Functional and morphological evaluation of hand microcirculation with nailfold capillaroscopy and laser Doppler imaging in Raynaud's and Sjögren's syndrome and poly/dermatomyositis

Szabó, Nóra Anna; Csiki, Zoltán; Szántó, Antónia; Dankó, Katalin; Szodoray, Péter; Zeher, Margit

doi:10.1080/03009740701640209

Cited by 32 publications

(16 citation statements)

References 26 publications

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“…The authors suggested that laser Doppler flowmetry may identify patients with secondary RP when NC images appeared normal. Szabo et al (27) compared NC and LDI at the nondominant ring finger in healthy controls and in patients with Sjögren's syndrome, polymyositis/dermatomyositis, and primary RP. They found decreased perfusion as compared with controls in all of the patient groups and found morphologic changes in patients with Sjögren's syndrome and polymyositis/dermatomyositis.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders

Murray¹,

Moore²,

Manning³

et al. 2009

Arthritis & Rheumatism

109

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Objective. Systemic sclerosis (SSc) affects both microvascular structure and function. Laser Doppler imaging (LDI) and thermal imaging can be used to measure cutaneous blood vessel function. Nailfold capillaroscopy (NC) measures capillary morphology. The aim of this study was to investigate the relationship between capillary morphology and blood flow, and to determine which combination of techniques allows the best discrimination between patients with SSc, primary Raynaud's phenomenon (RP), and healthy controls. Methods. NC was performed in 16 patients with SSc, 14 patients with primary RP, and 16 healthy controls. In addition, participants underwent cold stimulus with cold water. Hands were imaged to monitor rewarming and reperfusion. Nailfold morphologic features were measured and baseline images and rewarming curves were analyzed. Results. Significant differences were found between groups (analysis of variance) for capillary morphologic features and rewarming curve characteristics. A correlation (P < 0.001) was found between LDI and thermal imaging at baseline (0.667) and maximum (0.729) blood flow and skin temperature, and for the areas under the rewarming curves (0.684). Receiver operating characteristic curves indicated that NC, thermal imaging, and LDI allowed 89%, 74%, and 72%, respectively, of SSc patient data to be correctly classified versus primary RP patients and controls. Conclusion. NC, LDI, and thermal imaging each independently provide good discrimination between patients with SSc and those with primary RP and healthy controls (NC being the most suitable technique for classifying patient groups). However, a combination of all 3 techniques improves classification. LDI and thermal imaging give equivalent information on dynamic changes in the cutaneous microcirculation; however, these only weakly correspond to capillary morphology. INTRODUCTIONSystemic sclerosis (SSc; scleroderma) is a multisystem connective tissue disease characterized by vascular abnormalities and fibrosis, including those of the skin. SSc is known to affect both microvascular structure and function (1,2). The exact pathogenesis of these microvascular changes is as yet unknown (2-4). The most characteristic clinical expression of this vascular dysfunction/damage is severe Raynaud's phenomenon (RP; episodic color changes of the fingers, usually in response to cold exposure or to emotional stress) (5), which is experienced by more than 90% of patients (6). SSc can be categorized into diffuse cutaneous SSc (dcSSc) or limited cutaneous SSc (lcSSc) on the basis of the extent of the skin involvement (7). In contrast to SSc, primary (idiopathic) RP does not progress to irreversible tissue injury, and therefore, comparisons between patients with SSc and primary RP are of interest (4).Microvascular changes in morphology and function are most easily monitored in the skin. In SSc, structural cutaneous vascular abnormalities have been demonstrated with both widefield and high-magnification optical microscopy of the nailfold (nailfold capilla...

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Section: Discussionmentioning

confidence: 99%

Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders

Murray¹,

Moore²,

Manning³

et al. 2009

Arthritis & Rheumatism

109

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“…Previous studies have shown that LDPI is able to detect changes in SSc microvasculature, particularly when combined with NVC and thermal infrared imaging 13,32,33 . In addition, LDPI has been employed in a small group of patients to evaluate skin blood flow in secondary RP, hand-arm vibration syndrome, and morphea plaques [15][16][17] . Our study shows for the first time, in a representative group of patients, that LDPI is a useful noninvasive diagnostic technique for evaluating skin blood flow in patients with PRP and SSc.…”

Section: Discussionmentioning

confidence: 99%

“…LDPI can be useful for the detection of secondary RP, distinguishing whether the reduced blood flow is due to systemic autoimmune diseases, assessing peripheral vascular impairment in hand-arm vibration syndrome, and evaluating microvascular perfusion of morphea plaques [15][16][17] .…”

mentioning

confidence: 99%

Laser Doppler Perfusion Imaging Is Useful in the Study of Raynaud’s Phenomenon and Improves the Capillaroscopic Diagnosis

Rosato¹,

Borghese²,

Pisarri³

et al. 2009

J Rheumatol

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“…Nailfold capillaroscopy was performed on the 2nd and 4th digit of both hands as a representation of capillary vasculature, with clinical restraints (including discomfort) limiting a fuller examination in this paediatric population [14,15]. The 4th finger of the non-dominant hand is thought to be the most representative of morphological features [16].…”

Section: Methodsmentioning

confidence: 99%

Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes: a pilot cross-sectional study

et al. 2013

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BackgroundThe detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes.MethodsPatients aged between 8 – 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher’s exact and t-tests determined the association with clinical findings.Results26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy.ConclusionsThis pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes.Trial registrationClinical Trial number NCT01279928, ClinicalTrials.gov

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Functional and morphological evaluation of hand microcirculation with nailfold capillaroscopy and laser Doppler imaging in Raynaud's and Sjögren's syndrome and poly/dermatomyositis

Cited by 32 publications

References 26 publications

Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders

Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders

Laser Doppler Perfusion Imaging Is Useful in the Study of Raynaud’s Phenomenon and Improves the Capillaroscopic Diagnosis

Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes: a pilot cross-sectional study

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