Cold stimulus fingertip lacticemy test--an effective method to monitor acute therapeutic intervention on primary Raynaud's phenomenon and systemic sclerosis.
OBJECTIVE
The recently developed cold stimulus fingertip lacticemy test (CS-FTL) provides biochemical assessment of peripheral perfusion in patients with Raynaud's phenomenon (RP). We evaluated how the CS-FTL test can assess the acute effect of nifedipine in microvascular dynamics on primary RP and RP secondary to SSc.


METHODS
A double-blinded controlled trial with crossover design was performed in 20 primary RP and 20 SSc patients. Patients received one single sublingual placebo or 10 mg nifedipine capsule, with crossover after a 15-day washout period. FTL was determined in resting conditions (pre-CS-FTL) and 10 min after CS (post-CS-FTL), before and 1 h after drug administration. Percent variation in post- vs pre-CS-FTL was expressed as deltaCS-FTL.


RESULTS
Before intervention, CS induced FTL decrease in primary RP (deltaCS-FTL = -21.3 +/- 13.0%) and FTL increase in SSc patients (deltaCS-FTL = +24.5 +/- 21.2%). Placebo had no effect on pre-CS-FTL, post-CS-FTL and deltaCS-FTL in primary RP and SSc. Nifedipine induced a significant decrease in pre-CS-FTL (1.94 +/- 0.45 vs 1.57 +/- 0.41 mg/dl; P = 0.005) and post-CS-FTL (1.53 +/- 0.35 vs 1.32 +/- 0.37 mg/dl; P = 0.004) in primary RP and a significant decrease in post-CS-FTL (3.18 +/- 1.43 vs 2.56 +/- 1.30 mg/dl; P = 0.028) and deltaCS-FTL (+15.9 +/- 24.7% vs -12.9 +/- 16.6%; P = 0.001) in SSc.


CONCLUSIONS
The CS-FTL test was able to demonstrate and quantify a dual effect of nifedipine on the biochemical dimension of peripheral perfusion in primary RP and in SSc patients in which there was a significant improvement in tissue perfusion in resting conditions and after exposure to a CS. The CS-FTL test will enrich the armamentarium for investigation and clinical evaluation of conditions associated with RP.
Fontenelle
S M A
SM
Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP 04023-062, Brazil.
Kayser
C
C
Pucinelli
M L C
ML
Andrade
L E C
LE
D000286:Administration, Sublingual; D000328:Adult; D003080:Cold Temperature; D018592:Cross-Over Studies; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D011928:Raynaud Disease / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D045743:Scleroderma, Diffuse / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012594:Scleroderma, Localized / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012595:Scleroderma, Systemic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D019344:Lactic Acid; D009543:Nifedipine