Background/Purpose .  Typical clinical aspects of systemic sclerosis (SSc) include microvascular damage and reduction of peripheral blood perfusion, resulting in increased incidence of digital ulcers (DUs) (1-2). Several studies report different methods to assess the severity of DUs but, to the best of our knowledge, ulcer blood perfusion was not assessed (3-5). This study investigates blood perfusion (BP) of DUs by laser speckle contrast analysis (LASCA), a non-contact technique, during treatment for ten days with local medications (6).

Methods .  During their regular planned follow-up and systemic treatment, twenty SSc patients with DUs of recent onset (mean age 63±12 years, mean disease duration 7±6 years) were enrolled after informed consent. Local BP was studied in all patients by LASCA before starting local treatment (T0), both at the level of the dorsal and palmar aspect of the hands (6). Subsequently, regions of interest (ROIs) were created at the level of the fingertips, periungual, ulcer and periulcer areas and the perfusion values were reported as perfusion units (PU) (6). Hydrocolloid dressing was daily applied on ulcer area (7). After 10 days of treatment (T1) LASCA was repeated. Visual analogic scale for DU pain (VAS-pain)  (score 0-10) was administered to patients before and after the treatment. The patients marked on the line from 0 (“no pain”) to 10 (“worst imaginable pain”) the intensity of DU pain that they felt (8). Statistical analysis was performed by non parametric tests.

Results .  A statistically significant increase of BP was observed from T0 to T1 in the ROIs created at the level of the ulcer area (due to granulation tissue) (median 37 vs 57 PU, p<0.0001), as well as a significant decrease of BP was observed in the periulcer area (due to decreased inflammatory reaction) (median 108 vs 90 PU, p<0.0001). A positive correlation was observed between fingertip BP and periungual BP at both T0 (r=0.66, p=0.02) and T1 (r=0.44, p=0.05). There was a statistically significant decrease of VAS-pain scale during the ten days of treatment (median 9 vs 8; p=0.001).

Conclusion .  LASCA seems to offer a quantifiable and safe method to evaluate local blood perfusion changes of the DU area during local treatment, and it most likely represents a reliable technique to monitor DU evolution in SSc patients.

References.  1. Cutolo M, et al. J Rheumatol 2010;37:1174-80.  2. Rosato E, et al. Rheumatology 2011;50:1654-8.   3. Steen V, et al. Rheumatology 2009;48:19-24.   4. Guillevin L, et al. Clin Exp Rheumatol 2013; 31: S71-S80.   5. Kowal-Bielecka O, Landewé R, Avouac J, et al. Ann Rheum Dis 2009; 68: 620-8.   6. Ruaro B, et al. Ann Rheum Dis 2014;73:1181-5.  7. Guillén-Solà M, et al. BMC Fam Pract. 2013; Dec 21;14:196.  8. Wewers ME, et al. Research in Nursing and Health 1999; 13: 227-36.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/laser-speckle-contrast-analysis-in-the-follow-up-of-digital-ulcers-in-systemic-sclerosis-patients/