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Corrado A, Mansueto N, Correale M, Rella V, Tricarico L, Altomare A, Brunetti ND, Cantatore FP, Rotondo C. Flow Mediated Dilation in Systemic Sclerosis: Association with clinical findings, capillaroscopic patterns and endothelial circulating markers. Vascul Pharmacol 2024; 154:107252. [PMID: 38061409 DOI: 10.1016/j.vph.2023.107252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/19/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
AIM Endothelial dysfunction represents a key feature of the pathological process underlying micro and macro-vascular damage in Systemic Sclerosis (SSc). This study aims to improve knowledge of the physiopathology of vascular damage in SSc through the assessment of the endothelial dysfunction by Flow Mediated Dilation (FMD) and serum levels of circulating endothelial dysfunction markers and the correlation of macrovascular damage with clinical findings and microvascular capillaroscopic patterns. METHODS 57 SSc patients and 37 healthy subjects were recruited. All included subjects underwent radial artery FMD test and Nailfold Video-Capillaroscopy; serum levels of Vascular Endothelial Growth Factor (VEGF), Vascular Cell Adhesion Molecule-1 (VCAM-1) and angiopoietin-2 were evaluated. RESULTS Compared to healthy subjects, in SSc patients lower FMD and higher time needed to obtain the maximal FMD responsewere observed, whereas serum levels of VEGF, VCAM-1, and angiopoietin-2 were significantly higher. The impairment of FMD values was associated with disease duration, pulmonary arterial hypertension, and digital ulcers and correlates with greater microvascular damage evaluated by Nailfold Video-Capillaroscopy… An inverse relationship between VEGF, angiopoietin-2, VCAM-1 levels and FMD was observed, but only VEGF and angiopoietin-2 were significantly higher in patients with digital ulcers and pulmonary arterial hypertension. CONCLUSIONS FMD ultrasound test and circulating levels of endothelial dysfuncion markers could be useful as biomarkers of vasculopathy and could be a helpful tool in the overall assessment of vascular injury in Systemic Sclerosis patients.
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Affiliation(s)
- Addolorata Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy.
| | - Natalia Mansueto
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Valeria Rella
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Lucia Tricarico
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Alberto Altomare
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Cinzia Rotondo
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
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Poonia K, Bhalla M, Dogar K, Malhotra A, Aggarwal K. Brachial artery flow-mediated dilation in patients with systemic sclerosis: an experience from tertiary care center from North India. Clin Rheumatol 2023:10.1007/s10067-023-06562-3. [PMID: 36897457 DOI: 10.1007/s10067-023-06562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
Role of flow-mediated dilatation (FMD) testing in the assessment of the macrovascular dysfunction in systemic sclerosis (SS) and correlation of FMD values with disease severity. Twenty-five patients of SS and 25 healthy age-matched controls were recruited. Modified Rodnan skin thickness score (MRSS) was used for skin thickness assessment. FMD values were measured in the brachial artery. FMD values done at baseline before the initiation of treatment were lower in SSc patients (4.044 ± 2.742) compared to the healthy controls (11.076 ± 5.896) (P < 0.05). Comparison of FMD values between patients with limited cutaneous systemic sclerosis (LSSc) and diffuse cutaneous systemic sclerosis (DSSc) showed a trend toward lower in LSSc (3.182 ± 2.482) as compared to DSSc patients (5.111 ± 2.711); however, the difference was not statistically significant. Patients with lung manifestations on high-resolution CT chest showed lower FMD values (2.66 ± 2.23) compared to those without HRCT changes (6.45 ± 2.56) (P < 0.05). We demonstrate that FMD values in SSc patients were lower when compared to healthy controls. Patients with SS having pulmonary manifestations showed a lower value of FMD. Key Points • FMD is a simple non-invasive tool to assess the endothelial function in patients with systemic sclerosis. • Lower values of FMD in systemic sclerosis suggest that the endothelial dysfunction and values can also be correlated with other organ involvement such as lung and skin involvement. So, lower FMD values might be a useful marker for disease severity.
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Affiliation(s)
- Kavita Poonia
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, India.
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Science, Bathinda, India.
| | - Mala Bhalla
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, India
| | - Kanika Dogar
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, India
| | - Anita Malhotra
- Department of Physiology, Government Medical College and Hospital, Chandigarh, India
| | - Kajal Aggarwal
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, India
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Nam K, Mendoza FA, Wessner CE, Allawh TC, Forsberg F. Ultrasound quantitative assessment of ventral finger microvasculopathy in systemic sclerosis with Raynaud's phenomena: a comparative study. RMD Open 2023; 9:rmdopen-2022-002954. [PMID: 36787926 PMCID: PMC9930605 DOI: 10.1136/rmdopen-2022-002954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To assess the finger vascularity of systemic sclerosis patients with Raynaud's phenomenon (RP-SSc) using various ultrasound techniques. METHODS All fingers (except thumbs) of 18 RP-SSc patients and 18 controls were imaged at room temperature using four ultrasound vascular imaging techniques. The percent vascular area was quantified by counting blood flow pixels in a 25 mm2 square centred at the nail fold for the dorsal side and in 25 mm2 and 100 mm2 square from the fingertip for the ventral side. The mean vascular intensity was calculated from the corresponding areas for dorsal and ventral sides. RESULTS The percent vascular areas and mean vascular intensities in RP-SSc were significantly lower than those in controls for both dorsal and ventral sides (p<0.01). The mean vascular intensities showed slightly higher area under the curve (AUC) than the percent vascular areas (0.53-0.91 vs 0.53-0.90) regardless of imaging technique and assessment side. For each imaging technique, the ventral side vascularity showed a higher AUC (0.74-0.91) compared with the dorsal side (0.53-0.81). Moreover, ventral side abnormalities were associated with a history of digital ulcers. CONCLUSIONS Ultrasound demonstrated potential to quantify finger vascularity of RP-SSc. The ventral side of the fingers showed a higher accuracy in detecting RP-SSc than the dorsal side.
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Affiliation(s)
- Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fabian A Mendoza
- Department of Medicine, Division of Rheumatology and Jefferson Scleroderma Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tanya C Allawh
- Department of Medicine, Division of Rheumatology and Jefferson Scleroderma Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Vanhaecke A, Debusschere C, Cutolo M, Smith V. Predictive value of laser speckle contrast analysis in systemic sclerosis. A systematic review and pilot study. Eur J Clin Invest 2022; 52:e13672. [PMID: 34424550 DOI: 10.1111/eci.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess whether tools to functionally examine the microcirculation, such as laser speckle contrast analysis (LASCA), are predictive of ischaemic digital trophic lesions ([i]DTL) in patients with systemic sclerosis (SSc). METHODS First, a systematic review (according to PRISMA) was conducted to identify studies describing a link between LASCA and SSc-related (i)DTL. In the additional pilot study, consecutive SSc patients underwent clinical and LASCA examinations (to assess the peripheral blood perfusion [PBP] of both hands) at enrolment. For one year, a monthly telephone survey was conducted to investigate (i)DTL occurrence. Logistic regression and ROC analysis were performed. RESULTS None of the three manuscripts retained through the systematic review examined the predictive value of LASCA for future (i)DTL. In our pilot study, 7/106 (6.6%) SSc patients developed at least one iDTL during follow-up, with PBP not found to be predictive (OR = 0.995, p = .418; ROC-AUC = 0.597). Post hoc, when only patients not taking vasodilators were analysed (n = 57), all three who developed iDTL had an average PBP ≤ 70 PU, while only 9/54 (16.7%) patients without iDTL occurrence had such values. CONCLUSION A predictive role of LASCA for (i)DTL has not yet been described in the literature and could also not be attested by our additional pilot study, due to a lower-than-expected iDTL incidence in our day-to-day SSc population in which patients were allowed to continue their vasodilator medication. However, the promising observations in the subgroup of vasodilator-naïve patients encourage further investigation of this potential added value of LASCA.
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Affiliation(s)
- Amber Vanhaecke
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Claire Debusschere
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center, Ghent, Belgium
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Masini F, Galiero R, Pafundi PC, Gjeloshi K, Pinotti E, Ferrara R, Romano C, Adinolfi LE, Sasso FC, Cuomo G. Autonomic nervous system dysfunction correlates with microvascular damage in systemic sclerosis patients. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:256-263. [PMID: 35387218 PMCID: PMC8922659 DOI: 10.1177/23971983211020617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/24/2021] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Cardiac autonomic neuropathy is among the known cardiovascular complications of systemic sclerosis and may affect the whole prognosis of the disease. The aim of our study was to assess cardiac autonomic neuropathy prevalence in our cohort of systemic sclerosis patients and compare its main features with clinical and epidemiological data, particularly with the severity of microvascular damage, as detected by nailfold videocapillaroscopy. METHODS Twenty-six patients with definite systemic sclerosis were consecutively enrolled at our outpatient rheumatology clinic. All patients underwent physical examination, nailfold videocapillaroscopy, and autonomic neuropathy diagnostic tests (orthostatic hypotension test, deep breathing test, lying-to-standing, and Valsalva maneuvers). RESULTS Cardiac autonomic neuropathy prevalence was 50% (13 cases). On univariate analysis, cardiac autonomic neuropathy was shown to be significantly associated with an active pattern on nailfold videocapillaroscopy (odds ratio 5.86, 95% confidence interval 1.59-9.24; p = 0.032), whereas anti-Scl-70 positivity (odds ratio, 0.24; 95% confidence interval, 0.03-2.12; p = 0.049) and C-reactive protein (odds ratio, 19.32; 95% confidence interval, 1.79-56.71; p = 0.036) reached only a borderline statistical association. The time-dependent Cox multivariate regression model showed cardiac autonomic neuropathy development to be independently associated with an active pattern on nailfold videocapillaroscopy (odds ratio, 7.19; 95% confidence interval, 1.87-8.96; p = 0.042) and anti-Scl-70 positivity (odds ratio, 5.92; 95% confidence interval, 1.06-18.43; p = 0.048). CONCLUSIONS Severe microvascular damage, as detected by nailfold videocapillaroscopy, may suggest the coexistence of autonomic dysfunction and should be considered as a red flag for the identification of patients particularly at risk of cardiac morbidity and mortality.
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Affiliation(s)
- Francesco Masini
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Klodian Gjeloshi
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Emanuele Pinotti
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Roberta Ferrara
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Ciro Romano
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and
Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine,
University of Campania “Luigi Vanvitelli,” Naples, Italy
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Gigante A, Villa A, Rosato E. Laser speckle contrast analysis predicts major vascular complications and mortality of patients with systemic sclerosis. Rheumatology (Oxford) 2021; 60:1850-1857. [PMID: 33141226 DOI: 10.1093/rheumatology/keaa514] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/16/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The aim of study was to evaluate peripheral blood perfusion and the proximal-distal gradient (PDG) of the hands as biomarkers of SSc major vascular complications (digital ulcers, pulmonary arterial hypertension, scleroderma renal crisis) and mortality by laser speckle contrast analysis. METHODS In this retrospective observational study, 176 SSc patients [158 female, median age 53 (51-57) years] and 142 healthy controls [115 female, median age 53 (48-55) years] were enrolled. Clinical data were collected at baseline and annually through 5 years of follow-up. Hand dorsum perfusion images were divided into three regions of interest (ROI): ROI1 included the second, third, and fourth fingers distal to the proximal interphalangeal finger joint; ROI2 included the area between the proximal interphalangeal finger joint and the metacarpophalangeal joint; ROI3 included the hand dorsum. PDG was identified when the perfusion mean difference between ROI1 and ROI2 was >30 perfusion units. RESULTS Median peripheral blood perfusion was significantly lower for SSc patients than healthy controls. PDG was present in 51.5% of SSc patients and in 98.6% of healthy controls. Using the final multivariate model, nailfold videocapillaroscopy (NVC) pattern [hazard ratio (HR) 0.065 (0.015-0.283), P <0.0001] and PDG [HR 0.376 (0.194-0.727), P <0.01] were found to be risk factors for major vascular complications. By multivariate analysis, age [HR 1.051 (1.014-1.088), P <0.01), NVC pattern [HR 0.001 (0.000-3.111), P >0.05], and PDG [HR 0.207 (0.073-0.589), P <0.01] were found to be risk factors for 5-year SSc mortality. CONCLUSION PDG predicts major vascular complication and 5-year mortality of SSc patients.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Annalisa Villa
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Vascular endothelial injury assessed with functional techniques in systemic sclerosis patients with pulmonary arterial hypertension versus systemic sclerosis patients without pulmonary arterial hypertension: a systematic review and meta-analysis. Rheumatol Int 2021; 41:1045-1053. [PMID: 33830321 DOI: 10.1007/s00296-021-04850-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
Microvascular dysfunction is one of the hallmarks of systemic sclerosis (SSc). The presence of pulmonary-arterial-hypertension (PAH) in SSc-patients is associated with poor prognosis. This is a systematic review and meta-analysis of studies assessing microvascular and endothelial injury with functional techniques in SSc-patients with PAH (SSc-PAH) compared to those without PAH (SSc-non-PAH) (PROSPERO: CRD42021236212). Literature search involved PubMed, the-Cochrane-Library, Web-of-Science, Scopus and manual search of article references. Studies assessing microvascular function by all available functional methods were considered eligible. Preclinical studies and studies using structural nailfold-videocapillaroscopy or biomarkers were excluded. Newcastle-Ottawa-Scale (NOS) was applied to evaluate the quality of retrieved studies. From a total of 602 retrieved articles, four studies (n = 159 participants) were included in meta-analysis; three studies were of high quality (NOS ≥ 7). In pooled analysis, a marginally significant impaired microvascular function was observed in SSc-PAH compared to SSc-non-PAH patients [SMD - 0.71, 95% CI (- 1.53, 0.12)], with significant between-study heterogeneity (I2 = 80%, p = 0.002). Among the studies examining endothelium-dependent and -independent vasodilation with LDF-iontophoresis, SSc-PAH subjects had significantly impaired endothelium-dependent-vasodilation [Ach-stimulated %change WMD - 216.79, 95% CI (- 337.87, - 95.71), I2 = 0%, p = 0.40], but no significant differences in endothelium-independent-vasodilation [SNP-stimulated %change WMD 90.84, 95% CI (- 82.52, 264.19), I2 = 44%, p = 0.18] compared with SSc-non-PAH subjects. In sensitivity analysis including only studies where SSc-PAH patients were diagnosed by right-heart-catheterization, a borderline difference between the two groups was noted [SMD - 1.09, 95% CI (- 2.30, 0.13), I2 = 82%, p = 0.004]. SSc-PAH patients showed marginally impaired microvascular function in the pooled analysis, as well as impaired endothelium-dependent-vasodilation in subgroup analysis compared with SSc-non-PAH patients. Vascular endothelial dysfunction could be involved in high cardiovascular risk of patients with SSc and PAH.
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9
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Dinsdale G, Wilkinson S, Wilkinson J, Moore TL, Manning JB, Berks M, Marjanovic E, Dickinson M, Herrick AL, Murray AK. State-of-the-art technologies provide new insights linking skin and blood vessel abnormalities in SSc-related disorders. Microvasc Res 2020; 130:104006. [PMID: 32320708 PMCID: PMC7522709 DOI: 10.1016/j.mvr.2020.104006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE A key unanswered question in systemic sclerosis (SSc) is how microvascular abnormality and fibrosis inter-relate. Our aim was to use state-of-the-art non-invasive imaging methods to gain new insights into pathophysiology, comparing patients with different subtypes of SSc, including early dcSSc, not only to healthy controls but also to patients with causes of Raynaud's phenomenon not progressing to fibrosis. METHODS Laser Doppler imaging, nailfold capillaroscopy, spectroscopy, and ultrasound measured (respectively) perfusion, microvascular structure, oxygenation/oxidative stress, and skin thickening in the hands of 265 subjects: 31 patients with primary Raynaud's phenomenon (PRP), 35 with undifferentiated connective tissue disease (UCTD), 93 with limited cutaneous SSc (lcSSc), 46 with diffuse cutaneous SSc (dcSSc, including 27 'early') and 60 healthy controls. RESULTS Mean perfusion was reduced in SSc groups compared to controls (lcSSc 172 perfusion units [standard deviation 157], late-dcSSc 90 [145], early-dcSSc 68 [137] vs. controls 211 [146]; p = 0.0002) as was finger-oxygenation (lcSSc 12.1 [13.6] arbitrary units [AU], late-dcSSc 12.2 [8.4], early-dcSSc 11.1 [11.3] vs controls 14.9 [10.5]; p = 0.0049). Oxidative stress was increased at the hand-dorsum in SSc groups (p = 0.0007). Perfusion positively correlated with oxygenation (r = 0.23, p < 0.001), and capillary density negatively with skin thickness (r = -0.26, p < 0.001). CONCLUSION Our findings lend support to the hypothesis that in SSc, particularly early dcSSc, (but not in PRP or UCTD), reduced perfusion (together with structural microvascular abnormality) associates with reduced oxygenation, with oxidative stress and with skin thickening/fibrosis, most likely driving a vicious cycle which ultimately results in irreversible tissue injury. Findings in skin may mirror alterations in internal organs.
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Affiliation(s)
- Graham Dinsdale
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Wilkinson
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jack Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health The University of Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Tonia L Moore
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Joanne B Manning
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Elizabeth Marjanovic
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Mark Dickinson
- Photon Science Institute, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; The Dept of Physics and Astronomy, Unversity of Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland.
| | - Andrea K Murray
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
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Chrabaszcz M, Małyszko J, Sikora M, Alda-Malicka R, Stochmal A, Matuszkiewicz-Rowinska J, Rudnicka L. Renal Involvement in Systemic Sclerosis: An Update. Kidney Blood Press Res 2020; 45:532-548. [PMID: 32521536 DOI: 10.1159/000507886] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Systemic sclerosis is an immune-mediated rheumatic disease characterized by vascular abnormalities, tissue fibrosis and autoimmune phenomena. SUMMARY Renal disease occurring in patients with systemic sclerosis may have a variable clinicopathological picture. The most specific renal condition associated with systemic sclerosis is scleroderma renal crisis, characterized by acute onset of renal failure and severe hypertension. Although the management of scleroderma renal crisis was revolutionized by the introduction of angiotensin-converting enzyme inhibitors, there is still a significant proportion of patients with poor outcomes. Therefore, research on establishing disease markers (clinical, ultrasonographical and serological) and clear diagnostic criteria, which could limit the risk of developing scleroderma renal crisis and facilitate diagnosis of this complication, is ongoing. Other forms of renal involvement in systemic sclerosis include vasculitis, an isolated reduced glomerular filtration rate in systemic sclerosis, antiphospholipid-associated nephropathy, high intrarenal arterial stiffness and proteinuria. Key Messages: Scleroderma renal crisis is the most specific and life-threatening renal presentation of systemic sclerosis, albeit with declining prevalence. In patients with scleroderma renal crisis, it is mandatory to control blood pressure early with increasing doses of angiotensin-converting enzyme inhibitors, along with other antihypertensive drugs if necessary. There is a strong association between renal involvement and patients' outcomes in systemic sclerosis; consequently, it becomes mandatory to find markers that may be used to identify patients with an especially high risk of scleroderma renal crisis.
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Affiliation(s)
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland,
| | - Mariusz Sikora
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Anna Stochmal
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Lim WW, Ng B, Widjaja A, Xie C, Su L, Ko N, Lim SY, Kwek XY, Lim S, Cook SA, Schafer S. Transgenic interleukin 11 expression causes cross-tissue fibro-inflammation and an inflammatory bowel phenotype in mice. PLoS One 2020; 15:e0227505. [PMID: 31917819 PMCID: PMC6952089 DOI: 10.1371/journal.pone.0227505] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/19/2019] [Indexed: 01/19/2023] Open
Abstract
Interleukin 11 (IL11) is a profibrotic cytokine, secreted by myofibroblasts and damaged epithelial cells. Smooth muscle cells (SMCs) also secrete IL11 under pathological conditions and express the IL11 receptor. Here we examined the effects of SMC-specific, conditional expression of murine IL11 in a transgenic mouse (Il11SMC). Within days of transgene activation, Il11SMC mice developed loose stools and progressive bleeding and rectal prolapse, which was associated with a 65% mortality by two weeks. The bowel of Il11SMC mice was inflamed, fibrotic and had a thickened wall, which was accompanied by activation of ERK and STAT3. In other organs, including the heart, lung, liver, kidney and skin there was a phenotypic spectrum of fibro-inflammation, together with consistent ERK activation. To investigate further the importance of stromal-derived IL11 in the inflammatory bowel phenotype we used a second model with fibroblast-specific expression of IL11, the Il11Fib mouse. This additional model largely phenocopied the Il11SMC bowel phenotype. These data show that IL11 secretion from the stromal niche is sufficient to drive inflammatory bowel disease in mice. Given that IL11 expression in colonic stromal cells predicts anti-TNF therapy failure in patients with ulcerative colitis or Crohn's disease, we suggest IL11 as a therapeutic target for inflammatory bowel disease.
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Affiliation(s)
- Wei-Wen Lim
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Benjamin Ng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Anissa Widjaja
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Chen Xie
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Liping Su
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Nicole Ko
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Sze-Yun Lim
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Xiu-Yi Kwek
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Stella Lim
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Stuart Alexander Cook
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College London, London, England, United Kingdom
- MRC-London Institute of Medical Sciences, London, England, United Kingdom
| | - Sebastian Schafer
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
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12
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Khouri C, Lepelley M, Bailly S, Blaise S, Herrick AL, Matucci-Cerinic M, Allanore Y, Trinquart L, Cracowski JL, Roustit M. Comparative efficacy and safety of treatments for secondary Raynaud's phenomenon: a systematic review and network meta-analysis of randomised trials. THE LANCET. RHEUMATOLOGY 2019; 1:e237-e246. [PMID: 38229380 DOI: 10.1016/s2665-9913(19)30079-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several pharmacological treatments are available for secondary Raynaud's phenomenon, but there is uncertainty regarding the best options. We aimed to assess and compare the benefits and harms of treatments available for secondary Raynaud's phenomenon. METHOD We did a systematic review and network meta-analysis of randomised controlled trials (RCTs) of pharmacological treatments. We searched for systematic reviews published in MEDLINE and the Cochrane Database of Systematic Reviews up to Jan 31, 2017, and for RCTs published from inception to Sept 24, 2019 in MEDLINE, Embase, and ClinicalTrials.gov. We included double-blind RCTs (parallel or crossover) that compared two or more pharmacological treatments or placebo in patients with secondary Raynaud's phenomenon. Individual patient data were obtained for one unpublished RCT. Three researchers independently screened the texts and extracted the data. Efficacy outcomes included severity (on a ten-point scale), daily frequency, and mean duration of Raynaud's phenomenon attacks. We also examined tolerability and acceptability. Pairwise meta-analyses and Bayesian random-effects network meta-analyses were used to synthesise data. This study is registered with PROSPERO (CRD42017057518). FINDINGS We included 58 RCTs in the analysis, comprising 3867 patients (3540 [91·5%] with secondary Raynaud's phenomenon) and 15 classes of drugs. Phosphodiesterase 5 (PDE5) inhibitors were more effective than placebo for frequency (mean difference -0·36 [95% credibility interval -0·69 to -0·04]), severity (-0·34 [-0·66 to -0·03]), and duration (-3·42 [-6·62 to -0·29]) of attacks (low to moderate level of evidence). Calcium channel blockers (CCBs) were superior to placebo for frequency (-0·35 [-0·67 to -0·02]) and severity (-0·84 [-1·25 to -0·45]) of attacks (low level of evidence). For severity of attacks, selective serotonin-reuptake inhibitors (-1·54 [-2·68 to -0·41]; very low level of evidence) and oral prostacyclin receptor agonists (-0·48 [-0·80 to -0·16]; low level of evidence) were superior to placebo. No other drug classes were significantly superior to placebo with regard to efficacy outcomes. Compared with placebo, tolerability was lower for PDE5 inhibitors (incidence rate ratio for serious adverse events or early study exit due to adverse events 3·30 [95% CrI 1·49 to 7·55]) and CCBs (3·13 [1·33 to 7·04]). For all outcomes, global heterogeneity and between-study variance ranged from low (I2=0% and τ2=0·0 for attack severity and duration) to moderate (I2=41% and τ2=0·2 for tolerability). The overall risk of bias was judged to be low in 22 (38%), high in ten (17%), and unclear in 26 (45%) RCTs. INTERPRETATION PDE5 inhibitors and CCBs are the most effective pharmacological options, albeit with moderate efficacy and a low level of evidence. Current evidence does not support the use of any other drug in secondary Raynaud's phenomenon. FUNDING None.
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Affiliation(s)
- Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France; Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Marion Lepelley
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Sebastien Bailly
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Careggi University Hospital, Florence, Italy
| | - Yannick Allanore
- INSERM U1016 UMR8104 Cochin Institute, Paris Descartes University, Paris, France; Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jean-Luc Cracowski
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Matthieu Roustit
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France.
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13
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Ghouri MA, Gupta N, Bhat AP, Thimmappa ND, Saboo SS, Khandelwal A, Nagpal P. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges. Cardiovasc Diagn Ther 2019; 9:S152-S173. [PMID: 31559161 DOI: 10.21037/cdt.2018.09.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Imaging is needed for diagnosis, treatment planning, and follow-up of patients with pathologies affecting upper extremity vasculature. With growth and evolution of imaging modalities [especially CT angiography (CTA) and MR angiography (MRA)], there is need to recognize the advantages and disadvantages of various modalities and obtain the best possible imaging diagnostic test. Understanding various limitations and pitfalls as well as the best practices to minimize and manage these pitfalls is very important for the diagnosis. This article reviews the upper extremity arterial vascular anatomy, discusses the CTA and MRA imaging, various pitfalls, and challenges and discuss imaging manifestations of upper extremity arterial pathologies.
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Affiliation(s)
- Maaz A Ghouri
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nishant Gupta
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Ambarish P Bhat
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Sachin S Saboo
- Department of Radiology, UT Health Science Center, San Antonio, TX, USA
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Abstract
Despite our understanding that the microvasculature plays a multifaceted role in the development and progression of various conditions, we know little about the extent of this involvement. A need exists for non-invasive, clinically meaningful imaging modalities capable of elucidating microvascular information to aid in our understanding of disease, and to aid in the diagnosis/monitoring of disease for more patient-specific care. In this review article, a number of imaging techniques are summarized that have been utilized to investigate the microvasculature of skin, along with their advantages, disadvantages and future perspectives in preclinical and clinical settings. These techniques include dermoscopy, capillaroscopy, Doppler sonography, laser Doppler flowmetry (LDF) and perfusion imaging, laser speckle contrast imaging (LSCI), optical coherence tomography (OCT), including its Doppler and dynamic variant and the more recently developed OCT angiography (OCTA), photoacoustic imaging, and spatial frequency domain imaging (SFDI). Attention is largely, but not exclusively, placed on optical imaging modalities that use intrinsic optical signals to contrast the microvasculature. We conclude that whilst each imaging modality has been successful in filling a particular niche, there is no one, all-encompassing modality without inherent flaws. Therefore, the future of cutaneous microvascular imaging may lie in utilizing a multi-modal approach that will counter the disadvantages of individual systems to synergistically augment our imaging capabilities.
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Affiliation(s)
- Anthony J Deegan
- Department of Bioengineering, University of Washington, 3720 15th Ave. NE., Seattle, WA 98195, United States of America
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15
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Hearing loss in patients with scleroderma: associations with clinical manifestations and capillaroscopy. Clin Rheumatol 2018; 37:2439-2446. [PMID: 29860565 DOI: 10.1007/s10067-018-4162-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/18/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Systemic sclerosis is a multi-systemic disease with widespread small-vessel vasculopathy and fibrosis. Involvement of the middle and inner ear and hearing loss has been reported as an uncommon manifestation of scleroderma in some studies. In this study, we evaluated hearing problems in scleroderma patients and determined its association with clinical manifestations and capillaroscopy. We evaluated 54 patients with scleroderma referred to Hafez Hospital clinic of scleroderma related to Shiraz University of Medical Science; they fulfilled the LeRoy and ACR/EULAR criteria for scleroderma. Control group consisted of 60 normal individuals. All clinical manifestations, nail fold capillaroscopy, pure tone audiometry, speech reception threshold, and speech audiometry were recorded during evaluation. Subjective hearing loss and objective hearing loss were seen in 10 and 36 patients of the case group (18.5%, 66.7%) and 6 and 10 of the control group (10%, 28.3%) (P values 0.03, < 0.001). Sensorineural hearing loss, abnormal pure tone audiometry, and abnormal speech reception threshold were more common in scleroderma patients compared to the control group (P values of < 0.001, < 0.001, and < 0.001). There was no correlation between objective hearing loss and type of scleroderma, duration of disease, skin score, interstitial lung disease, digital ulcer, gastrointestinal involvement, or nail fold capillaroscopy patterns (all P values > 0.05). In our study, subjective and objective hearing loss were higher in patients with scleroderma compared to the control group and also sensorineural hearing loss, abnormal pure tone audiometry, and abnormal speech reception threshold. There was no correlation between objective hearing loss and clinical manifestations or capillaroscopy findings.
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Taylor DK, Mittereder N, Kuta E, Delaney T, Burwell T, Dacosta K, Zhao W, Cheng LI, Brown C, Boutrin A, Guo X, White WI, Zhu J, Dong H, Bowen MA, Lin J, Gao C, Yu L, Ramaswamy M, Gaudreau MC, Woods R, Herbst R, Carlesso G. T follicular helper–like cells contribute to skin fibrosis. Sci Transl Med 2018. [DOI: 10.1126/scitranslmed.aaf5307] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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17
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Certainties and uncertainties concerning the contribution of pericytes to the pathogenesis of systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2017; 3:14-20. [DOI: 10.5301/jsrd.5000254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/09/2017] [Indexed: 02/08/2023]
Abstract
The role of pericytes in systemic sclerosis (SSc) is unclear because of the difficulty in phenotyping them. They are mainly distributed in the pre-capillary, capillary and post-capillary abluminal side of non-muscular micro-vessels, express platelet-derived growth factor receptors (PDGFRs), and preside over vascular integrity and regeneration. By establishing close contact with many endothelial cells, a single pericyte can regulate ion influx, mechanical stress, leukocyte diapedesis, and platelet activation. Moreover, under pathological conditions such as SSc, pericytes may acquire a contractile phenotype and respond to various stimuli, including endothelin, angiotensin II and reactive oxygen species. The pericytes of SSc patients share some molecular patterns with myofibroblasts or fibroblasts, including A disintegrin and metalloproteinase domain 12 (ADAM-12), α-smooth muscle actin (α-SMA), the extra domain A (ED-A) variant of fibronectin, and Thy-1. Following stimulation with PDGF-β or transforming growth factor-β (TGF-β), pericytes may acquire a myofibroblast phenotype, and produce extracellular matrix or indirectly promote fibroblast activation. They may also contribute to fibrosis by means of epigenetic regulation. The pericyte plasmalemma is particularly rich in caveolae containing caveolin-1, a deficit of which has been associated with defective vessel tone control and lung fibrosis in mice. Consequently, dysfunctional pericytes may underlie the microangiopathy and fibrosis observed in SSc patients. However, given its variability in biological behaviour and the lack of a pan-pericyte marker, the exact role of these cells in SSc warrants further investigation.
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18
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Schwarz M, Soliman D, Omar M, Buehler A, Ovsepian SV, Aguirre J, Ntziachristos V. Optoacoustic Dermoscopy of the Human Skin: Tuning Excitation Energy for Optimal Detection Bandwidth With Fast and Deep Imaging in vivo. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1287-1296. [PMID: 28278460 DOI: 10.1109/tmi.2017.2664142] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Optoacoustic (photoacoustic) dermoscopy offers two principal advantages over conventional optical imaging applied in dermatology. First, it yields high-resolution cross-sectional images of the skin at depths not accessible to other non-invasive optical imaging methods. Second, by resolving absorption spectra at multiple wavelengths, it enables label-free 3D visualization of morphological and functional features. However, the relation of pulse energy to generated bandwidth and imaging depth remains poorly defined. In this paper, we apply computer models to investigate the optoacoustic frequency response generated by simulated skin. We relate our simulation results to experimental measurements of the detection bandwidth as a function of optical excitation energy in phantoms and human skin. Using raster-scan optoacoustic mesoscopy, we further compare the performance of two broadband ultrasonic detectors (a bandwidth of 20-180 and 10-90MHz) in acquiring optoacoustic readouts. Based on the findings of this paper, we propose energy ranges required for skin imaging with considerations of laser safety standards.
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19
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Dinsdale G, Moore T, O'Leary N, Tresadern P, Berks M, Roberts C, Manning J, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Taylor C, Murray A, Herrick AL. Intra-and inter-observer reliability of nailfold videocapillaroscopy - A possible outcome measure for systemic sclerosis-related microangiopathy. Microvasc Res 2017; 112:1-6. [PMID: 28163035 DOI: 10.1016/j.mvr.2017.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/12/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our aim was to assess the reliability of nailfold capillary assessment in terms of image evaluability, image severity grade ('normal', 'early', 'active', 'late'), capillary density, capillary (apex) width, and presence of giant capillaries, and also to gain further insight into differences in these parameters between patients with systemic sclerosis (SSc), patients with primary Raynaud's phenomenon (PRP) and healthy control subjects. METHODS Videocapillaroscopy images (magnification 300×) were acquired from all 10 digits from 173 participants: 101 patients with SSc, 22 with PRP and 50 healthy controls. Ten capillaroscopy experts from 7 European centres evaluated the images. Custom image mark-up software allowed extraction of the following outcome measures: overall grade ('normal', 'early', 'active', 'late', 'non-specific', or 'ungradeable'), capillary density (vessels/mm), mean vessel apical width, and presence of giant capillaries. RESULTS Observers analysed a median of 129 images each. Evaluability (i.e. the availability of measures) varied across outcome measures (e.g. 73.0% for density and 46.2% for overall grade in patients with SSc). Intra-observer reliability for evaluability was consistently higher than inter- (e.g. for density, intra-class correlation coefficient [ICC] was 0.71 within and 0.14 between observers). Conditional on evaluability, both intra- and inter-observer reliability were high for grade (ICC 0.93 and 0.78 respectively), density (0.91 and 0.64) and width (0.91 and 0.85). CONCLUSIONS Evaluability is one of the major challenges in assessing nailfold capillaries. However, when images are evaluable, the high intra- and inter-reliabilities suggest that overall image grade, capillary density and apex width have potential as outcome measures in longitudinal studies.
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Affiliation(s)
- Graham Dinsdale
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Tonia Moore
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Neil O'Leary
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Philip Tresadern
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Christopher Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Joanne Manning
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marina Anderson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Kevin Howell
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Andrea Murray
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Long-term clinical stabilization of scleroderma patients treated with a chronic and intensive IV iloprost regimen. Rheumatol Int 2016; 37:245-249. [PMID: 27796521 PMCID: PMC5258785 DOI: 10.1007/s00296-016-3582-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/19/2016] [Indexed: 12/02/2022]
Abstract
Intravenous iloprost is a first-line option for the treatment of scleroderma-related digital vasculopathy, and some studies have suggested its favourable role on disease progression. The aim of our study is to evaluate the disease progression, specifically in terms of cardiopulmonary function, in a group of consecutive patients chronically treated with intravenous iloprost. Our retrospective study enrolled 68 scleroderma patients (68 F, 54.4 ± 12.3 years) treated with iloprost for 7.1 ± 2.9 years, with a schedule of 5–6 consecutive daily infusions per month (6 h/day, 0.5–2.0 ng/kg/min). In all patients, modified Rodnan skin score (4.7 ± 5.3 vs. 3.7 ± 5.3, p < 0.0001), systolic pulmonary arterial pressure (sPAP) (30.9 ± 6.4 vs. 24.0 ± 3.2 mmHg, p < 0.0001), tricuspid annular plane systolic excursion (22.1 ± 2.4 vs. 23.8 ± 3.5 mm, p = 0.0001), pro-brain natriuretic peptide (97.2 ± 69.3 vs. 65.8 ± 31.7 pg/ml, p = 0.0005) showed statistically significant improvement from baseline. In the subgroup of patients with baseline sPAP ≥36 mmHg (n = 17), a significant sPAP reduction was observed (from 39.5 ± 3.8 to 25.1 ± 4.5 mmHg, p < 0.0001) after 7.6 ± 2.5 years of follow-up. The number of patients with digital ulcers (DUs) at follow-up was reduced from baseline (42.6 vs. 11.8%, p < 0.001), and none of the free-DU patients at baseline presented DUs at follow-up. An intensive and chronic regimen of IV iloprost administration seems to stabilize and potentially improve the long-term development of disease in SSc patients, as suggested by stabilization or significant improvement of cardiopulmonary parameters and vasculopathy.
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Meiszterics Z, Tímár O, Gaszner B, Faludi R, Kehl D, Czirják L, Szűcs G, Komócsi A. Early morphologic and functional changes of atherosclerosis in systemic sclerosis—a systematic review and meta-analysis. Rheumatology (Oxford) 2016; 55:2119-2130. [DOI: 10.1093/rheumatology/kew236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 04/29/2016] [Indexed: 02/03/2023] Open
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Kotzki S, Roustit M, Arnaud C, Godin-Ribuot D, Cracowski JL. Effect of continuous vs pulsed iontophoresis of treprostinil on skin blood flow. Eur J Pharm Sci 2015; 72:21-6. [PMID: 25712367 DOI: 10.1016/j.ejps.2015.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/11/2015] [Accepted: 02/15/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare disease affecting digital microcirculation, leading to finger ulcers and in some cases to amputation. Prostacyclin analogues can be used intravenously but their therapeutic effect is counterbalanced by potentially serious vasodilatation-induced side effects. Iontophoresis of treprostinil could be a promising local therapeutic alternative for SSc-related digital ulcers. Iontophoretic drug delivery is complex, and whether continuous or periodic current should be used remains debated. The objective of the present work is to compare the effect of continuous vs pulsed iontophoresis of treprostinil in rats. MATERIALS AND METHODS Treprostinil (0.64 mM and 0.064 mM) and NaCl were delivered by cathodal iontophoresis onto the hindquarters of anaesthetized rats. Three protocols delivering the same quantity of current were compared: one was continuous (100 μA during 20 min) and two were periodic (B: twenty 1-min cycles with 200 μA during 30 s followed by 30 s Off; and C: twenty 1-min cycles with 600 μA during 10s followed by 50s Off) (n=8 for each protocol with each concentration). Skin blood flow was quantified using laser Doppler imaging and skin resistance was calculated with Ohm's law. RESULTS All protocols induced a significant increase in skin blood flow. At the lower concentration (0.064 mM treprostinil) the pulsed 10/50 sequence significantly enhanced cutaneous blood flow (Table 1; Fig. 1B) compared to continuous iontophoresis or the 30/30 sequence. We noted that the pulsed iontophoresis of NaCl (10/50 sequence) induced a significant early increase in cutaneous blood flow in comparison with continuous iontophoresis. Skin resistance measures were negatively correlated with current intensity delivered. CONCLUSION In conclusion, pulsed iontophoresis of treprostinil with a 10 s/50 s (On/Off) protocol at 600 μA increases the efficacy of iontophoresis at 0.064 mM but not at a tenfold higher concentration. Pulsed iontophoresis could be used to optimize treprostinil iontophoresis, to provide similar efficacy with decreased costs, and should now be tested on humans.
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Affiliation(s)
- Sylvain Kotzki
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble University Hospital, Grenoble, France; Univ. Grenoble Alpes, Grenoble, France.
| | - Matthieu Roustit
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble University Hospital, Grenoble, France; UMR 1042-HP2, INSERM, Grenoble, France; Univ. Grenoble Alpes, Grenoble, France
| | - Claire Arnaud
- UMR 1042-HP2, INSERM, Grenoble, France; Univ. Grenoble Alpes, Grenoble, France
| | - Diane Godin-Ribuot
- UMR 1042-HP2, INSERM, Grenoble, France; Univ. Grenoble Alpes, Grenoble, France
| | - Jean-Luc Cracowski
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble University Hospital, Grenoble, France; UMR 1042-HP2, INSERM, Grenoble, France; Univ. Grenoble Alpes, Grenoble, France
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Humeau-Heurtier A, Abraham P, Mahe G. Analysis of laser speckle contrast images variability using a novel empirical mode decomposition: comparison of results with laser Doppler flowmetry signals variability. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:618-627. [PMID: 25347875 DOI: 10.1109/tmi.2014.2364079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Laser Doppler flowmetry (LDF) and laser speckle contrast imaging (LSCI) have emerged as noninvasive optical modalities to monitor microvascular blood flow. Many studies proposed to extract physiological information from LDF by analyzing signals variability. By opposition, such analyses for LSCI data have not been conducted yet. We propose to analyze LSCI variability using a novel data-driven method: the complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN). CEEMDAN is suitable for nonlinear and nonstationary data and leads to intrinsic mode functions (IMFs). It is based on the ensemble empirical mode decomposition (EEMD) which relies on empirical mode decomposition (EMD). In our work the average frequencies of LSCI IMFs given by CEEMDAN are compared with the ones given by EMD and EEMD. Moreover, LDF signals acquired simultaneously to LSCI data are also processed with CEEMDAN, EMD and EEMD. We show that the average frequencies of IMFs given by CEEMDAN depend on the signal-to-noise ratio (SNR) used in the computation but, for a given SNR, the average frequencies found for LSCI are close to the ones obtained for LDF. By opposition, EEMD leads to IMFs with frequencies that do not vary much when the SNR level is higher than a threshold. The new CEEMDAN algorithm has the advantage of achieving a complete decomposition with no error in the reconstruction but our study suggests that further work is needed to gain knowledge in the adjustment of the added noise level. CEEMDAN, EMD and EEMD are data-driven methods that can provide a better knowledge of LSCI.
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Schwarz M, Omar M, Buehler A, Aguirre J, Ntziachristos V. Implications of ultrasound frequency in optoacoustic mesoscopy of the skin. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:672-7. [PMID: 25361501 DOI: 10.1109/tmi.2014.2365239] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Raster-scan optoacoustic mesoscopy (RSOM) comes with high potential for in vivo diagnostic imaging in dermatology, since it allows for high resolution imaging of the natural chromophores melanin, and hemoglobin at depths of several millimeters. We have applied ultra-wideband RSOM, in the 10-160 MHz frequency band, to image healthy human skin at distinct locations. We analyzed the anatomical information contained at different frequency ranges of the optoacoustic (photoacoustic) signals in relation to resolving features of different skin layers in vivo. We further compared results obtained from glabrous and hairy skin and identify that frequencies above 60 MHz are necessary for revealing the epidermal thickness, a prerequisite for determining the invasion depth of melanoma in future studies. By imaging a benign nevus we show that the applied RSOM system provides strong contrast of melanin-rich structures. We further identify the spectral bands responsible for imaging the fine structures in the stratum corneum, assessing dermal papillae, and resolving microvascular structures in the horizontal plexus.
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Uppal L, Dhaliwal K, Butler PE. A prospective study of the use of botulinum toxin injections in the treatment of Raynaud's syndrome associated with scleroderma. J Hand Surg Eur Vol 2014; 39:876-80. [PMID: 24369360 DOI: 10.1177/1753193413516242] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raynaud's syndrome contributes to the pain, paraesthesia, ulceration, and gangrene of scleroderma. Botulinum toxin has been shown to improve digital perfusion in patients with Raynaud's. This is the first study to objectively assess hand function following this treatment in patients with scleroderma. Twenty patients were treated with 100 units of botulinum toxin injected into the hand. An assessment of hand function and symptoms was performed prior to injection and then 8-12 weeks later. The outcomes assessed were change in pain, appearance, cold intolerance, pinch and power grip, ranges of movement, and Disabilities of the Arm, Shoulder and Hand (DASH) score. In total, 80% of patients reported an overall improvement in their symptoms, reduction in pain, and improved DASH score and 65% reported improvement in cold intolerance. Overall, 90% showed an improvement in pinch grip and 65% an improvement in power grip. Objective parameters were statistically significantly improved; however, subjective outcomes only showed a trend. We have found botulinum toxin to be an effective treatment for Raynaud's syndrome secondary to scleroderma.
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Affiliation(s)
- L Uppal
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - K Dhaliwal
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - P E Butler
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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Aburizik A, Singh S, Al-Rabadi L, Blosser C. Mistaken identity: normotensive scleroderma renal crisis. BMJ Case Rep 2014; 2014:bcr-2013-202566. [PMID: 24876209 DOI: 10.1136/bcr-2013-202566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A patient presented with neuromuscular, respiratory and cardiac symptoms and was initially diagnosed with amyotrophic lateral sclerosis (ALS), myocardial ischaemia and pneumonia. He developed unexplained progressive kidney failure over the ensuing week, and his kidney biopsy showed thrombotic microangiopathy that led to the correct diagnosis of normotensive scleroderma renal crisis. His clinical presentation and course were consistent with systemic sclerosis and normotensive scleroderma renal crisis. He was treated with an ACE inhibitor (ACEi) and haemodialysis with significant functional improvement over the next 3 months to his prior baseline with the exception of kidney failure. This case highlights a diagnostic challenge requiring astute history and physical examination skills, and the value of a kidney biopsy in providing the final diagnosis.
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Affiliation(s)
- Arwa Aburizik
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Siddharth Singh
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Laith Al-Rabadi
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Blosser
- Department of Medicine-Nephrology, University of Washington, Seattle, Washington, USA
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Takahashi T, Asano Y, Amiya E, Hatano M, Tamaki Z, Ozeki A, Watanabe A, Kawarasaki S, Nakao T, Taniguchi T, Ichimura Y, Toyama T, Watanabe M, Hirata Y, Nagai R, Sato S. Improvement of endothelial function in parallel with the amelioration of dry cough and dyspnea due to interstitial pneumonia by intravenous cyclophosphamide pulse therapy in patients with systemic sclerosis: a preliminary report of two cases. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0545-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Partovi S, Schulte AC, Staub D, Jacobi B, Aschwanden M, Walker UA, Imfeld S, Broz P, Benz D, Zipp L, Takes M, Jäger KA, Huegli RW, Bilecen D. Correlation of skeletal muscle blood oxygenation level-dependent MRI and skin laser doppler flowmetry in patients with systemic sclerosis. J Magn Reson Imaging 2013; 40:1408-13. [DOI: 10.1002/jmri.24503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/10/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sasan Partovi
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Anja-Carina Schulte
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Daniel Staub
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Bjoern Jacobi
- Third Department of Internal Medicine; Johannes Gutenberg University Hospital of Mainz; Mainz Germany
| | - Markus Aschwanden
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Ulrich A. Walker
- Basel University Department of Rheumatology; Felix Platter-Spital; Basel Switzerland
| | - Stephan Imfeld
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Pavel Broz
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Daniela Benz
- Basel University Department of Rheumatology; Felix Platter-Spital; Basel Switzerland
| | - Lisa Zipp
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Martin Takes
- University Hospital Basel; Department of Radiology; Basel Switzerland
| | - Kurt A. Jäger
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Rolf W. Huegli
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Deniz Bilecen
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
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Kotzki S, Roustit M, Arnaud C, Boutonnat J, Blaise S, Godin-Ribuot D, Cracowski JL. Anodal Iontophoresis of a Soluble Guanylate Cyclase Stimulator Induces a Sustained Increase in Skin Blood Flow in Rats. J Pharmacol Exp Ther 2013; 346:424-31. [DOI: 10.1124/jpet.113.205484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hassan I, Sajad P, Majid S, Hassan T. Serum antioxidant status in patients with systemic sclerosis. Indian J Dermatol 2013; 58:239. [PMID: 23723482 PMCID: PMC3667294 DOI: 10.4103/0019-5154.110840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Vascular endothelial dysfunction is a central event in pathogenesis of a variety of human diseases. Systemic sclerosis is one of such diseases. The oxidative stress and depletion of antioxidants in the serum is believed to be one of the factors in causing this dysfunction. Aims: The aim of this case control study was to compare the levels of antioxidants in the serum of patients with systemic sclerosis and the normal age and sex matched controls. Materials and Methods: Our study consisted of 16 successively admitted patients with systemic sclerosis and 16 healthy, age and sex matched controls. The age group of patient's ranged between 25 and 55 years. The duration of the disease in patients ranged from 1 to 8 years. The serum of patients and controls were assayed for the levels of antioxidants (GSH, NO, MDA, SOD and GPX) by spectrophotometry. The statistical method of analysis used was the one sample t-test. Results: The median levels of antioxidants in the control patients were: SOD-4.14 units/ml; GSH-4.76 units/ml; NO-5.58 nmol/l; MDA-0.53 nmol/l and GPX-49 μmol/l. The levels of NO, GSH and SOD were decreased in these patients with a significant P value (<0.001) whereas the levels of GPX and MDA were normal to increased with a significant P value. Conclusion: The depletion of antioxidants and oxidative stress in serum might be responsible for the vascular dysfunction and other hallmark manifestations of systemic sclerosis. Therefore micronutrient antioxidant supplements may be of therapeutic value.
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Affiliation(s)
- Iffat Hassan
- Department of Dermatology, STD and Leprosy, Srinagar, Kashmir, India
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Bajraktari IH, Berisha I, Berisha M, Saiti V, Bajraktari H. Incidence, prevalence and clinical manifestations of systemic sclerosis in dukagjini plain. Mater Sociomed 2013; 25:14-8. [PMID: 23678335 PMCID: PMC3633486 DOI: 10.5455/msm.2013.25.14-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/20/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction: Progressive systemic sclerosis (PSS) is an inflammatory disease of connective tissue, with onset as edema that continues with fibrosis, induration, and skin atrophy, followed by attacks on the joints, internal organs, and secondary proliferation of connective tissue. Purpose: To research in which residence locations and among which group age is the most frequent incidence, prevalence and clinical manifestations of systemic sclerosis in Dukagjini Plain which is inhabited by 698450 resident citizens. Material and methods: 51 patients with progressive systemic sclerosis were studied, out them 44 were females (86.3%) and 7 males (13.7%) respectively, during the period from 2005 to 2010. Their illness was active from 18 to 60 months in accordance with EUSTAR criteria. They are of different age, median age is 44.2 ±10.1. Their diagnose is determined based on revised ACR criteria. Prevalence of patients with PSS was 14.61/100.000, while the incidence was 2.8/100.000, whereas CI (Confidence interval) or limit of accuracy was 95%. Results: Largest number of patients per 100.000 citizens has Istog municipality which has the largest number of patients with PSS. It is followed by Mamusha and Rahovec municipalities. The largest examined group age is 35-44 year old, 41.2% respectively. Conclusion: Additional studies are necessary to carry out in order to find the reasons of asymmetrical distribution of patients with systemic sclerosis in the municipalities of Dukagjini Plain.
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Affiliation(s)
- Ismet H Bajraktari
- Department of Rheumatology, University Clinical Centre, Prishtina, Kosovo
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Zielonka TM, Zycinska K, Radzikowska E, Filewska M, Bialas B, Obrowski MH, Skopinska-Rozewska E, Demkow U. Influence of sera from interstitial lung disease patients on angiogenic activity of mononuclear cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 756:139-45. [PMID: 22836629 DOI: 10.1007/978-94-007-4549-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Chronic inflammation stimulates of neovascularization. The aim of this study was to evaluate the effect of sera from interstitial lung diseases (ILD) patients on angiogenic capabilities of different subsets of mononuclear cells. Serum samples were obtained from 22 patients with sarcoidosis, 20 with hypersensitivity pneumonitis, 20 with idiopathic pulmonary fibrosis, 9 with systemic sclerosis, 6 with pulmonary Langerhans cells histiocytosis, and from 20 healthy volunteers. Animal model of leukocyte induced angiogenesis assay was used as an angiogenic test. The pattern of angiogenic reaction was different in different diseases. Sera from systemic sclerosis and pulmonary Langerhans cells histiocytosis patients exerted inhibitory effects on angiogenesis, but sera from sarcoidosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis patients stimulated angiogenesis. Sera from sarcoidosis and pulmonary Langerhans cells histiocytosis primed monocytes for the production of angiogenic factors. The number of microvessels created after incubation of mononuclear cells depleted of monocytes with sera from systemic sclerosis patients significantly decreased. We conclude that the role of monocytes in the modulation of angiogenesis varies depending on the type of ILD. Sera from sarcoidosis stimulate and from pulmonary Langerhans cells histiocytosis patients inhibit neovascularization induced by monocyte mediators. Sera from systemic sclerosis inhibit angiogenesis induced by lymphocyte products.
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Affiliation(s)
- T M Zielonka
- Department of Family Medicine, Medical University of Warsaw, Warsaw, Poland.
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Iontophoresis of endothelin receptor antagonists in rats and men. PLoS One 2012; 7:e40792. [PMID: 22808263 PMCID: PMC3396598 DOI: 10.1371/journal.pone.0040792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/13/2012] [Indexed: 11/19/2022] Open
Abstract
Introduction The treatment of scleroderma-related digital ulcers is challenging. The oral endothelin receptor antagonist (ERA) bosentan has been approved but it may induce liver toxicity. The objective of this study was to test whether ERAs bosentan and sitaxentan could be locally delivered using iontophoresis. Methods Cathodal and anodal iontophoresis of bosentan and sitaxentan were performed on anaesthetized rat hindquarters without and during endothelin-1 infusion. Skin blood flow was quantified using laser-Doppler imaging and cutaneous tolerability was assessed. Iontophoresis of sitaxentan (20 min, 20 or 100 µA) was subsequently performed on the forearm skin of healthy men (n = 5). Results In rats neither bosentan nor sitaxentan increased skin blood flux compared to NaCl. When simultaneously infusing endothelin-1, cathodal iontophoresis of sitaxentan increased skin blood flux compared to NaCl (AUC0–20 were 44032.2±12277 and 14957.5±23818.8 %BL.s, respectively; P = 0.01). In humans, sitaxentan did not significantly increase skin blood flux as compared to NaCl. Iontophoresis of ERAs was well tolerated both in animals and humans. Conclusions This study shows that cathodal iontophoresis of sitaxentan but not bosentan partially reverses endothelin-induced skin vasoconstriction in rats, suggesting that sitaxentan diffuses into the dermis. However, sitaxentan does not influence basal skin microvascular tone in rats or in humans.
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MURRAY ANDREAK, MOORE TONIAL, MANNING JOANNEB, GRIFFITHS CHRISTOPHERE, HERRICK ARIANEL. Noninvasive Measurement of Skin Autofluorescence Is Increased in Patients with Systemic Sclerosis: An Indicator of Increased Advanced Glycation Endproducts? J Rheumatol 2012; 39:1654-8. [DOI: 10.3899/jrheum.111359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Skin autofluorescence noninvasively assesses expression of advanced glycation endproducts and therefore potentially the presence of oxidative stress that is implicated in the pathogenesis of systemic sclerosis (SSc). We investigated whether autofluorescence was increased in patients with SSc, primary Raynaud’s phenomenon (RP), and morphea as compared to healthy controls.Methods.Measurements of autofluorescence were made at 5 upper limb sites in 16 healthy controls, 16 patients with diffuse cutaneous SSc (dcSSc), 15 with limited cutaneous SSc (lcSSc), 15 with primary RP, and 13 with morphea. For patients with morphea, additional measurements were made at the affected and an adjacent unaffected site.Results.Autofluorescence was significantly increased in patients with dcSSc but not lcSSc as compared to controls at the proximal phalanx [dcSSc median 0.15, interquartile range (IQR) 0.10–0.24, vs control 0.10, IQR 0.07–0.13; p = 0.014], dorsum of the hand (dcSSc 0.17, IQR 0.11–0.36, vs control 0.12, IQR 0.09–0.17; p = 0.031), the wrist (dcSSc 0.22, IQR 0.13–0.33, vs control 0.13, IQR 0.09–0.18; p = 0.005), and forearm (dcSSc 0.19, IQR 0.12–0.47, vs control 0.14, IQR 0.10–0.16; p = 0.022). There was a trend for autofluorescence to be increased in patients with lcSSc and at morphea sites, compared to noninvolved skin.Conclusion.Autofluorescence is increased in patients with dcSSc compared to primary RP and to healthy controls. This suggests increased oxidative stress and the potential for autofluorescence as a biomarker.
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ROUSTIT MATTHIEU, CRACOWSKI JEANLUC. Non-invasive Assessment of Skin Microvascular Function in Humans: An Insight Into Methods. Microcirculation 2011; 19:47-64. [DOI: 10.1111/j.1549-8719.2011.00129.x] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hofstee HMA, Voskuyl AE, Vonk Noordegraaf A, Smulders YM, Postmus PE, Dijkmans BAC, Serné EH. Pulmonary arterial hypertension in systemic sclerosis is associated with profound impairment of microvascular endothelium-dependent vasodilatation. J Rheumatol 2011; 39:100-5. [PMID: 22174212 DOI: 10.3899/jrheum.110397] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Impaired microvascular function may contribute to organ complications in patients with systemic sclerosis (SSc). We investigated whether SSc patients with and without pulmonary arterial hypertension (PAH) show a graded impairment of microvascular function compared to healthy controls. METHODS Twenty-two patients with SSc and 22 controls were studied. All patients underwent right heart catheterization; 6 had no PAH (SSc-nonPAH) and 16 had PAH (SSc-PAH). Acetylcholine (ACh)-mediated endothelium-dependent vasodilatation and sodium nitroprusside (SNP)-mediated endothelium-independent vasodilatation were assessed by iontophoresis combined with laser Doppler flowmetry. RESULTS Compared to sex- and age-matched controls, ACh-mediated vasodilatation was reduced in SSc-PAH (340.4% vs 79.5%, respectively; p < 0.01), but not in SSc-nonPAH (340.4% vs 397.9%; p = 0.90). No significant differences were present between the groups in SNP-mediated vasodilatation. CONCLUSION Systemic microvascular endothelium-dependent vasodilatation is markedly reduced in SSc complicated by PAH.
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Affiliation(s)
- Herman M A Hofstee
- Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Takahashi T, Asano Y, Amiya E, Hatano M, Tamaki Z, Ozeki A, Watanabe A, Kawarasaki S, Nakao T, Taniguchi T, Ichimura Y, Toyama T, Watanabe M, Hirata Y, Nagai R, Sato S. Improvement of endothelial function in parallel with the amelioration of dry cough and dyspnea due to interstitial pneumonia by intravenous cyclophosphamide pulse therapy in patients with systemic sclerosis: a preliminary report of two cases. Mod Rheumatol 2011; 22:598-601. [PMID: 22015621 DOI: 10.1007/s10165-011-0545-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022]
Abstract
Intravenous cyclophosphamide pulse therapy (IVCY) exerts its efficacy against interstitial lung disease (ILD) associated with systemic sclerosis (SSc) by restoring vascular injuries as well as aberrant immune activation. We recently experienced two patients with SSc-ILD in whom the values of brachial flow-mediated dilation (FMD) reflected the efficacy of IVCY. We herein report the details of these cases and discuss the potential of FMD to predict and evaluate the effect of IVCY on SSc-ILD.
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Affiliation(s)
- Takehiro Takahashi
- Department of Dermatology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Figueiras E, Roustit M, Semedo S, Ferreira LR, Crascowski J, Humeau A. Sample entropy of laser Doppler flowmetry signals increases in patients with systemic sclerosis. Microvasc Res 2011; 82:152-5. [DOI: 10.1016/j.mvr.2011.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/10/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
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SHAH PREETI, MURRAY ANDREAK, MOORE TONIAL, HERRICK ARIANEL. Effects of Iloprost on Microvascular Structure Assessed by Nailfold Videocapillaroscopy: A Pilot Study: Table 1. J Rheumatol 2011; 38:2079-80. [DOI: 10.3899/jrheum.110067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Blaise S, Roustit M, Millet C, Ribuot C, Boutonnat J, Cracowski JL. Cathodal iontophoresis of treprostinil and iloprost induces a sustained increase in cutaneous flux in rats. Br J Pharmacol 2011; 162:557-65. [PMID: 20860718 DOI: 10.1111/j.1476-5381.2010.01045.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE The treatment of scleroderma-related digital ulcers is still a therapeutic challenge. The most effective drugs are prostacyclin analogues. However, their usage is limited to an intravenous route of administration and by their frequent side effects. The objective of this study was to test whether treprostinil, iloprost and epoprostenol can induce sustained vasodilatation in rats when delivered locally using cutaneous iontophoresis. EXPERIMENTAL APPROACH Treprostinil, iloprost and epoprostenol were delivered by cathodal and anodal iontophoresis onto the hindquarters of anaesthesized rats (n= 8 for each group). Skin blood flow was quantified using laser Doppler imaging and cutaneous tolerance was assessed from day 0 to day 3. KEY RESULTS Cathodal but not anodal iontophoresis of treprostinil (6.4 mM), iloprost (0.2 mM) and epoprostenol (1.4 mM) induced a significant and sustained increase in cutaneous blood flow. The effects of treprostinil and iloprost were significantly different from those of treprostinil vehicle. Only weak effects were observed when both drugs were applied locally without current. Skin resistance was unchanged in areas treated with prostacyclin analogues. Finally, skin tolerance was good, with no evidence of epidermal damage. CONCLUSIONS AND IMPLICATIONS Cathodal iontophoresis of treprostinil and iloprost increases cutaneous blood flow with a good local tolerance. The effects of cathodal iontophoresis of these drugs should be investigated in humans, as they could have potential as new local therapies for digital ulcers in patients with scleroderma.
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Affiliation(s)
- S Blaise
- Inserm ERI17, Grenoble Medical School, University Grenoble 1, Grenoble, France
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Zhang W, Xu JR, Lu Q, Ye S, Liu XS. High-resolution magnetic resonance angiography of digital arteries in SSc patients on 3 Tesla: preliminary study. Rheumatology (Oxford) 2011; 50:1712-9. [DOI: 10.1093/rheumatology/keq453] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cusmà Piccione M, Bagnato G, Zito C, Di Bella G, Caliri A, Catalano M, Longordo C, Oreto G, Bagnato G, Carerj S. Early Identification of Vascular Damage in Patients With Systemic Sclerosis. Angiology 2011; 62:338-43. [DOI: 10.1177/0003319710387918] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Vascular involvement in systemic sclerosis (SSc) plays a key role in the pathogenesis of fibrosis. We assessed arterial stiffness using a new echo-tracking technique in patients with SSc asymptomatic for cardiovascular diseases. We enrolled 22 patients (21 female, 63 ± 14 years) and 20 controls (12 female, 62 ± 3 years). Carotid intima-media thickness (IMT) was comparable between the 2 groups (1.1 ± 0.3 vs 1.0 ± 0.4 mm, P = ns), whereas the stiffness parameters were significantly increased in patients (β: 9.5 ± 4.2 vs 5.8 ± 1.1, P = .001; pulse wave velocity [PWV]: 6.5 ± 1.5 vs 5.2 ± 0.6 m/sec, P = .003). A correlation between stiffness parameters, anti-Scl-70 antibodies (β: r = .46, P = .03; PWV: r = .50, P = .02), and anticentromere antibodies (β: r = -.54, P = .020; PWV: r = -.53, P = .023) was found. Echo-tracking technique may be valuable in early identification of vascular involvement in patients with SSc.
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Affiliation(s)
| | - Gianluca Bagnato
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Concetta Zito
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Gianluca Di Bella
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Annalisa Caliri
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Mariarita Catalano
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Caterina Longordo
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Giuseppe Oreto
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Gianfilippo Bagnato
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Scipione Carerj
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
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Rosato E, Molinaro I, Rossi C, Pisarri S, Salsano F. The combination of laser Doppler perfusion imaging and photoplethysmography is useful in the characterization of scleroderma and primary Raynaud's phenomenon. Scand J Rheumatol 2011; 40:292-8. [DOI: 10.3109/03009742.2010.530293] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sheehan JJ, Fan Z, Davarpanah AH, Hodnett PA, Varga J, Carr JC, Li D. Nonenhanced MR angiography of the hand with flow-sensitive dephasing-prepared balanced SSFP sequence: initial experience with systemic sclerosis. Radiology 2011; 259:248-56. [PMID: 21330560 DOI: 10.1148/radiol.10100851] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the image quality and degree of vessel narrowing at flow-sensitive dephasing (FSD) magnetic resonance (MR) angiography of the hands with those at contrast material-enhanced MR angiography of the hands in patients with systemic sclerosis. MATERIALS AND METHODS In a single-center study with institutional review board approval and HIPAA compliance, six healthy volunteers and six patients with systemic sclerosis were imaged at 1.5-T nonenhanced FSD MR angiography followed by contrast-enhanced MR angiography. Sixteen vascular segments in four vessel groups were evaluated for image quality and assessed semiquantitatively for stenosis degree by using Likert scales. The nonparametric Wilcoxon signed rank test was used to perform pairwise comparisons of the MR angiographic techniques. P < .05 indicated statistical significance. RESULTS Performing FSD MR angiography, as compared with time-resolved MR angiography and high-spatial-resolution MR angiography, improved the image quality for all arterial segments combined in the control (mean score, 2.9 [FSD] vs 3.7 [time-resolved technique] and 3.1 [high-spatial-resolution technique]) and patient (mean score, 4.0 [FSD] vs 4.2 [time-resolved technique] and 4.3 [high-spatial-resolution technique]) groups. In the control subjects, FSD angiography depicted proper digital artery stenosis that was less severe (mean grade, 0.7) than that seen with the time-resolved (mean grade, 1.6) and high-spatial-resolution (mean grade, 1.0) techniques. In the patient group, FSD angiography depicted lower degrees of stenosis, with a lower mean grade for all segments combined (1.3) compared with the corresponding mean grades for time-resolved (1.5) and high-spatial-resolution (1.8) MR angiography. CONCLUSION Preliminary data indicate that the proposed nonenhanced FSD MR angiographic technique is an improvement over existing contrast-enhanced techniques for evaluation of the hand vasculature in vasospastic disorders of the hand. Further technical improvements and a systematic clinical study are warranted.
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Affiliation(s)
- John J Sheehan
- Division of Cardiovascular Imaging, Northwestern Memorial Hospital, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, USA.
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Pathogenesis of systemic sclerosis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The Different Photoplethysmographic Patterns Can Help to Distinguish Patients With Primary and Sclerodermic Raynaud Phenomenon. Am J Med Sci 2010; 340:457-61. [DOI: 10.1097/maj.0b013e3181eecfad] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herrick AL, Cutolo M. Clinical implications from capillaroscopic analysis in patients with Raynaud's phenomenon and systemic sclerosis. ACTA ACUST UNITED AC 2010; 62:2595-604. [PMID: 20506306 DOI: 10.1002/art.27543] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ariane L Herrick
- University of Manchester, Manchester Academic Health Science Centre, Salford Royal National Health Service Foundation Trust, Salford, UK
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ROSATO EDOARDO, MOLINARO ILENIA, BORGHESE FEDERICA, ROSSI CARMELINA, PISARRI SIMONETTA, SALSANO FELICE. Bosentan Improves Skin Perfusion of Hands in Patients with Systemic Sclerosis with Pulmonary Arterial Hypertension. J Rheumatol 2010; 37:2531-9. [PMID: 20810512 DOI: 10.3899/jrheum.100358] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Our aim was to investigate effects of bosentan on hand perfusion in patients with systemic sclerosis (SSc) with pulmonary arterial hypertension (PAH), using laser Doppler perfusion imaging (LDPI).Methods.We enrolled 30 SSc patients with PAH, 30 SSc patients without PAH, and 30 healthy controls. In SSc patients and healthy controls at baseline, skin blood flow of the dorsum of the hands was determined with a Lisca laser Doppler perfusion imager. The dorsal surface of the hands was divided into 3 regions of interest (ROI). ROI 1 included 3 fingers of the hand from the second to the fourth distally to the proximal interphalangeal finger joint. ROI 2 included the area between the proximal interphalangeal and the metacarpophalangeal joint. ROI 3 included only the dorsal surface of the hand without the fingers. LDPI was repeated in SSc patients and controls after 4, 8, and 16 weeks of treatment. In SSc patients, nailfold videocapillaroscopy and Raynaud Condition Score (RCS) were performed at baseline and at 4, 8, and 16 weeks.Results.SSc patients with PAH enrolled in the study received treatment with bosentan as standard care for PAH. In these patients with PAH, after 8 and 16 weeks of treatment, bosentan improved minimum, mean, and maximum perfusion and the perfusion proximal-distal gradient. Bosentan seems to be most effective in patients with the early and active capillaroscopic pattern than in patients with the late pattern. Bosentan improved skin blood flow principally in the ROI 1 compared to the ROI 2 and ROI 3. Bosentan restored the perfusion proximal-distal gradient in 57% of SSc patients with the early capillaroscopic pattern. No significant differences from baseline were observed in the RCS in SSc patients with PAH.Conclusion.Bosentan improved skin perfusion in SSc patients with PAH, although it did not ameliorate symptoms of Raynaud’s phenomenon. Skin blood perfusion increased in SSc patients with PAH, particularly in the skin region distal to the proximal interphalangeal joint, and in patients with the early/active capillaroscopic pattern. Double-blind randomized clinical trials are needed to evaluate the effects of bosentan on skin perfusion of SSc patients without PAH and with active digital ulcers.
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Herrick AL, Moore TL, Murray AK, Whidby N, Manning JB, Bhushan M, Vail A. Nail-fold capillary abnormalities are associated with anti-centromere antibody and severity of digital ischaemia. Rheumatology (Oxford) 2010; 49:1776-82. [PMID: 20538680 DOI: 10.1093/rheumatology/keq139] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Advances in nail-fold capillaroscopy allow capillary abnormalities to be quantified. Our aim was to investigate, in patients with SSc, the relationships between the degree of nail-fold capillary abnormality and disease subtypes (lcSSc and dcSSc), duration of RP and the presence of (i) severe digital ischaemia (as defined by previous i.v. vasodilators, debridements or amputations), (ii) a positive ACA, (iii) clinically evident calcinosis, (iv) pulmonary arterial hypertension and (v) telangiectases. METHODS This was a retrospective study of 176 patients. Six capillary measurements (four semi-automated and two manual) were calculated (automated width, distance between capillaries, tortuosity and derangement, and manual distance and density). Relationships between these measurements and the different clinical features of SSc were examined using multiple linear regressions (adjusted for age, sex and smoking status). RESULTS One hundred and forty-two patients had lcSSc and 34 had dcSSc. Sixty-eight (39%) had a history of severe digital ischaemia, 66 (38%) were anti-centromere positive, 53 (30%) had clinically evident calcinosis and 26 (15%) had an estimated pulmonary artery pressure of >30 mmHg. Positive associations were found between both automated and manually measured distance between capillaries and (i) presence of severe digital ischaemia and (ii) positive ACA, and reduced density was also associated with positive anti-centromere. Patients with moderate/severe telangiectases had wider capillaries compared with those with 'mild' lesions. CONCLUSIONS Both severe digital ischaemia and positive ACA are associated with measurable nail-fold capillaroscopic change, which has the potential of being an outcome measure for the structural microvascular disease associated with SSc-spectrum disorders.
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Affiliation(s)
- Ariane L Herrick
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK.
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Rollando D, Bezante GP, Sulli A, Balbi M, Panico N, Pizzorni C, Negrini S, Brunelli C, Barsotti A, Cutolo M, Indiveri F, Ghio M. Brachial artery endothelial-dependent flow-mediated dilation identifies early-stage endothelial dysfunction in systemic sclerosis and correlates with nailfold microvascular impairment. J Rheumatol 2010; 37:1168-73. [PMID: 20436078 DOI: 10.3899/jrheum.091116] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess possible correlations between endothelial-dependent flow-mediated dilation (FMD) of the brachial artery and nailfold videocapillaroscopy (NVC) in patients with systemic sclerosis (SSc). Evidence has shown that vascular impairment in SSc may be a sign of endothelial dysfunction involving both microvascular and macrovascular systems, although the pathological mechanisms of the dysfunction are poorly understood. METHODS Forty-three consecutive patients (mean age 51 +/- 11 yrs) with SSc were studied. Thirty patients had limited cutaneous SSc, 13 had diffuse cutaneous SSc. Twenty-seven healthy subjects (mean age 48 +/- 8 yrs) were recruited as controls. Ultrasound assessment of FMD was performed on all subjects in order to evaluate macrovascular function. Patients were divided into 3 patterns of microvascular damage on the basis of NVC (early, active, and late), and the microangiopathy evolution score was calculated, as reported elsewhere. RESULTS FMD was significantly reduced in patients with SSc compared to healthy subjects [median 8.0% (3.0%-9.0%) vs 15.0% (12.0%-16.0%), respectively; p < 0.0001]. Patients with an early pattern of microangiopathy showed reduced FMD values compared to controls (p = 0.0001). FMD was significantly reduced in patients with SSc who had the late NVC pattern of microangiopathy compared to active and early patterns (p = 0.003 and p = 0.001, respectively). FMD was inversely correlated with the microvascular damage rate in patients with SSc (p < 0.0001). CONCLUSION We demonstrated the simultaneous presence of macrovascular and microvascular impairment in patients with SSc, which was already present in the early phase of the vascular disease.
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Affiliation(s)
- Daniela Rollando
- Academic Unit of Cardiovascular Diseases, Department of Internal Medicine, University of Genoa, Genoa, Italy
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