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Ruaro B, Smith V, Sulli A, Pizzorni C, Tardito S, Patané M, Paolino S, Cutolo M. Innovations in the Assessment of Primary and Secondary Raynaud's Phenomenon. Front Pharmacol 2019; 10:360. [PMID: 31073287 PMCID: PMC6495407 DOI: 10.3389/fphar.2019.00360] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: Raynaud's phenomenon (RP) is characterized by intense vasospasm of the digital arteries that causes characteristic color changes in fingers. There are two main types of RP: Primary RP (PRP) and Secondary RP (SRP). PRP is a benign condition. Whilst SRP is associated with several connective tissue diseases (CTD), in particular systemic sclerosis (SSc). The objectives of this report were: to present a short review on morphological (nailfold videocapillaroscopy, NVC) and functional techniques (laser tools and thermography) that allow for a correct diagnosis and treatment of RP and to investigate blood perfusion (BP) by laser speckle contrast analysis (LASCA) in different skin areas of hands and face in PRP, SRP to SSc, and healthy subjects (CNT). Methods: 31 PRP patients (LeRoy criteria), 70 SRP to SSc (ACR/EULAR criteria) and 68 CNT were enrolled. BP was assessed by LASCA at the level different areas of hands and face. NVC was performed to distinguish between PRP and SRP, and to detect the proper pattern of nailfold microangiopathy in SSc patients. Results: Both PRP and SRP showed a statistically significant lower BP than CNT at the level of fingertips (p < 0.0001), periungual (p < 0.0001), palmar aspect of 3rd finger (p < 0.0001), and palm areas (p < 0.0001). Moreover, BP was significantly lower in PRP than in SRP to SSc with the "Early" pattern of microangiopathy in the same areas as above (p < 0.04). Conclusion: By considering a small cohort of patients, BP of hands was found lower in PRP than in SSc patients with the "Early" NVC pattern of microangiopathy.
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Affiliation(s)
- Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Samuele Tardito
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Massimo Patané
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
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Ruaro B, Sulli A, Smith V, Pizzorni C, Paolino S, Alessandri E, Trombetta AC, Cutolo M. Advances in nailfold capillaroscopic analysis in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:122-131. [PMID: 35382238 PMCID: PMC8892861 DOI: 10.1177/2397198318757699] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/03/2018] [Indexed: 09/26/2023]
Abstract
Systemic sclerosis is an autoimmune connective tissue disease characterized by early and persistent microvascular impairment which leads to functional and organic manifestations, with progressive fibrosis of the skin and internal organs. Morphological and functional assessment of the peripheral microvasculature is a must, not only for diagnosis but also for the prognosis and therapeutical follow-up of systemic sclerosis patients, as reported in recent studies. Nailfold videocapillaroscopy is the validated technique for the study of scleroderma microangiopathy as it is able to detect peripheral microvascular morphology and both classify and score the capillary abnormalities into different microangiopathy patterns ('Early', 'Active' and 'Late'). Indeed, the possibility to early diagnose and follow the microvascular changes and the safety of the technique have made nailfold videocapillaroscopy a mandatory tool for patient evaluation and included its assessment in the new systemic sclerosis classification criteria. Important links between nailfold videocapillaroscopy patterns and systemic sclerosis clinical manifestations have been described.
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Affiliation(s)
- Barbara Ruaro
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Sulli
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent
University Hospital, Department of Internal Medicine, Ghent University, Ghent,
Belgium
| | - Carmen Pizzorni
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Alessandri
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Amelia Chiara Trombetta
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic
Division of Clinical Rheumatology, Department of Internal Medicine, University of
Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Matucci-Cerinic C, Nagaraja V, Prignano F, Kahaleh B, Bellando-Randone S. The role of the dermatologist in Raynaud's phenomenon: a clinical challenge. J Eur Acad Dermatol Venereol 2018; 32:1120-1127. [DOI: 10.1111/jdv.14914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. Matucci-Cerinic
- Dermatology Clinic - ASF; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - V. Nagaraja
- Department of Medicine; Division of Rheumatology; University of Michigan; Ann Arbor MI USA
| | - F. Prignano
- Dermatology Clinic - ASF; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - B. Kahaleh
- Department of Medicine; Division of Rheumatology; University of Toledo; Toledo USA
| | - S. Bellando-Randone
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- Department of Geriatric Medicine; Division of Rheumatology; AOUC; Florence Italy
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