Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: It is well established that measurements of cutaneous microvascular dysfunction (measured with laser Doppler imaging [LDI]) and structural abnormality (measured with nailfold capillaroscopy [NC]) differentiate between primary Raynaud’s phenomenon (PRP) and systemic sclerosis (SSc). Spectroscopy to measure free radical induced oxidative stress (OS) and oxygenation (OX) has been less well studied despite both being implicated in SSc pathogenesis. The aim of this study was to evaluate all of these parameters and to determine how the additional information provided by spectroscopy compares to established techniques in a population of patients with SSc (subtyped as limited or diffuse cutaneous (lcSSc, dcSSc) depending upon skin involvement), PRP and undifferentiated connective tissue disease (UCTD) and in healthy controls (HC).
Methods: Perfusion images (dual wavelength [superficial capillary and deeper thermoregulatory microcirculation layers, LDI]) were taken of the hand pre and post local heating. Distal dorsal difference (DDD, digit-dorsum) was calculated at baseline and perfusion increase (POST/PRE) calculated at the digit and dorsum. Nailfold capillaroscopy (NC) was carried out at 200x magnification over the whole nailbed on the non-dominant ring finger. Capillary density and width were calculated from images using automated software. Spectroscopy (light shone onto the skin with a fibre and collected by spectrometer) was carried out at 9 sites of the body. Oxidative stress (OS) measurements were taken with UV light and erythema (E, pseudo-measure of blood flow) and oxygenation (OX) with white light. Comparisons were made between groups with an ANOVA (STATA).
Results: 92 patients with lcSSc, 47 with dcSSc, 31 with PRP, 35 with UCTD, 61 HC were assessed. Data is presented in table 1. LDI showed smaller values for DDD (thermoregulatory layer) and POST/PRE digit and dorsum (thermoregulatory and capillary layers) for SSc vs HC. NC density was significantly lower and width significantly higher in the SSc vs HC group. OS was significantly increased in 7/9 sites in SSc vs HC groups. E was significantly lower at 8/9 sites for the SSc vs HC group. OX was lower at the digit in SSc vs HC group but overall showed no trend for increase or decrease.
Conclusion: The data confirms microvascular dysfunction and structural changes in SSc in a large data set. In addition these changes are matched by increased free radical stress (OS). These changes now need to be measured prospectively and these studies are underway.
Table 1. LDI, spectroscopy (E, OX, OS) and NC data [Median (IQR)] at the digit and dorsum.
|
Technique |
Parameter |
HC n=61 |
PRP n=31 |
UCTD n=35 |
LcSSc n=92 |
DcSSc n=47 |
P value (one-way ANOVA) |
| LDI | Red DDD (Arb PU) |
197 (89 to 261) |
118 (36 to 255) |
175 (61 to 285) |
162 (39 to 258) |
42 (-9 to 159) |
0.0019** |
| Red POST/PRE digit |
2.23 (1.68 to 2.98) |
2.16 (1.12 to 2.71) |
2.74 (2.00 to 3.57) |
2.00 (1.41 to 2.53) |
1.54 (1.28 to 2.46) |
0.0093** |
|
| Red POST/PRE dorsum |
1.99 (1.59 to 2.88) |
2.72 (2.12 to 3.30) |
2.51 (1.81 to 4.13) |
1.98 (1.47 to 2.95) |
1.87 (1.26 to 3.00) |
0.0064** |
|
| Green DDD (Arb PU) |
5.5 (-7 to 25.5) |
1.0 (-9.2 to 23.3) |
0.0 (-7.5 to 16) |
0.0 (-9 to 23) |
1.1 (-16 to 14.5) |
0.4302 |
|
| Green POST/PRE heating finger |
1.3 (1.2 to 1.7) |
1.3 (1.0 to 1.8) |
1.4 (1.2 to 2.4) |
1.3 (1.2 to 1.8) |
1.2 (1.0 to 1.5) |
0.0330* |
|
| Green POST/PRE dorsum |
1.4 (1.2 to 1.5) |
1.5 (1.3 to 1.9) |
1.6 (1.3 to 2.3) |
1.4 (1.2 to 1.8) |
1.4 (1.2 to 1.6) |
0.0136** |
|
| NC | Vessel density |
13.21 (10.99 to 15.79) |
13.50 (10.05 to 14.60) |
11.45 (8.81 to 14.10) |
9.07 (6.84 to 11.49) |
8.98 (6.73 to 11.19) |
<0.0001*** |
| Mean width (mm) |
13.37 (12.25 to 15.54) |
14.03 (12.91 to 15.59) |
14.78 (12.76 to 16.64) |
16.60 (14.14 to 21.27) |
17.38 (13.85 to 20.95) |
<0.0001*** |
|
| Spectroscopy (Arbitrary units) | OS digit |
3.86 (3.27 to 4.64) |
3.51 (2.80 to 3.95) |
3.61 (3.21 to 4.72) |
4.67 (3.7 to 5.40) |
4.32 (3.78 to 5.06) |
0.1706 |
| OS dorsum |
3.56 (3.17 to 4.27) |
3.62 (2.60 to 4.21) |
3.61 (3.00 to 4.01) |
4.32 (3.84 to 5.25) |
4.20 (3.34 to 4.78) |
<0.0001*** |
|
| E digit |
222.9 (218.6 to 224.9) |
218.1 (213.0 to 223.5) |
218.6 (208.8 to 222.4) |
220.4 (214.0 to 225.7) |
220.5 (207.9 to 225.3) |
0.0229* |
|
| E dorsum |
213.8 (208.3 to 219.0) |
206.4 (197.4 to 216.0) |
210.2 (200.1 to 218.9) |
207.0 (198.9 to 214.3) |
203.4 (192.8 to 209.7) |
0.0003** |
|
| OX digit |
0.15 (0.08 to 0.21) |
0.17 (0.12 to 0.23) |
0.22 (0.13 to 0.30) |
0.10 (0.02 to 0.23) |
0.13 (0.35 to 0.18) |
0.0021** |
|
| OX dorsum |
0.09 (0.01 to 0.14) |
0.12 (-0.00 to 0.21) |
0.07 (0.03 to 0.18) |
0.11 (0.05 to 0.16) |
0.12 (0.06 to 0.18) |
0.7213 |
|
|
* Significant at the p<0.05 level, ** Significant at the p<0.01 level, *** Significant at the p<0.0001 level |
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To cite this abstract in AMA style:
Murray A, Moore T, Manning J, Poxon I, Dinsdale G, Berks M, Leggett S, Dickinson M, Herrick AL. Non-Invasive Investigation of Perfusion, Microvascular Structure, Erythema, Oxidative Stress and Oxygenation in Healthy Controls and in Patients with Primary and Secondary Raynaud’s Phenomenon [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/non-invasive-investigation-of-perfusion-microvascular-structure-erythema-oxidative-stress-and-oxygenation-in-healthy-controls-and-in-patients-with-primary-and-secondary-raynauds-phenomenon/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/non-invasive-investigation-of-perfusion-microvascular-structure-erythema-oxidative-stress-and-oxygenation-in-healthy-controls-and-in-patients-with-primary-and-secondary-raynauds-phenomenon/