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Rheumatology Advance Access published online on April 4, 2008
Rheumatology, doi:10.1093/rheumatology/ken065
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Abnormal digital neurovascular response to local heating in systemic sclerosis

M. Roustit1,2, G. H. Simmons3, P. Carpentier4 and J. L. Cracowski1,2

1Inserm CIC03, Grenoble Clinical Research Center, Grenoble University Hospital, 2Inserm ERI17, Grenoble Medical School, Grenoble, France, 3Department of Human Physiology, University of Oregon, Eugene, OR, USA and 4Vascular Medicine Department, Grenoble University Hospital, Grenoble, France.

Correspondence to: J.-L. Cracowski, Inserm CIC03 – Centre d’Investigation Clinique, CHU de Grenoble, 38043 Grenoble Cedex 09, France. E-mail: Jean-Luc.Cracowski{at}ujf-grenoble.fr


  Abstract

Objectives. To investigate neurovascular dysfunction using the axon reflex-dependent hyperaemia (initial peak of skin local heating response) in fingers of patients with SSc or primary RP.

Methods. Ten healthy subjects were initially enrolled to compare axon reflex-dependent thermal hyperaemia between the finger and forearm cutaneous circulations. Then, 10 patients with primary RP and 16 patients with SSc participated in a similar protocol focusing on the finger circulation only. Lidocaine/prilocaine cream was applied for 1 h to produce local blockade of cutaneous sensory nerves. After lidocaine/prilocaine pre-treatment, laser Doppler probes were heated from skin temperature to 42°C for 30 min, and 44°C for 5 min to achieve maximal skin blood flow. Data were expressed as a percentage of maximal cutaneous vascular conductance.

Results. In healthy volunteers, we observed a significantly higher initial peak on the finger compared with the forearm, with both responses blunted following topical anaesthesia. In primary RP patients, we observed a decreased initial peak following lidocaine/prilocaine pre-treatment in the finger circulation [96.7% (33.4) vs 75.9% (29.5) with anaesthesia, P = 0.02]. In contrast, pre-treatment did not alter the initial peak in patients with SSc. A minute-by-minute analysis showed no delay of the initial peak.

Conclusions. We show an abnormal digital neurovascular response to local heating in SSc. Thermal hyperaemia could be monitored as a clinical test for neurovascular function in SSc. Further studies are required to test whether the abnormal digital neurovascular response correlates to the degree of peripheral vascular involvement.

KEY WORDS: Systemic sclerosis, Microcirculation, Thermal hyperaemia, Neurovascular, Raynaud's phenomenon

Submitted 9 November 2007; revised version accepted 28 January 2008.
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