Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Nailfold Microangiopathy and Pheripheral Blood Perfusion Correlate with Internal Organ Involvement in Sistemic Sclerosis.

Sulli1,  Alberto, Ferrone2,  Carmela, Pizzorni2,  Carmen, Alessandri2,  Elisa, Ravera2,  Francesca, Zampogna2,  Giuseppe, Seriolo2,  Bruno

Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy

Background:

Nailfold microangiopathy and peripheral blood hypoperfusion are key features of early systemic sclerosis (SSc) and internal organ involvement/skin lesions are frequently discovered during the follow-up.

Aim:

The aim of the study was to investigate possible correlations between nailfold capillary abnormalities, pheripheral blood perfusion (PBP), and internal organ involvement in patients affected by SSc.

Methods:

Seventy-one consecutive SSc patients (mean age 61±13 years, disease duration 7±5 years) were evaluated. Nailfold microangiopathy was detected by nailfold videocapillaroscopy (NVC), which was performed on 2nd to 5th finger of both hands, and the average semiquantitative scores for the capillaroscopic parameters were calculated1,2. PBP was analyzed by laser Doppler flowmetry at the central area of the fingertips of the same fingers, and the average value of PBP was recorded as perfusion units (PU)3. Oesophageal involvement was detected by manometry, pulmonary function by lung volume tests, DLCO and CT; cardiac performance was investigated by Doppler echocardiography, renal function by laboratory tests and arterial Doppler echography; active or recent history of ulcers were assessed by both clinical interview and examination. Statistical analysis was performed by non-parametric tests.

Results:

PBP was found significantly lower in SSc patients with active or recent history of ulcers (median 28 PU), when compared with those without ulcers (median 55 PU) (p=0.02). PBP was also lower in patients with esophageal, lung, renal, and pulmonary arterial involvement (median 29, 28, 29, 25 PU, respectively), than in those without (median 51, 46, 41, 57 PU, respectively), but this was not statistically significant (p=0.11), possibly due to the small study population. SSc patients showing higher microvascular abnormalities scores for NVC parameters like microhaemorrhages, capillary number, and capillary disorganization had significantly lower PBP (p<0.03). Oesophageal involvement correlated with higher NVC scores for capillary number and disorganization (p=0.03); lung disease with higher score for capillary disorganization (p=0.04); renal function impairment with higher scores for capillary number and disorganization (p=0.04); pulmonary arterial hypertension with higher scores for enlarged capillaries, capillary number, ramification and disorganization (p=0.05); digital ulcers with higher scores for capillary number, ramification and disorganization (p=0.01), as well as with lower score for giant capillaries (p=0.003).

Conclusions:

Nailfold capillary abnormalities extent negatively correlates with PBP and positively with internal organ involvement. Internal organ involvement seems to be associated with reduced PBP, but this should be confirmed on a larger SSc population. Finally, the occurrence of skin digital ulcers is associated with blunted peripheral blood perfusion in SSc patients, as well as with higher scores for several NVC parameters.

References:

1.Cutolo, M, et al. Rheumatology 2004; 43:719-26

2.Sulli, A, et al. Ann Rheum Dis 2008;67:885-7

3.Cutolo, M, et al. J Rheumatol 2010; 37:1174-80

To cite this abstract, please use the following information:
Sulli, Alberto, Ferrone, Carmela, Pizzorni, Carmen, Alessandri, Elisa, Ravera, Francesca, Zampogna, Giuseppe, et al; Nailfold Microangiopathy and Pheripheral Blood Perfusion Correlate with Internal Organ Involvement in Sistemic Sclerosis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :578
DOI: 10.1002/art.28347

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