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.


Wound Fluid of Skin Ulcers in Systemic Sclerosis: Cellular and Cytokines' Profile Helps To Define Healers Versus Non Healers Characteristics.

Alivernini1,  Stefano, Tolusso2,  Barbara, Gigante2,  Mariarita, Capacci2,  Annunziata, Faustini2,  Francesca, Bosello2,  Silvia Laura, Santis2,  Maria De

Rheumatology Division, Catholic University of the Sacred Heart, Rome, Italy
Rheumatology Division, Catholic University of the Sacred Heart, Rome, Italy

Background:

Skin ulcers, being a common vascular complication in Systemic Sclerosis (SSc), have a relevant impact in the patients' daily life, causing pain, infection and loss of function. Studies on chronic diabetic (DM) skin ulcers showed that the wound fluid (WF) analysis could help to understand the nature of the lesions.

Objective:

To evaluate cellular and soluble factors' profile of WF of SSc skin ulcers.

Patients and Methods:

SSc patients with skin ulcers attending the Wound Care Outpatient Clinic of Rheumatology division of the Catholic University (Rome) were enrolled in the study. MMP-9, VEGF and IL-6 levels were detected through ELISA and MCP-1, IL-1b, IL-8 and TNFa levels through Flow CytoMix™ technology in plasma and WF, whereas the WF percentages of CD16, CD14, CD3 and CD19 were evaluated through Flow-cytometry at baseline. Each patient underwent skin lesion's evaluation, microbiological analysis and treatment with Suprasorb X®± PHMB® or Suprasorb A®± Ag® twice a week. WF collection was done through transparent dressing (Opsite, Smith & Nephew, UK).

Results:

11 SSc patients with skin ulcers (18% in fingertips) were enrolled in the study. A higher healing rate after 3 months of follow-up with the standard protocol was found in SSc compared to DM patients with chronic ulcers treated with the same protocol (8 patients (73%) vs 1/5(20%); p<0.001). Compared to healthy controls, SSc patients had higher plasma levels of IL-6 (2.4 ± 1.5 pg/ml vs 6.9±1.8 pg/ml, p=0.01), VEGF (17.2±15.4 pg/ml vs 43.11±36.03 pg/ml p=0.01), MCP-1 (255.5±59.2 pg/ml vs 528.35±270.78 pg/ml p=0.001) and IL-8 (1.66±3.62 pg/ml vs 3.55±3.59 pg/ml p=0.02). SSc patients with fingertip ulcers had lower levels of VEGF in WF compared to patients with major lesions (5157.3±3767.3 pg/ml/1g albumin vs 216632.0 ± 515864.0 pg/ml/1g albumin; p=0.05).

Direct correlations in WF were found between IL6 and MMP-9 (r=0.64, p=0.04), MMP-9 and IL-8 (r=0.82, p=0.004) and between percentages of CD3 and CD19 (r=0.76, p=0.03). Moreover there were direct correlations between the extension and border scores of ulcers and MCP1 (r=0.62;p=0.05 for extension and r=0.63;p=0.03 for border score) and TNFa (r=0.65;p=0.03 for extension and r=0.65;p=0.02 for border score) in WF of SSc patients.

SSc patients who healed after 3 months of follow-up had lower WF levels of MCP-1 (5012.9 ± 3600.1 pg/ml/1g albumin vs 505173.1± 576739.8 pg/ml/1g albumin, p=0.03), TNFa (248.1±372.8 pg/ml/1g albumin vs 36789.1±79499.5 pg/ml/1g albumin, p=0.02) and VEGF (2114.0±3825.7 pg/ml/1g albumin vs 111381.1± 212446.0 pg/ml/1g albumin, p=0.03) compared to non healers. All the inflammatory soluble factors (IL-6, IL-1b, TNFa and IL-8) were higher in WF compared to plasma in SSc patients (p<0.05).

Conclusions:

A standard treatment seems to enhance healing rate in SSc skin ulcers. The plasma-WF polarization of factors such as IL-6, IL-1b, TNFa and IL-8 suggests that ulcers in SSc could be considered an acute phenomenon in a chronic inflammatory background. A stronger control of local inflammation should be looked for in the most inflamed lesions.

To cite this abstract, please use the following information:
Alivernini, Stefano, Tolusso, Barbara, Gigante, Mariarita, Capacci, Annunziata, Faustini, Francesca, Bosello, Silvia Laura, et al; Wound Fluid of Skin Ulcers in Systemic Sclerosis: Cellular and Cytokines' Profile Helps To Define Healers Versus Non Healers Characteristics. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1239
DOI: 10.1002/art.29005

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