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Clinical aspects

 

Pilot study assessing pathophysiology and healing of digital ulcers in patients with systemic sclerosis using laser Doppler imaging and thermography

1, 2, 3, 4, 5, 6, 7, 8, 9

 

  1. Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK; and Photon Science Institute, University of Manchester, UK. andrea.murray@manchester.ac.uk
  2. Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
  3. Rheumatology Directorate, Salford Royal NHS Foundation Trust, Salford, UK.
  4. Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
  5. School of Community Based Medicine, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
  6. Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
  7. Department of Hand Surgery, Salford Royal NHS Foundation Trust, Salford, UK.
  8. Dermatology Centre, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
  9. Inst.of Inflammation and Repair, University of Manchester, Salford Royal NHS Foundation Trust, Salford; and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, UK.

CER9397
2016 Vol.34, N°5 ,Suppl.100
PI 0100, PF 0105
Clinical aspects

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PMID: 27749241 [PubMed]

Received: 04/03/2016
Accepted : 04/07/2016
In Press: 14/10/2016
Published: 14/10/2016

Abstract

OBJECTIVES:
Systemic sclerosis (SSc)-related digital ulcers (DU) cause significant pain and disability and are often a primary endpoint in clinical trials. However, their pathophysiology has been little studied. The objectives of this prospective study were to determine whether laser Doppler imaging (LDI) and thermography can identify ischaemic components in both fingertip and extensor surface DU and assess ulcer healing.
METHODS:
Patients prospectively reported new DU over a year. Patients’ DU underwent imaging until the ulcer had healed. Ischaemia was defined as lower blood flow or skin temperature (and inflammation as higher) within the ulcer, compared to a non-affected site.
RESULTS:
53 ulcers (19 fingertip, 18 extensor, 16 ‘other’ sites) in 17 patients were imaged (53 with LDI, 52 with thermography). For LDI data 32 (60%) ulcers were ischaemic; median perfusion ulcer/unaffected area; 0.79 (range 0.11-2.9). For thermography data 35 (66%) were ischaemic; 0.98 (0.89 to 1.1). Inflammation in the surrounding area was identified for all ulcers by LDI but not thermography. In the 36 ulcers with repeat imaging, LDI showed trends (with healing) towards increased ulcer perfusion (p=0.23) and decreased hyperaemia in adjacent areas (p=0.59). Skin temperature at the ulcer site showed no significant change (p=0.13) but adjacent area showed decreased temperature (p=0.04 signifying decreased blood flow).
CONCLUSIONS:
LDI and thermography are sufficiently sensitive to measure ischaemia in both fingertip and extensor ulcers. LDI was better suited to monitoring change in perfusion with healing (due to higher imaging resolution, or vascular changes occurring in more superficial skin layers).

Rheumatology Article