Ultrasound classification of finger pulp blood flow in patients with systemic sclerosis: A pilot study

Alain Lescoat (1, 2, 3) , François Robin (4, 3) , Nicolas Belhomme (1, 2, 3) , Alice Ballerie (1, 2, 3) , Marine de Saint Riquier (3) , Martine Sebillot (3) , Jean-David Albert (4, 3) , Thomas Le Gallou (3) , Aleth Perdriger (3) , Jégo Patrick (1, 2, 3) , Guillaume Coiffier (3, 5) , Claire Cazalets (3)

1 Irset - Institut de recherche en santé, environnement et travail
2 EHESP - École des Hautes Études en Santé Publique [EHESP]
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 NuMeCan - Nutrition, Métabolismes et Cancer
5 Centre hospitalier Rene Pleven de Dinan

Objective - To define a semiquantitative classification of finger pulp blood flow (FPBF) and to evaluate whether this classification could be used to assess FPBF in healthy controls and in systemic sclerosis (SSc) patients. Methods - Thirty controls and 86 SSc patients were consecutively included. A classification of FPBF including 5 grades (from grade 0 [no signal] to 4 [signal detected on the entire finger pulp, including the subepidermal vascular network]) was evaluated. This classification was explored in basal conditions and after hand baths in hot and cold water in controls. Its relevance was also assessed at room temperature in SSc patients. Results - In controls, power Doppler ultrasonography (PDUS) of FPBF was improved after hot challenge (P = 0.024), whereas cold challenge decreased FPBF (P = 0.001). FPBF correlated with the vasodilation status assessed by the resistivity index of radial arteries (Spearman's correlation coefficient = -0.50, P = 0.0049). Grade 0 was more frequent in SSc patients than in controls (22.1% versus 3.3%; P < 0.05). In SSc patients, grade 0 was associated with severity markers of the digital vasculopathy such as digital ulcers (DUs) (current or past) (P < 0.05) or ulnar artery occlusion (P < 0.05). On the other hand, DUs were less frequent in patients with grade 4 (P < 0.05). A pathologic threshold of <2 (grade 0 or 1) was significantly associated with DUs (odds ratio 6.67 [95% confidence interval 2.31-19.21], P < 0.0001). Conclusion - PDUS allowed a semiquantitative evaluation of FBPF in SSc patients and controls. Further studies are warranted to validate these results in independent SSc populations and to compare PDUS to existing tools assessing digital blood flow.

Mots clés: Doppler; Ultra-sound; digital ulcers; finger pulp; scleroderma; systemic sclerosis

Domaines: Sciences du Vivant [q-bio]; Rhumatologie et système ostéo-articulaire

Alain Lescoat, François Robin, Nicolas Belhomme, Alice Ballerie, Marine de Saint Riquier, et al.. Ultrasound classification of finger pulp blood flow in patients with systemic sclerosis: A pilot study. Arthritis Care and Research, 2023, 75 (2), pp.299-306. ⟨10.1002/acr.24779⟩. ⟨hal-03359414⟩