Capillaroscopy is an easy, non-invasive, well-accepted, and safe method to early diagnose and follow nailfold microangiopathy in systemic sclerosis (SSc), having also prospective prognostic value for internal organ involvement [1,2]. In particular, nailfold videocapillaroscopy (NVC) is able to qualitatively and quantitatively assess SSc microvascular damage, by either detecting the “Early”, “Active” or “Late” pattern of microangiopathy, or calculating the microangiopathy evolution score (MES) [3,4]. Capillaroscopy is routinely used in clinical practice, and it has recently been included among ACR/EULAR classification criteria for SSc .
In contrast to capillaroscopy that allows a morphological study of microcirculation, Laser Doppler and laser speckle techniques are able to assess microvascular function at skin sites, and they have been used in SSc to detect and quantify blood perfusion, in particular at peripheral sites [6–8]. Among these techniques, laser Doppler flowmetry is a contact method able to measure blood flow at a single point, in particular at fingertips, while laser Doppler imaging and laser speckle are non-contact techniques able to measure blood perfusion in a large area. In particular, laser speckle contrast analysis in less time consuming compared to Laser Doppler techniques, and permits the evaluation of skin areas different from hands .
Negative correlations have been described between nailfold microangiopathy extent (assessed by either NVC patterns or MES) and blood perfusion values (assessed by the above reported laser techniques) in SSc patients, being the higher microangiopathy degree, the lower blood perfusion values [6–10]. Furthermore, a reduced vascular reactivity to heating has been detected in SSc patients compared to healthy subjects, and it was found progressively lower in SSc patients with either worst NVC pattern of microangiopathy or higher MES .
The combination of these imaging techniques allows an optimal investigation of microcirculation in SSc, and it is useful to monitor drug effect on SSc microvasculature [11,12].
Cutolo M, et al. Nat Rev Rheumatol 2010; 6:578-87.
Smith V, et al. J Rheumatol. 2013; 40:2023-8.
Sulli A, et al. Arthritis Rheum. 2012; 64:821-5.
Sulli A, et al. Ann Rheum Dis 2008; 67:885-7.
van den Hoogen F, et al. Ann Rheum Dis. 2013; 72:1747-55.
Cutolo M, et al. J Rheumatol 2010; 37:1174-80.
Rosato E, et al. J Rheumatol. 2009; 36:2257-63.
Ruaro B, Sulli A, et al. Ann Rheum Dis. 2014; 73:1181-5.
Sulli A, et al. Ann Rheum Dis 2014; 73:2059-61.
Sulli A, et al. Ann Rheum Dis. 2014; 73:247-51.
Cutolo M, et al. J Rheumatol. 2014; 81:881-6.
Cutolo M, et al. J Rheumatol. 2013; 40:40-5.
Disclosure of Interest None declared