eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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4/2020
vol. 37
 
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abstract:
Original paper

Endothelial dysfunction in patients with systemic sclerosis

Renata Pacholczak-Madej
1, 2
,
Piotr Kuszmiersz
3
,
Stanisława Bazan-Socha
3
,
Joanna Kosałka-Węgiel
3
,
Teresa Iwaniec
3
,
Lech Zaręba
4
,
Stan Kielczewski
1
,
Anna Rams
3
,
Jerzy A. Walocha
1
,
Jacek Musiał
3
,
Jerzy Dropiński
3

  1. Department of Anatomy, Jagiellonian University, Medical College, Krakow, Poland
  2. National Cancer Institute, Maria Skłodowska-Curie Memorial Institute, Krakow Branch, Poland
  3. Department of Internal Medicine, Jagiellonian University, Medical College, Krakow, Poland
  4. Interdisciplinary Centre for Computational Modelling, College of Natural Sciences, University of Rzeszow, Rzeszow, Poland
Adv Dermatol Allergol 2020; XXXVII (4): 495–502
DOI: https://doi.org/10.5114/ada.2019.83501
Online publish date: 2020/09/02
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Introduction
Patients with systemic sclerosis experience endothelial dysfunction and damage even in the absence of clinical manifestations.

Aim
To evaluate various methods for assessing the endothelial function for their applicability to clinical practice.

Material and methods
Forty-two patients (7 men and 35 women) with systemic sclerosis and 36 controls (11 men and 25 women) matched for age, sex, body mass index, smoking habit, and comorbidities were enrolled in the study. We assessed each participant for typical risk factors for cardiovascular diseases and measured serum levels of vascular cell adhesion molecule-1 (VCAM-1) and thrombomodulin together with flow-mediated dilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the common carotid artery using ultrasonography.

Results
Patients with systemic sclerosis did not differ from controls in serum levels of VCAM-1 and thrombomodulin, however, the statistical analysis with adjustment for potential confounders revealed increased levels of thrombomodulin in the patients (p = 0.03). They also had a 45% lower relative increase of FMD (FMD%), and 13% higher IMT (p < 0.01, both, also after adjustment for potential confounders). In a simple regression model, lower FMD% was determined by age (b = –0.57, 95% confidence interval (CI): –0.72 to –0.43) and C-reactive protein levels (b = –0.38, 95% CI: –0.55 to –0.22). Thicker IMT was related to age (b = 0.64, 95% CI: 0.52–0.67), glomerular filtration rate (b = –0.34, 95% CI: –0.5 to –0.18), and blood thrombomodulin levels (b = 0.45, 95% CI: 0.13–0.76).

Conclusions
Patients with systemic sclerosis present with endothelial dysfunction which may be detected using ultrasonographic methods. The exact mechanism of observed abnormalities is unknown, but it is possibly related to the chronic inflammation and ischemia-reperfusion injury.

keywords:

atherosclerosis, endothelium, flow-mediated dilatation, intima-media thickness, scleroderma
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