Background Systemic sclerosis is a chronic disease of the connective tissue, featured by excessive collagen deposition in the skin and internal organs associated to vascular damage. Its limited form (lSSc) is characterized by cutaneous fibrosis restricted to face, neck and extremities.
Objectives The aim of this study was to evaluate the reactivity of the brachial artery, endothelium-dependent and endothelium-independent, in patients with lSSc comparing with healthy subjects of the same sex, age and race and also compare these findings with the structural abnormalities found in capillaroscopy of the scleroderma group.
Methods Twenty women, adults, non-obese, non-smokers, non-diabetics, non- dyslipidemics or hypertensive who fulfill criteria to lSSc according to American College of Rheumatology were submitted to Doppler exam of the right brachial artery. The dilatators response was analyzed; endothelium-dependent, after ischemia for 5 minutes in the right low arm and the dilatator response, endothelium-independent, after administering 300 micrograms of sublingual nitroglycerin (NTG). Such results were compared with the response obtained in healthy subjects. Controls were comparable to the study group according to age, sex and race. Only the scleroderma group was submitted to capillaroscopy after Doppler exam.
Results The brachial artery longitudinal diameter (BAD) was significantly lower in the basal moment 1, 3.57±0.52mm and 3.93±0.39mm, respectively on patient group(P) and control group(C), p=0.005. The vascular reactivity after ischemia/reactive hyperaemia (RH) and NTG showed no significant difference between the groups (8.60±5.45mm vs. 9.26±5.91mm and 25.01±12.55mm vs. 19.59±7.94 mm, respectively in group P and group C). Furthermore, no statistically significant difference was found between erythrocyte velocity (EV) after RH and NTG (110.2±43.86cm/s vs. 102.0±25.89cm/s and 63.80±17.69cm/s vs. 65.4±12.90cm/s, respectively in group P and group C).
Conclusions Although group P has shown lower BAD, the endothelium-dependent and independent dilatation was preserved in both groups. Scleroderma subjects who have more anatomical abnormalities in microcirculation demonstrated by capillaroscopy were the same individuals who presented less reaction to ischemic stimulus during echo Doppler. The authors concluded that in the scleroderma group, although advanced structural disease in microcirculation was identified by capillaroscopy it did not correlate with a dysfunctional endothelium. These findings reinforce the benefit of treating these patients in attempt to reduce the morbid-mortality in the evolution of this severe disease.
Disclosure of Interest None Declared
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