Background Peripheral blood perfusion is reduced in patients with both primary (PRP) or secondary Raynaud's phenomenon (SRP) (1–2).
Objectives To investigate blood perfusion (BP) in different skin areas of hands in patients with PRP, SRP to systemic sclerosis (SSc), and healthy subjects (CNT).
Methods 70 SSc patients (ACR/EULAR criteria) (3) (mean age 63±12 years, mean disease duration 6±5 years), 31 PRP patients (LeRoy criteria) (4) (mean age 48±18 years, mean Raynaud duration 3±2 years) and 68 CNT (mean age 59±19 years) were enrolled during winter time, after informed consent. BP was assessed by Laser speckle contrast analysis (LASCA) at the level of fingertips, periungual areas, dorsal and palmar aspect of 3rd finger bilaterally, dorsum and palm of both hands, and the average BP calculated as perfusion units (PU) (1). Nailfold videocapillaroscopy (NVC) was also performed to distinguish between PRP and SRP, and to detect the proper pattern of nailfold microangiopathy (“early”, “active” or “late”) in SSc patients (5). Patients were not taking vasodilator drug since at least two weeks.
Results Both PRP and SSc patients showed a statistically significant lower BP than CNT at the level of fingertips (median 86, 88, 186 PU, respectively, p<0.0001), periungual (median 75, 76, 142 PU, respectively, p<0.0001), palmar aspect of 3rd finger (median 71, 81, 134 PU, respectively, p<0.0001), and palm areas (median 61, 78, 112 PU, respectively, p<0.0001). On the contrary, the three groups displayed similar BP values at the level of other areas of hands. Of interest, PRP patients showed lower BP values than SSc patients in all areas of hand, even if BP was found statistically different only at the level of both palmar aspects of 3rd finger (p=0.04) and palm of hands (p=0.008). The gradients of BP fingertip-phalanx-palm and periungual-phalanx-dorsum were significantly lower in PRP than in SSc patients (p<0.0001), as well as significantly higher in CNT when compared with both PRP and SSc patients (p<0.0001). A statistically significant progressive decrease of BP was observed in SSc patients with progressive pattern of nailfold microangiopathy (“early”, “active”, and “late”) at the level of fingertips, periungual, palmar aspect of 3rd fingers and palm areas (p<0.05). Moreover, BP was significantly lower in PRP than in SSc patients with the “early” pattern of microangiopathy in all areas (p<0.04), with the exception of dorsal phalanx and hand dorsum.
Conclusions By considering a small cohort of patients, BP of hand was found lower in PRP than in SSc patients with the “early” NVC pattern of microangiopathy. Also the gradients of perfusion between distal and proximal areas of hand were significantly lower in PRP than in SSc patients. The clinical value of this new early finding is matter of further analysis.
Ruaro B, et al. Ann Rheum Dis 2014;73:1181–5.
Rosato E, et al. Rheumatology 2009;36:2257–63.
van den Hoogen F, et al. Ann Rheum Dis 2013;72:1747–55.
LeRoy EC, et al. Clin Exp Rheumatol.1992;10:485–8.
Sulli A, et al. Arthritis Rheum. 2012;64:821–5.
Disclosure of Interest None declared