Disturbances of the Acral Perfusion Detected By Fluorescence Optical Imaging Are Associated with the Development of Ischemic Complications in Patients with Systemic Sclerosis

Stefanie Friedrich^1,2, Susanne Lueders³, Stephanie Werner^3,4, Anne-Marie Glimm⁵, Gabriela Schmittat⁵, Gerd R. Burmester⁶, Gabriela Riemekasten⁷, Marina Backhaus⁸ and Sarah Ohrndorf⁹, ¹Department of of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; Germany, Berlin, Germany, ²Department of Radiology, Department of Radiology, Charité University Hospital, Berlin; Germany, Berlin, Germany, ³Department of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; Germany, Berlin, Germany, ⁴Department of Rheumatology, Helios St. Johannes Clinic, Duisburg, Germany, ⁵Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany, ⁶Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany, ⁷Department of Rheumatology, Universitatsklinikum Schleswig-Holstein, Lubeck, Germany, ⁸Rheumatology, Park-Klinik Weissensee, Berlin, Germany, ⁹Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Capillaroscopy, imaging techniques, risk, systemic sclerosis and ulcers

Session Information

Date: Tuesday, November 7, 2017

Title: Imaging of Rheumatic Diseases Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Systemic sclerosis (SSc) is a condition causing impaired microcirculation with the risk of ischemic complications such as digital ulcers and pitting scars (DU/PS). Fluorescence optical imaging (FOI) is an imaging method that detects enhanced microcirculation as a sign of joint inflammation in both hands of patients with rheumatoid arthritis and other arthritides [1, 2]. FOI’s impact to record disturbed microcirculation in the hands of patients with systemic sclerosis has not yet been sufficiently investigated [3]. The aim of this study is to find associations of disturbed microcirculation initially detected by FOI and the development of new DU/PS throughout a follow-up of 12 months.

Methods:

Sixty-three patients with SSc were included and received FOI examination following the Xiralite-System guidelines (ICG 0.1mg/kg BW i.v.; 6 minute duration) as well as capillaroscopy at baseline. After a mean follow-up time of 12 months (min-max: 8-20 months), all participants were followed regarding the development of new ulcers and pitting scars.

Results:

A disruption of microcirculation in FOI was defined as a lack of a sufficient fluorescent signal in at least one fingertip over the entire course of the examination and was found in 11 of 63 SSc patients. All of these patients had a history of DU/PS and frequently presented with a late pattern capillaroscopy (9 of 11) at baseline. Fingers with a disrupted microcirculation also showed a reduced capillary density to a greater extend (96.0%) than fingers with a sufficient signal in FOI (76.0%; p=0.0241).

30 of 60 patients developed digital ulcers or pitting scars during follow up (3 drop outs due to death [n=2] or withdrawal). 81.8% of patients with a disturbed microcirculation in FOI developed these complications during follow-up compared with 42.9% of patients without a disruption in FOI (p=0.0419; OR=6.0 [95%CI 1.2 – 30.7]). A disruption of microcirculation especially increased the risk of developing DU/PS in the same finger: 20.1% of fingers with normal, but 65.4% with a missing FOI signal in the fingertip presented with an ischemic complication during follow-up (p<0.0001; OR=7.5 [95%CI 3.3 – 17.3]).

Conclusion:

Fluorescence optical imaging can reveal an impaired microcirculation in patients with systemic sclerosis, which is associated with microangiopathic changes as seen in capillaroscopy as well as the subsequent development of digital ulcers and pitting scars. Therefore, FOI might help to identify patients at risk for these complications.

Disclosure: S. Friedrich, None; S. Lueders, None; S. Werner, None; A. M. Glimm, None; G. Schmittat, None; G. R. Burmester, AbbVie, BMS, MSD, Pfizer, Roche, and UCB, 5; G. Riemekasten, CellTrend, 4; M. Backhaus, None; S. Ohrndorf, None.

To cite this abstract in AMA style:

Friedrich S, Lueders S, Werner S, Glimm AM, Schmittat G, Burmester GR, Riemekasten G, Backhaus M, Ohrndorf S. Disturbances of the Acral Perfusion Detected By Fluorescence Optical Imaging Are Associated with the Development of Ischemic Complications in Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/disturbances-of-the-acral-perfusion-detected-by-fluorescence-optical-imaging-are-associated-with-the-development-of-ischemic-complications-in-patients-with-systemic-sclerosis/. Accessed .

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