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IMPAIRED SKIN MICROCIRCULATION DYNAMICS IN PATIENTS WITH RHEUMATOID ARTHRITIS: ASSOCIATION WITH ARTERIAL STIFFNESS AND CORONARY MICROVASCULAR PERFUSION
Rheumatoid arthritis (RA) is characterized by excess cardiovascular risk. Laser Speckle Contrast Imaging (LSCI) is a novel and highly reproducible technique for the real-time evaluation of skin microcirculation. However, relevant data using non-invasive laser techniques remain far too limited in RA, especially in patients free from cardiovascular risk factors with relatively suppressed inflammatory load. We assessed skin microvascular function in a well-characterized sample of RA patients free from hypertension and cardiovascular diseases with low levels of systemic inflammation, compared to non-RA individuals. Microvascular function was dynamically evaluated using LSCI coupled with a post-occlusive reactive hyperaemia protocol.
Microcirculation dynamics appear impaired even in RA patients with relatively low inflammatory load, regardless of cardiovascular risk factors. Importantly, we showed for the first time an association between impaired skin microvascular dynamics assessed with LSCI and microvascular myocardial perfusion using SEVR. Further studies need to evaluate the prognostic potential of LSCI in terms of cardiovascular risk in RA.
Disturbed microcirculation in the hands of patients with systemic sclerosis detected by fluorescence optical imaging: a pilot study
Background
Utilising fluorescence optical imaging (FOI), the distribution of an intravenously applied colouring agent indocyanine green (ICG) can be analysed with the potential to identify malperfusion by little to no tissue enhancement. Systemic sclerosis (SSc) is characterised by the presence of digital ulcers reflecting progressive vasculopathy.
The objective was to investigate the potential of FOI in the detection of disturbed microcirculation in the hands and fingers of patients with SSc and to link FOI findings to clinical signs of ischemia such as digital ulcers and pitting scars.
Methods
In this cross-sectional study, 63 patients with SSc and 26 healthy subjects were examined. FOI was performed in all 89 individuals and compared to clinical data and capillaroscopic findings assembled for the SSc cohort.
Results
Healthy subjects showed initial ICG signals in their fingertips in 93.6%, SSc patients in 78.5% (limited SSc) and 43.2% (diffuse SSc). Moreover, in SSc patients, FOI findings were significantly associated with a late capillaroscopic pattern, disseminated SSc features, a diffuse SSc subtype, and the presence of digital ulcers or pitting scars. Intra- and inter-reader reliability for FOI amounted to κ = 0.786 and κ = 0.834, respectively.
Conclusions
FOI is able to detect areas of reduced microcirculation in patients with SSc with high association to capillaroscopic findings. The results pave the way for future FOI investigations into its role in the prediction of complications due to an impaired acral perfusion.
Source: https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-017-1300-6
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