Detection of severe digital vasculopathy in systemic sclerosis by colour Doppler sonography is associated with digital ulcers

Rheumatology (Oxford). 2017 Nov 1;56(11):1865-1873. doi: 10.1093/rheumatology/kex045.


Objective: Colour Doppler ultrasonography (CDUS) is very important in general vascular diagnostic procedures. Its role in determining the extent of vasculopathy in Systemic Sclerosis (SSc) needs further investigation. The aim of this study was to compare the presence of altered arteries with nailfold capillaroscopy and clinical signs of ischaemia, that is, digital ulcers or pitting scars (DU/PS). A feasible CDUS protocol is provided.

Methods: Two thousand five hundred and twenty-eight arteries of the fingers, palms and wrists from 79 SSc patients (32 arteries per patient) were examined using CDUS. Furthermore, nailfold capillaroscopy, clinical and laboratory data were evaluated.

Results: Narrowed or occluded lumens were seen in 39.8% of all assessable arteries (n = 2489) and 48.9% of all proper palmar digital arteries (n = 1564) but only 15.6% (P < 0.0001) of proximal arteries (n = 924). Fingerwise analyses presented significant coincidence of pathological CDUS findings and DU/PS (P = 0.0009). Pathological CDUS findings were also associated with elevated CRP concentrations, current or past smoking with ⩾20 pack-years, male gender and present or past DU/PS. Receiver operating characteristic curve analysis (area under the curve = 0.727) suggested a cut-off value of ⩾20% pathological vessels (sensitivity: 90.7%; specificity: 47.8%) for the presence of DU/PS. An examination protocol focusing on the right-hand digits II-V (proper palmar digital arteries) revealed similar results (area under the curve = 0.751; sensitivity: 93.0%; specificity: 43.5%).

Conclusion: CDUS of hand and finger arteries allows measurement of the extent of SSc vasculopathy, which is associated with clinical signs of chronic malperfusion. A shortened examination protocol of CDUS (right-hand digits II-V; 15 min instead of 45 min examination time) could complement vascular diagnostics in SSc.

Keywords: colour Doppler ultrasonography; digital arteries; digital ulcers; malperfusion; nailfold capillaroscopy; systemic sclerosis; vasculopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-Antagonists / therapeutic use
  • Adult
  • Aged
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • C-Reactive Protein / metabolism
  • Calcium Channel Blockers / therapeutic use
  • Endothelin Receptor Antagonists / therapeutic use
  • Female
  • Fingers*
  • Humans
  • Iloprost / therapeutic use
  • Male
  • Microscopic Angioscopy
  • Middle Aged
  • Peripheral Arterial Disease / diagnostic imaging*
  • Peripheral Arterial Disease / drug therapy
  • Peripheral Arterial Disease / epidemiology
  • Peripheral Arterial Disease / etiology
  • Phosphodiesterase 5 Inhibitors / therapeutic use
  • ROC Curve
  • Scleroderma, Systemic / complications*
  • Scleroderma, Systemic / epidemiology
  • Scleroderma, Systemic / metabolism
  • Sensitivity and Specificity
  • Skin Ulcer / diagnostic imaging*
  • Skin Ulcer / etiology
  • Smoking / epidemiology
  • Ultrasonography, Doppler, Color
  • Vasodilator Agents / therapeutic use


  • Adrenergic alpha-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Calcium Channel Blockers
  • Endothelin Receptor Antagonists
  • Phosphodiesterase 5 Inhibitors
  • Vasodilator Agents
  • C-Reactive Protein
  • Iloprost