Background In systemic sclerosis (SSc), blood perfusion (BP) may be evaluated by laser speckle contrast analysis (LASCA), as well as nailfold microangiopathy may be assessed by nailfold videocapillaroscopy (NVC) (1-3).
Objectives To investigate BP by LASCA in different skin areas of SSc patients, looking for possible correlations with the extent of the nailfold microvascular damage.
Methods Seventy SSc patients (mean age 62±14 years, mean disease duration 7±5 years) and 70 sex and age matched healthy subjects (CNT) were enrolled during their regular clinical follow-up. After informed consent, BP was assessed by LASCA at the level of face and dorsal and palmar regions of the hands in both SSc patients and CNT. Afterward, different regions of interest (ROIs) were created at the level of the hands (fingertips, periungual areas, dorsum and palm of both hands), as well as of the face (forehead, tip of nose, zygomas and perioral regions), and the average BP evaluated as perfusion units (PU) (1). NVC was performed to detect the proper pattern of nailfold microangiopathy (“early”, “active” or “late”) and to calculate the microangiopathy evolution score (MES) (2-4). Statistical analysis was carried out by non parametric tests.
Results SSc patients showed a statistically significant lower median BP than CNT at the level of fingertips (median 86 and 189 PU, respectively, p<0.0001), periungual (69 and 140 PU, respectively, p<0.0001) and palm areas (78 and 111 PU, respectively, p<0.0001). On the contrary, both groups displayed similar BP values at the level of dorsum of hands, whole face, as well as at different ROIs of the face. The median BP difference between fingertips and palm was lower in SSc patients than in CNT (11 and 67 PU, respectively, p<0.0001), as it was the gradient between the dorsum and periungual areas (25 and 69 PU, respectively, p=0.0009). A significant progressive decrease of BP was observed at the level of fingertips (median 103, 86 and 80 PU, respectively, p=0.004), periungual (median 86, 65, and 57 PU, respectively, p=0.007) and palm areas (median 92, 82, and 67 PU, respectively, p=0.02) in SSc patients in relation to the progressive pattern of nailfold microangiopathy (“early”, “active”, and “late”), as well a statistically significant negative correlation between BP and MES in the same areas was detected (r=0.49, p<0.0001, (r=0.30, p=0.01, and r=0.35, p=0,003, respectively).
Conclusions As assessed by LASCA technique, BP is significantly lower in SSc patients in comparison with healthy subjects at the level of fingertips, periungual areas, and palm of hands, and a statistically significant negative correlation exists between nailfold microangiopathy extent and BP at the level of the same skin areas in SSc patients. Both combined investigations might optimize the follow-up of SSc patients.
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Disclosure of Interest None declared