Session Information
Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s - Clinical Aspects and Therapeutics II
Session Type: Abstract Submissions (ACR)
Background/Purpose: In systemic sclerosis (SSc), blood perfusion (BP) may be evaluated by both laser speckle contrast analysis (LASCA) and laser Doppler flowmetry (LDF) techniques, as well as microangiopathy may be assessed by nailfold videocapillaroscopy (NVC) (1-3). This study aimed at investigating BP by LASCA in different skin areas of SSc patients, looking for any correlations with the extent of the nailfold microvascular damage. Correlations between LASCA and LDF analysis at fingertips were also checked.
Methods: Sixty-eight SSc patients and 68 sex and age matched healthy subjects were enrolled. The BP was assessed in the area of fingertips, periungual areas, dorsum and palm of both hands, as well as of face, forehead, tip of nose, zygomas and perioral region by LASCA, and scored as perfusion units (PU) (1). LDF was performed at the level of 2nd, 3rd, 4th, and 5th fingertip bilaterally (2), and average blood perfusion recorded as PU (2). NVC was performed in SSc patients and images classified and scored as previously reported (4-6). Non-parametric tests were used for the statistical analysis.
Results: Median BP was significantly lower in SSc patients when compared to healthy subjects at fingertips (86 vs 189 PU, respectively, p<0.0001), periungual areas (69 vs 140 PU, respectively, p<0.0001) and palms (77 vs 111 PU, respectively, p<0.0001). Conversely, both groups showed similar BP values at dorsum of hands and different areas of the face. The median BP gradient between fingertips and palm was lower in SSc patients than in healthy subjects (11 vs 67 PU, respectively, p<0.0001), as well as was the gradient between dorsum and periungual areas (25 vs 69 PU, respectively, p=0.0009). There was a statistically significant progressive decrease of BP in SSc patients with different NVC pattern of microangiopathy ("early", "active", or "late"), as well as a statistically significant negative correlation between microangiopathy evolution score (MES) and BP, at the level of fingertip areas (p<0.004), periungual areas (p<0.01) and palms (p<0.02), but not in the other areas. A positive correlation was detected between LASCA and LDF values at fingertip level, in all subjects (p<0.0001). LASCA, since evaluating large skin areas, is significantly less time consuming, is more accepted by patients and shows lower intra-operator variability than LDF (95% vs 88%).
Conclusion: This study shows that LASCA technique detects differences of BP at fingertips, periungual and palm areas between SSc patients and healthy subjects. Statistically significant correlations were observed between nailfold microangiopathy damage extent and BP at the level of fingertips, periungual and palm areas. LASCA positively correlates with LDF values at fingertips, but brings an higher reproducibility.
References: 1. Draijer M, et al. Laser Med Sci (2009); 24: 639-51. 2. Cutolo M, et al. J Rheumatol 2010; 37:1174-80. 3. Cutolo M, et al. Nature Rev Rheumatol 2010; 6, 578-87. 4. Cutolo M, et al. Rheumatology 2004; 43:719-26.4. 5. Sulli A, et al. Ann Rheum Dis 2008;67:885-7. 6. Smith V, et al. Ann Rheum Dis 2010; 69:1092-6.
Disclosure:
A. Sulli,
None;
B. Ruaro,
None;
G. Ferrari,
None;
E. Bernero,
None;
C. Pizzorni,
None;
V. Smith,
Actelion Pharmaceuticals US,
5;
M. Cutolo,
Actelion Pharmaceuticals US,
2,
BMS,
2,
Mundipharm,
2,
Sanofi-Aventis Pharmaceutical,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/laser-speckle-contrast-analysis-a-new-method-to-evaluate-blood-perfusion-in-different-skin-areas-of-systemic-sclerosis-patients-comparison-with-laser-doppler-flowmetry/