Although more common in women, SSc appears as strikingly more severe in men. Our results obtained through the largest worldwide database demonstrate a higher risk of severe cardiovascular involvement in men. These results raise the point of including sex in the management and the decision-making process.

In dcSSc infliximab did not show clear benefit at 26 weeks but was associated with clinical stabilisation and a fall in two laboratory markers of collagen synthesis. The frequency of suspected infusion reactions may warrant additional immunosuppression in any future studies in systemic sclerosis.

A new method for noninvasive measurement of cutaneous blood flow is laser-Doppler flowmetry. The technique is based on the fact that laser light is back-scattered from the moving red blood cells, with Doppler-shifted frequencies; these impulses lead to photodetectors and are converted to flow signals. In this work we used a new system with a low noise level. Comparison was made between this technique and the atraumatic epicutaneous 133Xenon technique for measurement of cutaneous blood flow during reactive hyperemia and orthostatic pressure changes. The laser-Doppler flowmeter seems to measure blood flow in capillaries as well as in arteriovenous anastomoses, while the 133Xe method probably measures only capillary flow. A calibration of the laser-Doppler method against the 133Xe method would appear to be impossible in skin areas where arteriovenous anastomoses are present. The changes in blood flow during reactive hyperemia, orthostatic pressure changes, and venous stasis were found to be parallel as measured by the two methods in skin areas without shunt vessels. The laser-Doppler flowmeter would appear to be a useful supplement to the 133Xe washout method in cutaneous vascular physiology, but it is important to keep in mind that different parameters may be measured.

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