Background/Purpose:

Digital ulcers (DUs) are a major burden in patients with systemic sclerosis (SSc). Laser speckle contrast analysis (LASCA) is a novel technique that can analyse blood perfusion (BP) in the fingers and in DU areas. The objective of the present study was to evaluate BP in patients with SSc and DUs and correlate these values with the treatments and healing time.

Methods:

From February 2016 to March 2017, 23 consecutive Ssc patients presenting with DU at fingertips were enrolled: M:F=2:21; 15 lcSSc and 8 dcSSc; mean age 56±15.8 years. BP was assessed by LASCA in fingers affected by DUs, unaffected fingers, DU area, peri-ulcer area and the same area of unaffected fingers. DUs were defined infected if local signs of infection were present (swelling, severe pain, erythema, discharge). The treatment with major vasoactive drugs (iloprost, bosentan, sildenafil), the latency between the appearance of DU and first evaluation, and the time to DU healing under standard local treatment were collected.

Results:

BP was higher in peri-ulcer area with respect to the DUs area ( 84.1±21.0 vs 60.3±15.1 p<0.001), and no differences were observed between DUs area and similar area of unaffected fingers.

In patients without infection (n=17), healing time was negatively associated both to DUs BP (r=-0.618 p=0.011) and peri-ulcer BP (r=-0.488 p=0.011). The latency between appearance of DUs and first evaluation in our centre was also negatively correlated to mean healing time (r=0.36 p=0.036).

Patients with infection (n=6) presented a higher ulcer BP compared to non-infected pts (198.0±112.2 vs 103.3±66 p=0.023) and DUs needed a longer healing time (mean 130 vs 100 days).

The treatment with bosentan and iloprost was associated with higher BP in the unaffected fingers (respectively p=0.002 and p=0.001) but no BP changes at DU area or at fingers with DUs were observed. Sildenafil was not associated with significant differences in blood perfusion.

Conclusion:

Our study suggests a potential usefulness of LASCA analysis of BP in the assessment of DUs in SSc patients. Although all DUs are ischaemic in nature (blood flow is lower than in unaffected area and periulcer area), BP values could help in identifying difficult to heal lesions, either due to a markedly reduced perfusion (low BP) or to the presence of an infection (higher than expected BP).

Additional data are needed to better define the role of BP as a guide to treatment, ulcer management and prevention in routine clinical practice.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/healing-time-and-blood-perfusion-by-laser-speckle-contrast-analysis-in-patients-with-systemic-sclerosis-and-digital-ulcers/