title: The digital thermal hyperemia pattern is associated with the onset of digital ulcerations in systemic sclerosis during 3 years of follow-up.
abstract: OBJECTIVE
  One of the most important skin complications in systemic sclerosis (SSc) is digital ulceration. Local thermal hyperemia (LTH) in the skin is a biphasic response to local heating involving both neurovascular and endothelial responses. Since LTH is abnormal in SSc patients, we aimed at testing whether LTH could be a prognostic tool for the onset of digital ulcers.
  
  
  METHODS
  We prospectively enrolled 51 patients with SSc. Nailfold capillaroscopy and LTH were recorded at baseline, and patients were followed for 3 years.
  
  
  RESULTS
  No patient with a LTH peak/plateau ratio ≥1 (n=19) developed digital ulcerations during the 3 year follow-up (100% negative predictive value), while 6 out of 32 patients with a LTH peak/plateau ratio <1 at enrolment presented with finger pad ulcerations within 3 years (p=0.05). In contrast, when lidocaine/prilocaine was applied to the finger pad, no relationship between thermal hyperemia and digital ulcerations was observed.
  
  
  CONCLUSIONS
  A LTH peak/plateau ratio on the finger pad greater than 1, which can easily be determined in routine clinical practice, could be used to reassure patients, whatever the subtype of SSc, about the low probability of future digital ulceration. However, the prognostic value of this parameter should be confirmed in a larger cohort.
authors: Vascular Medicine Department, Grenoble University Hospital, F-38000 Grenoble, France; Inserm ERI17, Grenoble Medical School, F-38000 Grenoble, France. Electronic address: SBlaise@chu-grenoble.fr.
authors: S
authors: S
authors: Blaise
authors: Inserm ERI17, Grenoble Medical School, F-38000 Grenoble, France; Inserm CIC3, Grenoble Clinical Research Center, Grenoble University Hospital, F-38000 Grenoble, France.
authors: M
authors: M
authors: Roustit
authors: Vascular Medicine Department, Grenoble University Hospital, F-38000 Grenoble, France.
authors: P
authors: P
authors: Carpentier
authors: Vascular Medicine Department, Grenoble University Hospital, F-38000 Grenoble, France.
authors: C
authors: C
authors: Seinturier
authors: Vascular Medicine Department, Grenoble University Hospital, F-38000 Grenoble, France.
authors: B
authors: B
authors: Imbert
authors: Inserm ERI17, Grenoble Medical School, F-38000 Grenoble, France; Inserm CIC3, Grenoble Clinical Research Center, Grenoble University Hospital, F-38000 Grenoble, France.
authors: J L
authors: JL
authors: Cracowski
mesh_terms: D000328:Adult; D005260:Female; D005385:Fingers / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000209:etiology*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology; D020678:Microscopic Angioscopy; D008875:Middle Aged; D011446:Prospective Studies; D011928:Raynaud Disease / Q000150:complications; D012595:Scleroderma, Systemic / Q000473:pathology*; D012867:Skin / Q000098:blood supply; D012883:Skin Ulcer / Q000175:diagnosis / Q000473:pathology*; D013696:Temperature; D013997:Time Factors; D014664:Vasodilation / Q000502:physiology
keywords: Capillaroscopy; Digital ulcer; Fluxmetry; Laser Doppler; Microcirculation; Microvascular blood flow; Prognosis value; Raynaud; Systemic sclerosis; Thermal hyperemia