Abstract
ObjectiveTo investigate the link between bone alteration and micro- and macro-vascular disease in patients with systemic sclerosis (SSc).Results33 SSc patients were included. In univariate analysis, low values of cortical vBMD were significantly associated with a low DBI at the 2nd finger (p = 0.004) and at the 4th (p = 0.002) and with severe capillaroscopic score (p = 0.008). In multivariate analyses, low cortical vBMD was associated with a low DBI at the 4th finger, age and severe capillaroscopic score (adjusted R2 = 0.58; p = < 0.001). Low cortical thickness was associated with a low DBI at the 4th finger, severe capillaroscopic score and age (adjusted R2 = 0.49, p = < 0.001).ConclusionOur study findings showed an association between micro- and macro-vessel damage and altered microarchitectural indices at the radius in SSc.MethodsWe performed a pilot study in female patients with SSc. Microvascular disease was assessed by the capillaroscopic score of Cutolo. Macrovascular involvement was measured by digito-brachial pressure index (DBI) on laser-Doppler at the 2nd and 4th finger. Volumetric bone mineral density (vBMD) and bone microarchitecture involvement were analysed by High-Resolution peripheral Quantitative Computed Tomography (HRpQCT) at the distal radius.
Highlights
Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology characterized by immunological disturbances, microangiopathy, and fibrosis of tissues and vessels, which can cause failure of vital organs [1]
Low values of cortical Volumetric bone mineral density (vBMD) were significantly associated with a low digito-brachial pressure index (DBI) at the 2nd finger (p = 0.004) and at the 4th (p = 0.002) and with severe capillaroscopic score (p = 0.008)
Low cortical vBMD was associated with a low DBI at the 4th finger, age and severe capillaroscopic score
Summary
Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology characterized by immunological disturbances, microangiopathy, and fibrosis of tissues and vessels, which can cause failure of vital organs [1]. The vascular abnormalities are defined by a dysfunction of the endothelium [2], with an inability to control the inflammation leading to a recruitment of inflammatory cells in the perivascular areas and to a permanent connective tissue remodeling, causing fibrosis [2]. This results in an obliteration of the vascular lumen inducing ischemia [3, 4]. Occlusion of the ulnar arteries was found in half of the patients suffering from systemic sclerosis, responsible for digital trophic disorders and Raynaud’s phenomenon [6]. The non-invasive detection of these lesions is possible thanks to Doppler flowmeter and ultrasound with high frequency probe or angio-MRI [7]
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