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Rheumatology Advance Access published online on July 15, 2008
Rheumatology, doi:10.1093/rheumatology/ken248
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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

Decreased capillary permeability and capillary density in patients with systemic sclerosis using large-window sodium fluorescein videodensitometry of the ankle

M. E. Hettema1, D. Zhang1, Y. Stienstra2, P. N. H. Oomen3, A. J. Smit4, C. G. M. Kallenberg1 and H. Bootsma1

1Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, 2Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, 3Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden and 4Department of Internal Medicine, Division of Vascular Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Correspondence to: M. E. Hettema, Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands. E-mail: m.e.hettema{at}int.umcg.nl


  Abstract

Objective. Local capillary permeability in patients with SSc has been reported increased when assessed by nail-fold capillaroscopy. We measured capillary permeability at a clinically less affected site by using large-window fluorescein videodensitometry of the ankle. We hypothesized that increased capillary permeability or leakage is a generalized phenomenon in SSc.

Methods. Large-window videodensitometry with sodium fluorescein was performed in 38 SSc patients and 20 healthy controls. Capillary permeability was expressed as the average relative light intensity over the first 7 min [Iav(7)] after appearance of fluorescein in skin capillaries.

Results. Capillary permeability, expressed as Iav(7) was significantly decreased in patients with SSc (47.3 ± 15.0% vs 57.6 ± 9.4% in controls, P = 0.007), as was capillary density (12 ± 6/mm2 vs 26 ± 11/mm2, P < 0.001). Adjustment for capillary density in multivariate regression analysis demonstrated that differences in Iav(7) between SSc patients and controls were related to differences in capillary density, BMI and high density lipoprotein cholesterol.

Conclusion. At the level of the ankle decreased capillary permeability was found in SSc patients, related to decreased capillary density. Microvascular involvement in SSc is widespread, but no evidence was established for increased capillary permeability at the level of individual capillaries as a generalized phenomenon.

KEY WORDS: Systemic sclerosis, Capillary permeability, Sodium fluorescein, Videodensitometry

Submitted 1 October 2007; revised version accepted 9 June 2008.
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