition, there was a trend towards the increase in the prevalence of decreased %DLco, but not decreased %VC, in lcSSc patients with decreased %FMD as compared to those with normal %FMD.

Conclusion: Endothelial function evaluated by %FMD is markedly impaired in SSc patients. lcSSc patients with decreased %FMD exhibited a significantly higher prevalence of clinical symptoms associated with vasculopathy. Furthermore, the values of %FMD greatly and inversely correlated with disease duration in lcSSc patients. Collectively, %FMD is potentially a powerful tool to evaluate the damage of vascular system in SSc, especially in limited cutaneous subtype of this disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-correlation-of-flow-mediated-endothelium-dependent-vasodilatation-in-systemic-sclerosis/