Background Systemic sclerosis (SSc) is a chronic connective tissue disorder of unknown etiology characterized by tissue fibrosis and vascular damage [1]. Digital ulcerations (DUs) are common manifestations of vascular involvement [2]. Althoughthe vascular dysfunction of SSc has been considered mainly to affect microvasculature [3], there is recent evidence showing that SSc is associated with the prevalence of large vessel disease [4]. However, only a few studies investigated the relationship between macrovascular disease and its role in the clinical manifestations of SSc such as ulcers.

Objectives To assess the relationship between the Macrovascular dysfunction of upper and lower limbs with digital ulcerations in patients with systemic sclerosis.

Methods Ninety patients with SSc (45 cases with DUs and 45 cases without DUs) enrolled in this study. Patients with other rheumatologic diseases and diabetics patients were excluded from the study. Data which were collected from the patients, included, age, past medical history of cardiovascular disease and dyslipidemia, SSc disease duration, type of SSc (lcSSc or dcSSc), Raynaud's phenomenon (RP), RP duration and digital ulcerations (DUs), Body weight (BW), Height, Waist circumference (WC), Body mass index (BMI), Blood pressure (BP), serum levels of SCL-70 antibody and Anti β2 microglobulin antibody. Then Doppler sonographies were performed. The outcome variables were the peak systolic velocity (PSV) and resistance index (RI) of ulnar, radial, popliteal, dorsalis pedis and tibia artery.

Results The SSc patients with DUs have significantly lower PSV and higher RI in the ulnar (PSV:52.1±7.9 vs 55.7±4.1, p=0.006 and RI: 0.58±0.15 vs 0.52±0.06, p=0.003), dorsalis pedis (PSV: 33.9±1.9 vs 34.5±0.4, p=0.027 and RI: 0.54±0.11 vs 0.50±0.04, p=0.045) and tibial artery (PSV: 32.6±3.1 vs 34.4±0.9, p<0.001 and RI: 0.62±0.16 vs 0.51±0.07, p<0.001) in comparison to SSc patients without DUs. PSV and RI of ulnar artery were significantly correlated with age (p=0.012 and p=0.019), disease duration (p=0.001and p=0.001) and Raynaud's phenomenon (RP) duration (p=0.048 and p=0.028). PSV and RI of tibial artery had significant correlation with age (p=0.038 and p=0.009), systolic blood pressure (p=0.022 and p=0.037) and diastolic blood pressure (p=0.015 and p=0.010).

Conclusions We concluded that digital ulceration in patients with SSc might be frequently related to the macrovascular dysfunction in below the elbow and knee.

References

1. Walmsley D, Goodfield MJ. Evidence for an abnormal peripherally mediated vascular response to temperature in Raynaud's phenomenon. Br J Rheumatol 1990;29:181–4.

2. Chung L, Fiorentino D. Digital ulcers in patients with systemic sclerosis. Autoimmun Rev 2006;5:125–28.

3. Ho M, Veale D, Eastmond C, Nuki G, Belch J. Macrovascular disease and systemic sclerosis. Ann Rheum Dis 2000;59:39–43.

4. Veale DJ, Collidge TA, Belch JJ. Increased prevalence of symptomatic macrovascular disease in systemic sclerosis. Ann Rheum Dis 1995;54:853–5.

References

Disclosure of Interest None declared