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Rheumatology Advance Access originally published online on June 15, 2004
Rheumatology 2004 43(8):986-991; doi:10.1093/rheumatology/keh244
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Rheumatology Vol. 43 No. 8 © British Society for Rheumatology 2004; all rights reserved

Paper

Digital iontophoresis of vasoactive substances as measured by laser Doppler imaging—a non-invasive technique by which to measure microvascular dysfunction in Raynaud's phenomenon

M. E. Anderson1, T. L. Moore1, M. Lunt2 and A. L. Herrick1,2

1 University of Manchester Rheumatic Diseases Centre, Hope Hospital, Salford M6 8HD and 2 ARC Epidemiology Unit, University of Manchester, Manchester M13 9PT, UK.

Correspondence to: A. L. Herrick. E-mail: aherrick{at}fs1.ho.man.ac.uk

Objective. To test the hypothesis that microvascular vasodilation is impaired in patients with systemic sclerosis (SSc) compared with patients with primary Raynaud's phenomenon (PRP) and healthy controls, using the technique of laser Doppler imaging to quantify blood flow responses to iontophoresis of vasoactive agents.

Methods. Microvascular blood flow was measured by laser Doppler imaging before, during and after 120 s iontophoresis (30 µA) of 1% acetylcholine chloride (ACh, endothelium-dependent) and 1% sodium nitroprusside (NaNP, endothelium-independent). Two adjacent fingers of the left hand were studied, and the procedure then repeated on the right. Ten patients with limited cutaneous SSc (LCSSc), 10 patients with PRP and 11 healthy control subjects were studied.

Results. Vasodilation in response to both ACh and NaNP iontophoresis, as measured by ‘area under the blood flow.time curve’ (AUC), normalized for baseline flux, was similar in the control and PRP groups, but was diminished in the LCSSc group compared with both control and PRP groups (ACh results: control vs LCSSc P = 0.028, PRP vs LCSSc P = 0.005; NaNP results: control vs LCSSc P = 0.004, PRP vs LCSSc P = 0.005). There were no differences between groups in baseline flux values nor in voltages required to drive the 30 µA current.

Conclusions. Both endothelium-dependent and endothelium-independent vasodilation are impaired in patients with LCSSc. Vasodilatory responses in patients with PRP are similar to those in controls. If reproducibility is confirmed to be satisfactory, then these techniques could be used to examine disease progression over time and responsiveness to vasoactive treatment, thus facilitating clinical trials.

KEY WORDS: Iontophoresis, Laser Doppler imaging, Endothelium, Microvasculature, Raynaud's phenomenon, Systemic sclerosis


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