Altered Skin Microcirculation in Patients with Systemic Lupus Erythematosus

Abstract

Although microvasculitis is one of the more common manifestations of systemic lupus erythematosus, there is no data on the hemodynamics of the skin microcirculation in such patients. The combination of dynamic capillaroscopy measuring capillary blood cell velocity (CBV) and laser Doppler fluxmetry (LDF) was used to simultaneously evaluate the nutritional and the total skin microcirculation in the fingers of 24 consecutive patients with SLE, using normal matched subjects as controls. The nutritional skin flow, as assessed by the CBV, was significantly impaired in patients, as compared with controls, both at rest (p = 0.001) and during postocclusive reactive hyperemia (p = 0.006). By contrast, no differences were observed in total skin microcirculation, as assessed by LDF (n.s.). There was no significant correlation between hemodynamic parameters and the presence of Raynaud’s phenomenon, morphological capillary changes or anticardiolipine antibodies. There was no correlation between the magnitude of the alteration of the capillary blood flow and capillary morphological abnormalities, suggesting that the microvascular damage might be caused by different pathophysiological mechanisms.

Scleroderma-like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud's phenomenon in SLE patients

“…At the moment we do not know the biologica l signi cance of this association, but it might be that aCL and SD microangiopathy are features of two mutually exclusive subsets of SLE. The literature also points to a lack of association between these two parameters, 21,22,35 although there is one study that showed a signi cant association between abnormal NFC and aCL. 20 However, the criteria for abnormal NFC did not include enlarged capillaries nor avascular areas but considered less speci c alterations such as hemorrhage, tortuous and meandering capillaries.…”

“…Thus far, the studies which have evaluated the association between aCL, anti-U1-RNP antibodies, and RP and capillaroscopic ndings in SLE patients have shown discordant results. [19][20][21][22] The objective of the present study was to evaluate the potential association of wide eld nailfold capillaroscopic and videomorphometri c abnormalitie s with the presence of RP, anti-U1-RNP, and aCL antibodie s in SLE patients.…”

Cutaneous blood flow in dermatomyositis and its association with disease severity

“…However, the observation of significantly increased cutaneous blood flow in DM contrasts with previous studies of blood flow in SLE. Using laser Doppler fluxmetry, Bongard et al (31) found no differences in skin microcirculation in the fingers of patients with SLE vs. controls. Similarly, Bergman et al (8) found evidence of nailfold capillary changes in less than 5% of patients with SLE vs. 64% of DM patients.…”

Microvascular involvement in systemic sclerosis and systemic lupus erythematosus

“…Studies that explored the utility of laser Doppler flowmetry in SLE were less promising than those done in patients with SSc. For instance, the microvascular perfusion measured by laser Doppler flowmetry and its response to acetylcholine‐iontophoresis were not different between patients with SLE and controls . However, SLE patients with RP had an impaired vascular response to acetylcholine‐ and sodium nitroprusside‐iontophoresis suggesting that SLE patients with RP have more pronounced microvasculatory involvement than those without RP …”