Digital ulcers in systemic sclerosis: role of flow-mediated dilatation and capillaroscopy as risk assessment tools

作者：Silva Ivone^*; Loureiro Tiago; Teixeira Andreia; Almeida Isabel; Mansilha Armando; Vasconcelos Carlos; Almeida Rui

来源：European Journal of Dermatology, 2015, 25(5): 444-451.

DOI：10.1684/ejd.2015.2605

• Raynaud's phenomenon
• systemic sclerosis
• digital ulcer
• endothelial dysfunction
• flow-mediated dilatation
• capillaroscopy

Aim: The aim of this study was to evaluate macrovascular endothelial dysfunction and microvascular damage as clinical markers of peripheral microangiopathy in patients with Raynaud's phenomenon (RP). Patients and methods: Seventy-seven secondary RP with systemic sclerosis, 32 primary RP and 34 healthy controls were included in our study. Secondary RP patients were divided into two subgroups: 39 with digital ulcers (DU) and 38 without digital ulcers (non-DU). Results: Patients with DU had significantly lower flow-mediated dilatation values (5.34 +/- 7.49%) compared to non-DU patients (16.21 +/- 11.31%), primary RP (17.96 +/- 12.78%) and controls (20.17 +/- 8.86%), p<0.001, favouring macrovascular endothelium dysfunction. Regarding microvascular damage, the DU group had a predominately capillaroscopic late pattern (71.1%) whereas non-DU patients had an active pattern (56.4%). The microangiopathy evolution score was significantly higher in the DU group compared to the non-DU group (4.79 +/- 1.82 vs. 1.79 +/- 1.56, p<0.001). Flow-mediated dilation was significantly lower in late pattern (6.13 +/- 7.09%) compared to active (12.58 +/- 10.66%) and early patterns (17.72 +/- 14.90%), p = 0.016 and p = 0.044 respectively. Conclusions: Low flow-mediated dilatation and microvascular damage in capillaroscopy are early clinical markers of DU risk in RP patients.

• 出版日期2015-10