Clinical Bedside Tools to Assess Systemic Sclerosis Vasculopathy: Can digital thermal monitoring and sublingual microscopy identify patients with digital ulcers?

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Sublingual microscopy assesses systemic sclerosis (SSc) vasculopathy. Digital thermal monitoring (DTM) may identify patients at risk for digital ulcer (DU). The purpose of this analysis was to assess sublingual microscopy and DTM in SSc patients with and with no previous DU in order to determine the utility of these clinical tools.SSc registry patients with clinical data had both DTM and sublingual microscopy on the same day were included in this cross-sectional analysis. DTM quantifies vascular reactivity index (VRI). Sublingual microscopy measures longitudinal red blood cell fraction (RBC fract) and perfused boundary region (PBR). We evaluated the pairwise association between VRI, RBCfract and PBR in a monotonic relationship using Spearman's rank correlation in the DU subset. Correlation coefficients (rs) and their 95% confidence intervals (CIs) were reported.Ninety patients were included; 29 had digital pits and/or active DU and 61 never had a DU. The only significant clinical feature associated with DU was modified Rodnan skin score (p=0.003) with DU being higher. The VRI was lower in patients with DU (p=0.01). The higher RBCfract the lower PBR (rs =- 0.71, 95% CI: -0.86, -0.47, p<0.001). VRI was not associated with RBCfract or PBR (p=0.24 or 0.55, respectively) in the DU patients.DTM is a useful tool for assessing SSc-DU. While sublingual microscopy measurements did not significantly correlate to VRI in SSc-DU patients, a longitudinal study may be more helpful in capturing vasculopathy activity prior to possibly irreversible damage.

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