title: Small, medium but not large arteries are involved in digital ulcers associated with systemic sclerosis.
abstract: OBJECTIVE
  Digital ulcers (DU) are a burden in systemic sclerosis (SSc). Microangiopathy is a cardinal feature of SSc that plays a critical role in the development of DU. However, whether injury of medium or large vessels also contributes to DU in SSc remains controversial.
  
  
  METHODS
  To measure concomitantly in SSc patients with and without active DU: (i) the Augmentation Index of the reflected wave (Aix_75) by radial applanation tonometry, an index of small and medium arterial function; (II) the aortic pulse wave velocity (PWV), a marker of large vessel injury (aortic stiffness).
  
  
  RESULTS
  Sixty-three consecutive SSc patients were included (49 females, aged 60 [49-65] years, disease duration of 8.5 [5-13] years), including 10 (15.9%) with active DU. Patients with active DU versus those without had increased Aix_75 (35% [28-38] versus 28% [20-34], P=0.041) whereas no difference existed in PWV (7.0m/s [6.7-10.1] versus 7.6m/s [6.8-8.7], P=0.887), in systolic, diastolic, as well as aortic pulse pressure (P=0.126, 0.592, and 0.161, respectively). When compared to patients in the low tertile, patients having Aix_75 in the highest tertile had 10-fold more DU (OR=10.23; 95% CI 1.12 to 93.34, P=0.039).
  
  
  CONCLUSIONS
  The presence of DU is associated with increased Aix_75 whereas there is no relation with PWV. These data suggest that small and medium arteries are involved in the occurrence of DU whether large vessel stiffness does not contribute. Whether Aix_75 is predictive of further DU remained to be studied.
authors.affiliation: Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, AP-HP, 93000 Bobigny, France; Paris XIII University, 93017 Bobigny cedex, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Aïssou
authors.affiliation: Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, AP-HP, 93000 Bobigny, France; Paris XIII University, 93017 Bobigny cedex, France; UMR S 942, 75475 Paris cedex 10, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.affiliation: Inserm U1016, Paris Descartes University, 75014 Paris, France; Rheumatology A department, Cochin Hospital, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
authors.affiliation: Inserm U1016, Paris Descartes University, 75014 Paris, France; Rheumatology A department, Cochin Hospital, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Meunier
authors.affiliation: Inserm U1016, Paris Descartes University, 75014 Paris, France; Rheumatology A department, Cochin Hospital, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Elhaï
authors.affiliation: Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, AP-HP, 93000 Bobigny, France; Paris XIII University, 93017 Bobigny cedex, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.affiliation: Inserm U1016, Paris Descartes University, 75014 Paris, France; Rheumatology A department, Cochin Hospital, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Kahan
authors.affiliation: Inserm U1016, Paris Descartes University, 75014 Paris, France; Rheumatology A department, Cochin Hospital, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. Electronic address: yannick.allanore@cch.aphp.fr.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
mesh_terms: D017677:Age Distribution; D000368:Aged; D001158:Arteries / Q000033:anatomy & histology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005384:Finger Joint / Q000098:blood supply; D005602:France; D006801:Humans; D015994:Incidence; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D063177:Pulse Wave Analysis; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D012720:Severity of Illness Index; D017678:Sex Distribution; D012883:Skin Ulcer / Q000175:diagnosis / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D014033:Toe Joint / Q000098:blood supply; D059289:Vascular Stiffness / Q000502:physiology*
keywords: Applanation tonometry; Arterial stiffness; Augmentation index; Digital ulcers; Medium arteries; Pulse wave velocity; Systemic sclerosis