Abstract
Objective
Digital ulcers (DUs) represent one major burden for patients with systemic sclerosis (SSc). The objectives of our study were to evaluate blood flow in SSc-DUs with laser speckle contrast analysis (LASCA) and to correlate the skin perfusion to clinical and laboratory data.
Methods
Forty DUs in 31 consecutive patients with SSc according to 2013 ACR/EULAR criteria (20 with limited cutaneous disease, 3 males) were prospectively examined with LASCA. Clinical and laboratory data were collected at the same time. DUs were classified according to clinical features and presence of infection.
Results
At LASCA analysis, patients with diffuse SSc had lower mean values of blood flow compared with those with limited disease at the finger affected by DUs (88.80 vs 44.40, p = 0.036) and at the periulcer area (p = 0.041). The presence of infection was associated to a higher flow at the finger with DU (103.02 vs 58.05 p = 0.04), at the level of ulcer (217.63 vs 67.15, p < 0.001), and at the periulcer area (p = 0.001). The ratio between the blood flow at the ulcer area and the finger base (UA/FB) showed a bimodal trend in patients with infected DUs and in those without infections. Infection was positive correlated to the time of healing (HT) (r = 0.648, p = 0.023), while in DUs without infection a negative correlation to HT (r = − 0.46, p = 0.015) was identified.
Conclusions
This study demonstrates for the first time that the UA/FB ratio may predict the healing time of DUs in SSc patients and may be crucial for the prognostic stratification of patients. Infection remains one of the main predictors of DU healing.
Key Points • The prognostic value of laser speckle contrast analysis (LASCA) in patients with digital ulcers (DUs) in systemic sclerosis remains to be clarified. • LASCA may be able to predict the haling time of the digital ulcers. • The presence of infection of the wound bed may greatly influence the LASCA parameters and the healing time of the digital ulcer. |
Similar content being viewed by others
References
Klein-Weigel P, Opitz C, Riemekasten G (2011) Systemic sclerosis - a systematic overview: part 1 - disease characteristics and classification, pathophysiologic concepts, and recommendations for diagnosis and surveillance. Vasa 40:6–19
Walker UA, Tyndall A, Czirják L, Denton C, Farge-Bancel D, Kowal-Bielecka O et al (2007) Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis 66:754–763
Cutolo M, Sulli A, Smith V (2010) Assessing microvascular changes in systemic sclerosis diagnosis and management. Nat Rev Rheumatol 6:578–587
Chung L, Fiorentino D (2006) Digital ulcers in patients with systemic sclerosis. Autoimmun Rev 5:125–128
Hughes M, Moore T, Manning J, Dinsdale G, Herrick AL, Murray A (2017) A pilot study using high-frequency ultrasound to measure digital ulcers: a possible outcome measure in systemic sclerosis clinical trials? Clin Exp Rheumatol 35(Suppl 1):218–219
Galluccio F, Allanore Y, Czirjak LL, Furst DE, Khanna D, Matucci-Cerinic M (2017) Points to consider for skin ulcers in systemic sclerosis. Rheumatology (Oxford) 56:v67–v71
Wilkinson JD, Leggett SA, Marjanovic EJ, Moore TL, Allen J, Anderson ME, Britton J, Buch MH, del Galdo F, Denton CP, Dinsdale G, Griffiths B, Hall F, Howell K, MacDonald A, McHugh NJ, Manning JB, Pauling JD, Roberts C, Shipley JA, Herrick AL, Murray AK (2018) A multicenter study of the validity and reliability of responses to hand cold challenge as measured by laser speckle contrast imaging and thermography: outcome measures for systemic sclerosis-related Raynaud’s phenomenon. Arthritis Rheumatol 70:903–911
Cutolo M, Ferrone C, Pizzorni C, Soldano S, Seriolo B, Sulli A (2010) Peripheral blood perfusion correlates with microvascular abnormalities in systemic sclerosis: a laser-Doppler and nailfold videocapillaroscopy study. J Rheumatol 37:1174–1180
Della Rossa A, D’Ascanio A, Barsotti S, Stagnaro C, Mosca M (2016) Post-occlusive reactive hyperaemia (POHR) in systemic sclerosis: very early disease (VEDOSS) represents a separate entity compared to established disease. Scand J Rheumatol 45:408–411
Della Rossa A, Cazzato M, D’Ascanio A, Tavoni A, Bencivelli W, Pepe P et al (2013) Alteration of microcirculation is a hallmark of very early systemic sclerosis patients: a laser speckle contrast analysis. Clin Exp Rheumatol 31:109–114
Barbano B, Marra AM, Quarta S, Gigante A, Barilaro G, Gasperini ML, Rosato E (2017) In systemic sclerosis skin perfusion of hands is reduced and may predict the occurrence of new digital ulcers. Microvasc Res 110:1–4
Blaise S, Roustit M, Carpentier P, Seinturier C, Imbert B, Cracowski JL (2014) The digital thermal hyperemia pattern is associated with the onset of digital ulcerations in systemic sclerosis during 3 years of follow-up. Microvasc Res 94:119–122
Meijs J, Voskuyl AE, Bloemsaat-Minekus JPJJ, Vonk MC (2015) Blood flow in the hands of a predefined homogeneous systemic sclerosis population: the presence of digital ulcers and the improvement with bosentan. Rheumatol 54:262–269
Ruaro B, Sulli A, Smith V, Paolino S, Pizzorni C, Cutolo M (2015) Short-term follow-up of digital ulcers by laser speckle contrast analysis in systemic sclerosis patients. Microvasc Res 101:82–85
Murray AK, Moore TL, Wragg E, Ennis H, Vail A, Dinsdale G et al (2016) Pilot study assessing pathophysiology and healing of digital ulcers in patients with systemic sclerosis using laser Doppler imaging and thermography. Clin Exp Rheumatol 34(Suppl 1):100–105
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA Jr, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Csuka ME, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE (2013) 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 65:2737–2747
LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA et al (1988) Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 15:202–205
Amanzi L, Braschi F, Fiori G, Galluccio F, Miniati I, Guiducci S, Conforti ML, Kaloudi O, Nacci F, Sacu O, Candelieri A, Pignone A, Rasero L, Conforti D, Matucci-Cerinic M (2010) Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology 49:1374–1382
Barsotti S, Di Battista M, Venturini V, Della Rossa A, Mosca M (2019) Management of digital ulcers in systemic sclerosis. Chronic Wound Care Manag Res 6:9–18
Briers D, Duncan DD, Hirst E, Kirkpatrick SJ, Larsson M, Steenbergen W, Stromberg T, Thompson OB (2013) Laser speckle contrast imaging: theoretical and practical limitations. J Biomed Opt 18:066018
Giuggioli D, Manfredi A, Lumetti F, Colaci M, Ferri C (2018) Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature. Autoimmun Rev 17:155–164
Lambrecht V, Cutolo M, De Keyser F, Decuman S, Ruaro B, Sulli A et al (2016) Reliability of the quantitative assessment of peripheral blood perfusion by laser speckle contrast analysis in a systemic sclerosis cohort. Ann Rheum Dis 75:1263–1264
Cutolo M, Vanhaecke A, Ruaro B, Deschepper E, Ickinger C (2018) Is laser speckle contrast analysis (LASCA) the new kid on the block in systemic sclerosis? A systematic literature review and pilot study to evaluate reliability of LASCA to measure peripheral blood perfusion in scleroderma patient. Autoimmun Rev 17:775–780
Hughes M, Moore T, Manning J, Wilkinson J, Dinsdale G, Roberts C, Murray A, Herrick AL (2017) Reduced perfusion in systemic sclerosis digital ulcers (both fingertip and extensor) can be increased by topical application of glyceryl trinitrate. Microvasc Res 111:32–36
Maeda H (1996) Role of microbial proteases in pathogenesis. Microbiol Immunol 40:685–699
Acknowledgments
The authors would like to thank Ms. Luisa Marconcini for reviewing the manuscript and Fondazione ARPA Onlus (Pisa) for supporting the outpatient wound clinic of the Rheumatology Unit—Pisa University Hospital.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics and consent
The results of the procedures reported in this study are in accordance with the ethical standards and the study was conducted in accordance with the Declaration of Helsinki. The study was approved by the local ethic committee and each subject signed the informed consent for the participation in this study.
Disclosures
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Barsotti, S., d’Ascanio, A., Valentina, V. et al. Is there a role for laser speckle contrast analysis (LASCA) in predicting the outcome of digital ulcers in patients with systemic sclerosis?. Clin Rheumatol 39, 69–75 (2020). https://doi.org/10.1007/s10067-019-04662-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-019-04662-7