Background Raynaud Phenomenon (RP) is a clinical marker for microangiopathy. Systemic sclerosis is a chronic autoimmune disease characterized by widespread vasculophaty and tissue fibrosis. Vasculopathy includes vascular remodelling with progressive narrowing of small arteries and capillary loss that manifest initially as Raynaud phenomenon (RP) but can lead to ischemia and necrosis. Digital Ulcers (DU) are a major disabling complication of SSc interfering with personal and professional life of our patients.
Objectives The aim of this study was to investigate possible correlations between different nailfold videocapillaroscopy (NVC) patterns and endothelium-dependent flow mediated dilation of braquial artery in patients with Raynaud Phenomenon. (RP). We compared microvascular changes shown in NVC and with hemodynamic changes resulting from the dysfunctional endothelium in patients with secondary RP.
Methods Hundred and nine patients with RP were studied. Mean age of 52 years +_ 12.6 yrs. 32 patients had primary RP. Secondary RP patients were 60 limited cutaneous systemic Sclerosis, 12 diffuse cutaneous SSc, 3 mixed connective tissue disease and 2 undifferentiated connective tissue disease. 38 patients with secondary RP had at least 1 active digital ulcers at the time of investigation. Thirty four healthy subjects with a a mean age of 47 +- 11 years were aleatory selected as control group. NVC was performed to all 143 patients and classified in 4 groups: normal, early, active or late pattern of scleroderma spectrum based on Cutolo`s classification. FMD was performed to all subjects following the International Brachial Artery Reactivity Task Force Guidelines
Results Flow mediated dilation (FMD) was reduced in patients with digital ulcers. The brachial artery diameter at 60 s after cuff deflation had statistical differences (P<0.001) between SSc patients with digital ulcers compared to SSc patients without DU or primary Raynaud phenomenon (RP). End diastolic volume was significantly different between groups (P<0.001) suggesting an increase in peripheral resistance in patients with DU. FMD was more reduced in patients with late pattern (Cutolo s classification) in capillaroscopy and a statistical differences (P<0.001) between early and late pattern (P<0.007) was found.
Conclusions In our study we demonstrated that patients with secondary RP (most of them with SSC) and with digital ulcers have micro and macrovascular disease. Flow mediated dilation is reduced due a dysfunctional endothelial dependent response and there is an increase in peripheral resistance with a decrease in end diastolic volume in ultrasound assessment. This microvascular impairment is confirmed with NVC late pattern.
References: Rollando D, Bezante GP, Sulli A, Balbi M, Panico N, Pizzorni C, Negrini S, Brunelli C, Barsotti A, Cutolo M, Indiveri F, Ghio M. Brachial Artey Endothelial-dependent Flow-mediated Dialtion Identifies Early-satge Endothelial Dysfunction in Systemic Sclerosis and Correlates with Nailfold Mocrovascular Impairment. J Rheumatol 2010
Disclosure of Interest: None Declared