Premium
Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study
Author(s) -
Lescoat Alain,
Coiffier Guillaume,
Rouil Alban,
Droitcourt Catherine,
Cazalets Claire,
de Carlan Marine,
Perdriger Aleth,
Jégo Patrick
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22965
Subject(s) - medicine , confidence interval , odds ratio , prospective cohort study , power doppler , surgery , duplex ultrasonography , predictive value of tests , ultrasonography , radiology
Objective To evaluate the relevance of power Doppler ultrasonography (PDUS) as a predictive tool of 1‐year digital ulcer (DU) occurrence in systemic sclerosis (SSc). Methods A total of 55 SSc patients and 19 controls underwent PDUS of both hands to evaluate the prevalence of ulnar artery occlusion (UAO) at baseline. Finger pulp blood flow (FPBF) of the third and fourth fingers was also assessed and considered as pathologic if a defect of the Doppler signal on a finger pulp was observed. All patients were clinically re‐evaluated 6 and 12 months later and new ischemic DU occurrences in the meantime were retrospectively recorded. Patients were also asked to call if new DUs occurred between consultations. Results PDUS parameters were normal in all controls. The prevalence of UAO was 36.4% and was bilateral in 70% of the SSc cases. A total of 56.4% of SSc patients had a pathologic FPBF. UAO and pathologic FPBF were associated with a history of multiple DU episodes (odds ratio [OR] 8.98 [95% confidence interval (95% CI) 2.52–32.01], P < 0.001, and OR 4.69 [95% CI 1.30–16.93], P = 0.014, respectively) and the occurrence of new DUs during the followup in the univariable model (OR 8.73 [95% CI 2.00–38.16], P = 0.005, and OR 12.65 [95% CI 1.50–106.77], P = 0.005, respectively). The association of UAO and pathologic FPBF in the same patient was a predictive factor of new DUs in the multivariable analysis ( P = 0.015). Conclusion This study suggests that UAO and pathologic FPBF are associated with a history of multiple DUs and are predictors of new ischemic DUs. These parameters could be used as prognostic factors and considered in further studies evaluating DU treatment strategies.