Andrea K Murray1, Tonia L Moore2, Elizabeth Wragg3, Holly Ennis2, Andy Vail4, Graham Dinsdale2, Lindsay Muir5, Christopher E M Griffiths6, Ariane L Herrick7. 1. Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK; and Photon Science Institute, University of Manchester, UK. andrea.murray@manchester.ac.uk. 2. Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. 3. Rheumatology Directorate, Salford Royal NHS Foundation Trust, Salford, UK. 4. School of Community Based Medicine, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. 5. Department of Hand Surgery, Salford Royal NHS Foundation Trust, Salford, UK. 6. Dermatology Centre, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. 7. Inst.of Inflammation and Repair, University of Manchester, Salford Royal NHS Foundation Trust, Salford; and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, UK.
Abstract
OBJECTIVES: Systemic sclerosis (SSc)-related digital ulcers (DU) cause significant pain and disability and are often a primary endpoint in clinical trials. However, their pathophysiology has been little studied. The objectives of this prospective study were to determine whether laser Doppler imaging (LDI) and thermography can identify ischaemic components in both fingertip and extensor surface DU and assess ulcer healing. METHODS: Patients prospectively reported new DU over a year. Patients' DU underwent imaging until the ulcer had healed. Ischaemia was defined as lower blood flow or skin temperature (and inflammation as higher) within the ulcer, compared to a non-affected site. RESULTS: 53 ulcers (19 fingertip, 18 extensor, 16 'other' sites) in 17 patients were imaged (53 with LDI, 52 with thermography). For LDI data 32 (60%) ulcers were ischaemic; median perfusion ulcer/unaffected area; 0.79 (range 0.11-2.9). For thermography data 35 (66%) were ischaemic; 0.98 (0.89 to 1.1). Inflammation in the surrounding area was identified for all ulcers by LDI but not thermography. In the 36 ulcers with repeat imaging, LDI showed trends (with healing) towards increased ulcer perfusion (p=0.23) and decreased hyperaemia in adjacent areas (p=0.59). Skin temperature at the ulcer site showed no significant change (p=0.13) but adjacent area showed decreased temperature (p=0.04 signifying decreased blood flow). CONCLUSIONS: LDI and thermography are sufficiently sensitive to measure ischaemia in both fingertip and extensor ulcers. LDI was better suited to monitoring change in perfusion with healing (due to higher imaging resolution, or vascular changes occurring in more superficial skin layers).
OBJECTIVES:Systemic sclerosis (SSc)-related digital ulcers (DU) cause significant pain and disability and are often a primary endpoint in clinical trials. However, their pathophysiology has been little studied. The objectives of this prospective study were to determine whether laser Doppler imaging (LDI) and thermography can identify ischaemic components in both fingertip and extensor surface DU and assess ulcer healing. METHODS:Patients prospectively reported new DU over a year. Patients' DU underwent imaging until the ulcer had healed. Ischaemia was defined as lower blood flow or skin temperature (and inflammation as higher) within the ulcer, compared to a non-affected site. RESULTS: 53 ulcers (19 fingertip, 18 extensor, 16 'other' sites) in 17 patients were imaged (53 with LDI, 52 with thermography). For LDI data 32 (60%) ulcers were ischaemic; median perfusion ulcer/unaffected area; 0.79 (range 0.11-2.9). For thermography data 35 (66%) were ischaemic; 0.98 (0.89 to 1.1). Inflammation in the surrounding area was identified for all ulcers by LDI but not thermography. In the 36 ulcers with repeat imaging, LDI showed trends (with healing) towards increased ulcer perfusion (p=0.23) and decreased hyperaemia in adjacent areas (p=0.59). Skin temperature at the ulcer site showed no significant change (p=0.13) but adjacent area showed decreased temperature (p=0.04 signifying decreased blood flow). CONCLUSIONS: LDI and thermography are sufficiently sensitive to measure ischaemia in both fingertip and extensor ulcers. LDI was better suited to monitoring change in perfusion with healing (due to higher imaging resolution, or vascular changes occurring in more superficial skin layers).
Authors: Michael Hughes; Yannick Allanore; Lorinda Chung; John D Pauling; Christopher P Denton; Marco Matucci-Cerinic Journal: Nat Rev Rheumatol Date: 2020-02-25 Impact factor: 20.543
Authors: M Hughes; T Moore; J Manning; J Wilkinson; G Dinsdale; C Roberts; A Murray; A L Herrick Journal: Microvasc Res Date: 2016-12-24 Impact factor: 3.514
Authors: Nicholas Lebedoff; Tracy M Frech; Victoria K Shanmugam; Aryeh Fischer; Daniel Erhardt; Jason Kolfenbach; Kevin Kohler; Kurt Bernhisel; Giavonni M Lewis Journal: J Scleroderma Relat Disord Date: 2017-11-17
Authors: M Hughes; T Moore; J Manning; J Wilkinson; S Watson; P Samraj; G Dinsdale; C Roberts; L E Rhodes; A L Herrick; A Murray Journal: J Dermatolog Treat Date: 2018-07-31 Impact factor: 3.359
Authors: Elizabeth Marjanovic; Tonia L Moore; Joanne B Manning; Graham Dinsdale; Sarah Wilkinson; Mark R Dickinson; Ariane L Herrick; Andrea K Murray Journal: Rheumatology (Oxford) Date: 2020-11-01 Impact factor: 7.580