Background Although micro-vessel alterations have been largely described, macrovascular involvement is also frequent in Systemic Sclerosis (SSc). Macrovascular damages specifically involve narrowing or occlusions of proper palmar digital arteries and ulnar artery. On the contrary, radial artery is rarely concerned. Ulnar artery occlusion (UAO) assessed by power doppler ultra-sonography (PDUS) has proven to be predictive of the onset of new ischaemic DUs in longitudinal studies (1). PDUS could also be a reliable tool to evaluate finger pulp blood flow (FPBF). Only few studies have explored the association between macrovascular damages evaluated by PDUS and microvascular involvement assessed by nailfold capillaroscopy (NC) (2). The association between macrovascular disease and calcinosis or Acro-osteolysis is still to be determined in SSc.
Objectives to confront microvascular damages on NC with macrovascular manifestations evaluated by PDUS in SSc patients. Micro and macro-vascular damages were confronted with the main digital manifestations of the disease: digital ulcers (DU), Acro-osteolysis and Calcinosis.
Methods NC, hand X-Rays and PDUS were systematically performed in 64 unselected SSc patients. PDUS evaluation with assessment of Ulnar Artery Occlusion (UAO) and finger pulp blood flow (FPBF) was performed blinded for the results of X-Rays and NC.
Results UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NC (respectively OR=4.04 (1.23–13.29); p<0.05 and OR=3.38 (1.03–11.05); p<0.05). UAO was significantly associated with Cutolo's late NC pattern (OR=3.80 (1.31–11.01); p<0.05). A DU history was associated with UAO (OR=10.71 (3.36–34.13); p<0.0001), pathologic FPBF (OR=7.67 (2.52–23.28); p<0.0001), late pattern (OR=6.33 (2.03–19.68) and severe capillary loss (OR=8.52 (2.15–33.78); p=0.001). Acro-osteolysis was also associated with UAO (OR=15.83 (3.95–63.54); p<0.001), pathologic FPBF (5.52 (1.71–17.90) p=0.003), late NC pattern (OR=6.86 (2.18–21.53); p=0.001) and severe capillary loss (OR=7.20 (2.16–24.02), p=0.001). Calcinosis on X-rays were associated with late NC pattern (5.41 (1.82–16.12); p=0.002), severe capillary loss (OR=12.69 (3.14–51.26); p<0.0001) and UAO (3.19 (1.14–8.92); 0.025) but not with pathologic FPBF. Combination of UAO and severe capillary loss in a same patient was especially associated with DU history (OR=18.60 (2.24–154.34); p=0.001) and Acro-osteolysis (OR=10.83 (2.56–45.88); p=0.001).
Conclusions The combination of macro and microvascular evaluations by PDUS and NC may help to detect patients with a more severe vasculopathy.
Lescoat A, Coiffier G, Rouil A, Droitcourt C, Cazalets C, de Carlan M et al. Vascular evaluation of the hand by Power Doppler Ultrasonography provides new predictive markers of ischemic digital ulcers in systemic sclerosis. Arthritis Care Res (Hoboken). 2016 Jul 7.
Rosato E, Gigante A, Barbano B, Cianci R, Molinaro I, Pisarri S, et al. In systemic sclerosis macrovascular damage of hands digital arteries correlates with microvascular damage. Microvasc Res. nov 2011;82(3):410–5.
Disclosure of Interest None declared