Disturbed microcirculation in the hands of patients with systemic sclerosis detected by fluorescence optical imaging: a pilot study

Friedrich, Stefanie; Lüders, S.; Werner, S. G.; Glimm, Anne-Marie; Burmester, Gerd‐Rüdiger; Riemekasten, Gabriela; Backhaus, Marina; Ohrndorf, Sarah

doi:10.1186/s13075-017-1300-6

Cited by 24 publications

(17 citation statements)

References 31 publications

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“…The included SSc patients received clinical examination, nailfold capillaroscopy (NC), colour Doppler ultrasonography (CDUS) [8,9], and fluorescence optical imaging (FOI) [8,10] of both hands at baseline, and also their patient history was taken as described in detail in our previous publications [8][9][10]. The two examiners were not blinded to patient history or clinical manifestations of the disease when performing the imaging techniques.…”

Section: Methodsmentioning

confidence: 99%

The first composite score predicting Digital Ulcers in systemic sclerosis patients using Clinical data, Imaging and Patient history—CIP-DUS

et al. 2020

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Background: Digital ulcers (DU) present a challenging complication in systemic sclerosis (SSc). The aim of this study was to combine clinical characteristics and imaging methods to a composite score for the prediction of DU in SSc patients. Methods: Seventy-nine SSc patients received clinical examination, their patient history was taken and nailfold capillaroscopy (NC), colour Doppler ultrasonography (CDUS) and fluorescence optical imaging (FOI) of the hands were performed at baseline. Newly developed DU over a period of approximately 12 months were registered. We used criteria with area under the curve (AUC) of at least 0.6 in regard to the development of these new DU to create the score (CIP-DUS, clinical features, imaging, patient history-digital ulcer score). Results: Twenty-nine percent of all SSc patients developed new DU during follow-up (48.1% diffuse, 18.4% limited SSc). Based on the cross-validated (cv) AUC, a weight (cvAUC > 0.6 and ≤ 0.65: 1; cvAUC > 0.65 and ≤ 0.7: 2; cvAUC > 0.7: 3) was assigned to each selected parameter. The performance of the final CIP-DUS was assessed with and without the CDUS/FOI component. For the scleroderma patterns in NC, three points were appointed to late, two to active and one point to early capillaroscopy pattern according to Cutolo et al. The CIP-DUS including the CDUS and FOI parameters resulted in a good diagnostic performance (AUC after cross-validation: 0.83, 95%CI 0.74 to 0.92) and was well calibrated (chi-square = 12.3, p = 0.58). The cutoff associated with the maximum of sensitivity and specificity was estimated at ≥ 10 points resulting in a sensitivity of 100% and specificity of 74% for new DU during follow-up. Excluding CDUS and FOI parameters leads to a non-statistically significant lower performance (AUC after cross-validation: 0.81, 95%CI 0.72 to 0.91). However, including CDUS and FOI resulted in a better classification of patients in respect to the outcome new DU in follow-up due to significantly better reclassification performance (NRI = 62.1, p = 0.001) and discrimination improvement (IDI = 9.7, p = 0.01).

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Section: Methodsmentioning

confidence: 99%

The first composite score predicting Digital Ulcers in systemic sclerosis patients using Clinical data, Imaging and Patient history—CIP-DUS

et al. 2020

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“…Furthermore, it has been shown that FOI is able to visualize changes in joint inflammation during anti-rheumatic therapy [30,31] and that it can even detect subclinical synovitis in patients with inflammatory arthritis [32]. It was not only used in diagnostics and monitoring of RA and other arthritic diseases, but also for the detection of a disturbed microcirculation and prediction of digital ulcers in systemic sclerosis (SSc) [33,34]. Pfeil et al used FOI in SSc patients to detect inflammation of the soft tissue and monitor the effectiveness of treatment [35].…”

Section: Introductionmentioning

confidence: 99%

Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging

et al. 2020

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Objectives: To investigate the frequency of subclinical skin inflammation in both hands by fluorescence optical imaging (FOI) in patients with psoriasis/psoriatic arthritis (Pso/PsA) vs. rheumatoid arthritis (RA) and healthy individuals, and to correlate these findings with cardiovascular (CV) risk factors. Patients and methods: The FOI scans were analyzed retrospectively to detect clinically invisible skin enhancement (0-3 scale) in both hands without relationship to underlying joints or blood vessels. We further characterized the FOI patterns and sorted the scans into groups based on the assumed diagnosis (Pso/PsA, RA, and healthy controls), which was compared with the physician's diagnosis. Furthermore, the associations between CV risk factors and imaging findings were investigated by regression analyses. Results: We included FOI scans of patients with Pso/PsA (n = 80), RA (n = 78), and healthy controls (n = 25). Subclinical skin enhancement on the back of their hands was more common in Pso/PsA (72.5%) than in RA patients (20.5%) and healthy individuals (28.0%) (p < 0.001). Based on the FOI pattern, the majority of patients with Pso/PsA (72.5%), RA (76.9%), and healthy controls (68.0%) were classified correctly using the physician-based diagnosis as reference (overall agreement of 74%, kappa = 0.57). No CV risk factors except body weight (kg) were associated with subclinical skin enhancement (OR 1.04, 95% CI 1.02-1.06; p < 0.001). Conclusion: Subclinical subdermal skin inflammation was common in Pso/PsA patients using FOI. Based on the FOI pattern, most patients with Pso/PsA and were classified with the correct diagnosis. We demonstrated an important influence of the body weight on our FOI results. FOI may be a helpful novel tool to study microcirculation in rheumatic diseases with skin involvement.

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“…(28,30,(39)(40)(41) Following studies concentrated on the examination of OA with different in ammatory patterns (36) or decreased blood ow in systemic sclerosis. (33,34) To our knowledge, we are the rst group to investigate potential subclinical in ammation of the skin in Pso/PsA patients. Since skin in ammation, increased rate of vessel in ammation (42) and arterial stiffness (25) has been shown in patients with Pso/PsA, we hypothesized that ICG-based FOI would be a valuable method to visualize impaired microcirculation in Pso/PsA.…”

Section: Discussionmentioning

confidence: 99%

Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging

Schmidt

Glimm

Haugen

et al. 2020

Preprint

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Objectives: To investigate the frequency of subclinical skin inflammation in both hands by fluorescence optical imaging (FOI) in patients with psoriasis/psoriatic arthritis (Pso/PsA) vs. rheumatoid arthritis (RA) and healthy individuals, and to correlate these findings with cardiovascular (CV) risk factors.Patients and Methods: The FOI scans were analyzed retrospectively to detect clinically invisible skin enhancement (0-3 scale) in both hands without relationship to underlying joints or blood vessels. We further characterized the FOI patterns and sorted the scans into groups based on the assumed diagnosis (Pso/PsA, RA and healthy controls), which was compared with the physician’s diagnosis. Furthermore, the associations between CV risk factors and imaging findings were investigated by regression analyses.Results: We included FOI scans of patients with Pso/PsA (n=80), RA (n=78) and healthy controls (n=25). Subclinical skin enhancement on the back of their hands was more common in Pso/PsA (72.5%) than in RA patients (20.5%) and healthy individuals (28.0%) (p<0.001). Based on the FOI pattern, the majority of patients with Pso/PsA (72.5%), RA (76.9%) and healthy controls (68.0%) were classified correctly using the physician-based diagnosis as reference (overall agreement of 74%, kappa=0.57). No CV risk factors except body weight (kg) was associated with subclinical skin enhancement (OR 1.04, 95% CI 1.02-1.06; p<0.001). Conclusion: Subclinical subdermal skin inflammation was common in Pso/PsA patients using FOI. Based on the FOI pattern, most patients with Pso/PsA and were classified with the correct diagnosis. We demonstrated an important influence of the body weight on our FOI results. FOI may be a helpful novel tool to study microcirculation in rheumatic diseases with skin involvement.

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Disturbed microcirculation in the hands of patients with systemic sclerosis detected by fluorescence optical imaging: a pilot study

Cited by 24 publications

References 31 publications

The first composite score predicting Digital Ulcers in systemic sclerosis patients using Clinical data, Imaging and Patient history—CIP-DUS

The first composite score predicting Digital Ulcers in systemic sclerosis patients using Clinical data, Imaging and Patient history—CIP-DUS

Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging

Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging

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