{
  "abstract": "Introduction Digital vasculopathy is central to the pathogenesis of systemic sclerosis (SSc), and is one of its earliest clinical manifestations. While nailfold capillaroscopy (NFC) is well-established for microvascular assessments, the role of proper palmar digital artery (PPDA) is unclear. We hypothesized that PPDA intima-media thickness (IMT) represents an independent macrovascular manifestation distinct from capillary patterns. To this end, we evaluated PPDA IMT and finger blood pressure in SSc patients (compared to age/sex matched healthy controls (HC)) and correlated our findings with NFC patterns.Material and Methods We included 29 SSc patients and 13 HC. PPDA IMT of the radial and ulnar sides of the 2nd and 4th fingers was measured using a high-resolution ultrasound (UHF70 transducer, 50 MHz B-mode frequency). Maximum IMT values were used for analysis. Finger systolic blood pressure (fSBP) was measured on all five fingers after warming, and finger-brachial index (FBI) was calculated as the ratio of mean fSBP to mean ipsilateral brachial systolic blood pressure. NFC was performed using a handheld USB capillaroscope at a 200x magnification, with patterns classified as normal, early, active, or late patterns.Results SSc patients demonstrated significantly higher PPDA IMT and lower fSBP and FBI compared to HC across all fingers (p<0.006 for all comparisons). Importantly, even SSc patients with normal NCM patterns showed higher IMT and lower finger blood flow measures compared to HC. At individual finger level, IMT correlated significantly with reduced fSBP (r=-0.347, N= 151, p<0.001) and FBI (r=-0.304, N= 151, p<0.001) but not with brachial blood pressure (r=-0.081, p=0.313). A progressive decrease in finger perfusion was observed with qualitatively assessed PPDA changes from normal through thickened to unilateral and bilateral occlusion. Digital ulcer or pitting scar history was present in 9 patients, predominantly affecting the right 2nd finger, which demonstrated further impaired vascular measurements including increased IMT and reduced fSBP and FBI. Importantly, capillary patterns at individual finger level were not associated with IMT (r=0.150, p=0.132), fSBP (r=-0.106, p=0.310), or FBI (r=-0.096, p=0.359).Conclusions Digital artery thickening in SSc patients directly correlates with reduced finger blood flow, independently of nailfold capillary patterns. The presence of arterial thickening and compromised perfusion even in fingers with normal capillaroscopy suggests that PPDA vasculopathy may represent an independent vascular manifestation in SSc. Notably, patients with digital ulcer or pitting scar history showed the most severe vascular impairment. High-resolution ultrasound assessment of digital arteries provides valuable complementary information to capillaroscopy for evaluating SSc vascular involvement.Abstract P.191 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University of Groningen, University Medical Center Groningen, Department of Internal Medicine-Vascular Medicine, Groningen, The Netherlands"
      ],
      "name": "Anne Van Gessel"
    },
    {
      "affiliations": [
        "University of Groningen, University Medical Center Groningen, Department of Internal Medicine-Vascular Medicine, Groningen, The Netherlands"
      ],
      "name": "Ruby Welman"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada"
      ],
      "name": "Mohammed Osman"
    },
    {
      "affiliations": [
        "University of Groningen, University Medical Center Groningen, Department of Rheumatology and Clinical Immunology, Groningen, The Netherlands"
      ],
      "name": "Alja Stel"
    },
    {
      "affiliations": [
        "University of Groningen, University Medical Center Groningen, Department of Internal Medicine-Vascular Medicine, Groningen, The Netherlands"
      ],
      "name": "Arie Van Roon"
    },
    {
      "affiliations": [
        "University of Groningen, University Medical Center Groningen, Department of Internal Medicine-Vascular Medicine, Groningen, The Netherlands"
      ],
      "name": "Douwe Johannes Mulder"
    }
  ],
  "title": "P.191 Digital artery thickening in systemic sclerosis correlates with reduced finger blood flow independent of nailfold capillary patterns: a high-resolution ultrasound study",
  "uid": "511508ed-8e3d-5669-af18-50ccb968a9e8"
}