Background/Purpose: Intravital microscopy of the sublingual microcirculation provides estimates of perfused barrier region (PBR) and red blood cell fraction (RBCfract), which quantifies vasculopathy and, similar to nailfold capillaroscopy, may be valuable in serial assessment of systemic sclerosis (SSc) disease progression. In this report, we examine the longitudinal correlates of sublingual videomicroscopy with gastrointestinal symptoms of SSc.

Methods: Patients enrolled in a single center SSc (2013 ACR/EULAR Classification Criteria) registry, who completed the Scleroderma Clinical Trials Consortium Gastrointestinal Tract (GIT 2.0) questionnaire and had sublingual videomicroscopy are in this analysis. The GIT 2.0 includes 34 questions (assessing reflux, bloating/distention, diarrhea, soilage, emotional well-being, social function, and constipation), and provides a total score of GIT severity.  Automated capture and analysis of sublingual microvessel segments provides detailed, objective microvascular structural (RBCfract) and functional data (PBR). To find the association between the GIT 2.0 and vascular outcomes (PBR and RBC fract), we ran 2 different models for a) Baseline vascular outcome vs baseline GIT score (total score and 7 individual scales + severity) and b) Delta vascular outcome vs delta GIT scores (Stable / improved GIT score  vs worse GIT score; total score and 7 individual scales + severity). All models are adjusted by SSc disease duration, reflux medication, vasodilator, and immunosuppression use.

Results: There were a total of 116 participants with complete vascular outcomes, treatment data, and GIT scores at baseline visit and 55 participants with a second complete measurement set. These SSc patients were mostly female (n=100), white (n=110) with a SSc mean disease duration of 9.7 years (SD 8.3) and ANA/SSc-specific antibody positive (n=92). At baseline, GIT 2.0 total severity score significantly associated with PBR (p=0.01) and RBCfract (p=0.015); and the subdomains of reflux (p=0.02) and distention (p=< .001) were significantly associated with PBR. The association of vascular outcomes with change in GIT 2.0 components are shown in Table 1.
Table 1

Conclusion: Gastrointestinal complaints are common in SSc and may be due to progressive vasculopathy. Intravital microscopy provides a bedside monitoring approach that can be correlated easily to clinical features and warrants further study.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/serial-sublingual-videomicroscopy-in-systemic-sclerosis-clinic-are-the-microcirculation-measurements-correlated-with-gastrointestinal-symptoms/