Jacek Kita

Raynaud's phenomenon: new aspects of pathogenesis and the role of nailfold videocapillaroscopy

Raynauds phenomenon (RP) refers to paroxysmal pallor or cyanosis of the digits of the hands or feet and, infrequently, the tips of the nose or ears (acral parts) owing to cold-induced vasoconstriction of the digital arteries, precapillary arterioles, and cutaneous arteriovenous shunts. Raynauds phenomenon reflects an exaggeration of normal central and local vasomotor responses to cold or emotion. Raynauds phenomenon has been classified as primary or secondary, depending on whether it occurs as an isolated condition or is associated mainly with a connective tissue disease. Dysregulation of autonomic and sensitive nerve fibers, functional and structural vessel changes, and intravascular alterations can be observed in the pathogenesis of RP. Nailfold videocapillaroscopy (NVC) is the best non-invasive and repetitive diagnostic technique for detecting morpho-functional changes in the microcirculation. Nailfold videocapillaroscopy is accepted in early diagnosis and monitoring of primary and secondary RP.

AB0675 Correlation Between Microvascular Abnormalities in Videocapillaroscopy and Angiogenesis Modulators in Patients with Raynaud's Phenomenon Before and After Multiwave Locked System (MLS) Laser Therapy

Background Raynauds phenomenon (RP) is a vascular disorder characterised by reversible vasospastic response of the fingers and toes to cold or emotional stimuli. Microvascular abnormalities, manifested as RP, may be due to a severe underlying disease with reduced life expectancy. The unsuccessful effects and limitations of the pharmacological treatment are the reason of searching for new therapeutical methods, such as non-pharmacologic therapy. Objectives The aim of this study was to investigate the correlation between the Multiwave Locked System (MLS) laser therapy, clinical features, microvascular changes in nailfold videocapillaroscopy (NVC) and circulating modulators releasing as a consequence of vascular endothelium injury such as vascular endothelial growth factor (VEGF), angiopoietin 2 (Ang-2) and nitrogen oxide (NO) in patients with RP. Methods Seventy-eight RP patients and 30 healthy subjects were recruited into the study. All patients with RP received MLS laser irradiation for 3 weeks. Clinical, NVC and laboratory investigations were performed before and after the MLS laser therapy. The serum concentration of VEGF and Ang-2 were determined by an enzyme-linked immunosorbent assay (ELISA). Total NO concentration was determined using an indirect method based on assessment of nitrite concentration according to Griesss reaction. Results After three weeks of MLS laser therapy the clinical improvement manifested by decreasing of the number of RP attacks, duration of single attack and pain intensity in RP patients was observed. In RP patients before MLS laser therapy the strong positive correlations between the severity of microvascular abnormalities and Ang-2 (r =0.535, p<0.001), NO (r =0.443, p<0.001) and VEGF (r =0.0382, p<0.05) were observed. After MLS laser therapy such correlations were still observed, however there were not so strong as before therapy and in case of NO the correlation was not significant. Conclusions Our results suggest that NVC may reflect microvascular changes associated with clinical improvement after MLS laser therapy in patients with primary and secondary RP. Ang-2, VEGF and NO serum levels may be the useful markers of microvascular changes in patients with RP before and after MLS laser therapy. Disclosure of Interest None declared

FRI0474 Association of serum vascular endothelial growth factor and angiopoietin-2 levels with clinical manifestations and nailfold capillaroscopic changes in patients with raynaud’s phenomenon

Background Raynaud’s phenomenon (RP) is an exaggerated vasospastic response to cold and emotion, which can be primary (idiopathic) or secondary to a number of different conditions, including rheumatological diseases. Functional and/or structural vascular involvement is a key feature of RP. Nailfold capillary microscopy (NC) is the best technique to investigate microvascular abnormalities and to differentiate between primary and secondary RP. Objectives Based on the findings, suggesting an important role of microvascular involvement in the pathogenesis of RP, we evaluated whether the vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang2) serum levels are associated with clinical manifestations and microvascular changes in NC in patients with RP. Methods Serum levels of VEGF and Ang2 were determined by an enzyme-linked immunosorbent assay (ELISA) in 78 patients with RP (38 with primary and 40 with secondary RP) and in 30 healthy controls. Results Morphological changes in nailfold capillaroscopy were seen in 56 out of 76 (73.7%) patients with RP. A normal capillaroscopic pattern or mild changes were found in 36 (47.3%) and moderate/severe abnormalities - in 40 (52.6%) of all RP patients. In all patients with secondary RP, severe or moderate changes in capillaroscopy were found. The severity of microvascular abnormalities were associated with the frequency and severity of vasospastic episodes as well as with the duration of RP. In the control group no pathological changes in nailfold capillaroscopy were observed. Patients with severe changes in nailfold capillaroscopy showed significantly higher serum levels of VEGF and Ang2 than those without or with mild changes and in the control group. Moreover, there was a significant positive correlation between Ang2 serum levels and the duration of RP as well as the pain severity rating on the VAS scale. Conclusions Our findings confirm the usefulness of NC as a non-invasive technique in the evaluation of microvascular involvement in RP patients. Moreover, a relationships between the changes in nailfold capillaroscopy and serum levels of VEGF and Ang2 point to a pathogenic role of these molecules in the clinical manifestation of RP. Disclosure of Interest None Declared