Background Patients with scleroderma (SSc) have a significant reduction of blood flow in the hands, compared to healthy controls (Rosato et al.2010). The relationship between the blood flow and the presence of digital ulcers (DU) or pitting scars (PS) is currently unknown.
Objectives The aim of this study is to obtain better understanding of the blood flow in the hands of SSc patients.
Methods The blood flow in both hands in healthy volunteers (n=52) and SSc patients (n=56) with a history of DU in the previous 2 years was assessed with the PeriScan PIM 3 laser Doppler (Perimed, Sweden). The hand was categorized into 3 separate regions: ROI1, distal to the PIP joint of the 3 middle fingers; ROI2, distal to the metacarpal joints and proximal to the PIP joint and ROI 3, the hand proximal to the metacarpal joints. The patients were divided into 4 groups: no current DU or PS (NO) (n=10); PS only (PS) (n=25), new DU (<3 mo) (DU-new) (n=9), persistent DU (>3mo) (DU-pers) (n=8). MEC approval was obtained. The study is registered in clinicaltrials.gov (NCT01395732).
Results The healthy volunteers were younger compared to SSc patients (45±16 versus 55±12), whereas no difference in age was found between the SSc patients groups. The blood flow in all 3 defined regions varied widely within both the healthy volunteer group andthe SSc patient groups. The blood flow distal to the interphalangeal joint was significantly lower for all SSc patients compared to healthy controls (74,0±24,4 vs 62,4±28,8, p=0.003). The blood flow tended to be higher for patients with new DU’s compared to patients with persistent DU’s. In healthy subjects, the perfusion gradient descended between ROI1, ROI2 ROI3. This descent was less pronounced in SSc patients and virtually absent in patients with persistent DU’s.
Conclusions Individual perfusion of the hands shows a wide variation, both in healthy volunteers and in SSC patients. The extent of the DU disease seems to effect the blood flow; however more data are needed to confirm this.
Rosato et al. Bosentan Improves Skin Perfusion of Hands in Patients with Systemic Sclerosis with Pulmonary Arterial Hypertension. J. Rheumatol 2010; 37(12)2531-9.
Disclosure of Interest H. Knaapen: None Declared, A. Voskuyl: None Declared, P. van Daele: None Declared, J. Bloemsaat-Minekus Employee of: Actelion Pharmaceuticals Nederland B.V., M. Vonk: None Declared, A. Schuerwegh: None Declared
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