Patients with systemic lupus erythematosus (SLE), including those without cardiovascular (CV) disease or risk factors, have a blunted microvascular reactivity compared with control patients, according to study data published in Rheumatology.

Patients who met the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were recruited from a rheumatology outpatient unit from March 2017 to November 2019. A total of 35 patients with SLE (mean age, 46.3 [8.6] years; 85.7% women) with a median disease duration of 12.0 (6.5-17.5) years and 31 control participants (mean age, 46.4 [9.2]; 77.4% women) matched for age, sex, and BMI were included.

Investigators assessed skin microvascular function with use of laser speckle contrast analysis (LASCA) in patients with SLE, with and without cardiovascular disease and risk factors. They recorded continuous blood flow with the LASCA device at baseline, a 5-minute arterial occlusion, and a 5-minute reperfusion period.


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During reperfusion, peak flux increased in both groups. However, patients with SLE had a smaller peak magnitude compared with control patients (161.0 [47.1] vs 197.2 [41.4]%, respectively, P = .002). The findings were unchanged in 24 patients with SLE and without cardiovascular disease compared with control patients (169.2 [48.1] vs 195.6 [34.0]%, respectively, P = .002).

“The results revealed that patients with SLE demonstrate impaired skin microvascular reactivity as compared with individuals matched for age, sex, and the presence of cardiovascular risk factors,” stated the study authors. “Most importantly, when we examined separately SLE patients free of any CV comorbidities, the dysfunction of skin microcirculation was still present as compared with healthy individuals. [This] finding possibly indicates that vascular impairment is present in SLE independently of the coexistence of other CV factors and may explain, at least in part, the increased CV risk of these patients.”

Study limitations include the relatively small sample size, and no further associations or risk factors could be identified.

“The estimation of skin microcirculation by LASCA may provide a novel, accessible, non-invasive and reliable technique for the early diagnosis of a more generalized microvascular damage,” the researchers commented. “However, larger studies are needed to confirm the impairment in skin microcirculation and to explore prognostic factors and associations with other micro or macrocirculation indices.”

Reference

Koletsos N, Gkaliagkousi E, Lazaridis A, et al. Skin microvascular dysfunction in systemic lupus erythematosus patients with and without cardiovascular risk factors [published online December 31, 2020]. Rheumatology (Oxford). doi: 10.1093/rheumatology/keaa722