title: Digital ulcers in systemic sclerosis: role of flow-mediated dilatation and capillaroscopy as risk assessment tools.
abstract: OBJECTIVE
  The aim of this study was to evaluate macrovascular endothelial dysfunction and microvascular damage as clinical markers of peripheral microangiopathy in patients with Raynaud's phenomenon (RP).
  
  
  METHODS
  Seventy-seven secondary RP with systemic sclerosis, 32 primary RP and 34 healthy controls were included in our study. Secondary RP patients were divided into two subgroups: 39 with digital ulcers (DU) and 38 without digital ulcers (non-DU).
  
  
  RESULTS
  Patients with DU had significantly lower flow-mediated dilatation values (5.34 ± 7.49%) compared to non-DU patients (16.21 ± 11.31%), primary RP (17.96 ± 12.78%) and controls (20.17 ± 8.86%), p<0.001, favouring macrovascular endothelium dysfunction. Regarding microvascular damage, the DU group had a predominately capillaroscopic late pattern (71.1%) whereas non-DU patients had an active pattern (56.4%). The microangiopathy evolution score was significantly higher in the DU group compared to the non-DU group (4.79 ± 1.82 vs. 1.79 ± 1.56, p<0.001). Flow-mediated dilation was significantly lower in late pattern (6.13 ± 7.09%) compared to active (12.58 ± 10.66%) and early patterns (17.72 ± 14.90%), p = 0.016 and p = 0.044 respectively.
  
  
  CONCLUSIONS
  Low flow-mediated dilatation and microvascular damage in capillaroscopy are early clinical markers of DU risk in RP patients.
authors.affiliation: Angiology, Vascular Surgery Service, Clinical Immunology Unit.
authors.forename: Ivone
authors.initials: I
authors.lastname: Silva
authors.affiliation: Angiology and Vascular Surgery Service.
authors.forename: Tiago
authors.initials: T
authors.lastname: Loureiro
authors.affiliation: Health Information and Decision Sciences Department, Universidade do Porto.
authors.forename: Andreia
authors.initials: A
authors.lastname: Teixeira
authors.affiliation: Clinical Immunology Unit, Centro Hospitalar do Porto, Praça da Revista o Tripeiro, n° 42, hab 23, 4415-789 Porto, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Almeida
authors.affiliation: Unit of Angiology and Vascular Surgery; Faculty of Medicine of University of Porto.
authors.forename: Armando
authors.initials: A
authors.lastname: Mansilha
authors.affiliation: Clinical Immunology Unit, Centro Hospitalar do Porto, Praça da Revista o Tripeiro, n° 42, hab 23, 4415-789 Porto, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vasconcelos
authors.affiliation: Angiology and Vascular Surgery Service.
authors.forename: Rui
authors.initials: R
authors.lastname: Almeida
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005385:Fingers; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D011928:Raynaud Disease / Q000175:diagnosis / Q000453:epidemiology*; D012016:Reference Values; D018570:Risk Assessment; D012380:Role; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply*; D012883:Skin Ulcer / Q000188:drug therapy / Q000503:physiopathology*; D018084:Ultrasonography, Interventional; D014664:Vasodilation / Q000502:physiology
keywords: Raynaud's phenomenon; capillaroscopy; digital ulcer; endothelial dysfunction; flow-mediated dilatation; systemic sclerosis