To the Editor:
In patients with systemic sclerosis (SSc), both structural and functional abnormalities of the microvasculature occur1, often resulting in severe digital ischemia with ulceration, scarring, and sometimes even gangrene. The structural abnormalities are well demonstrated by nailfold capillaroscopy2, especially using high magnification videocapillaroscopy3, which allows measurement of capillary density and dimensions.
Intravenous (IV) prostanoids, such as iloprost and epoprostenol, are currently the mainstay of treatment for severe SSc-related digital ischemia4,5. In the UK, iloprost is most commonly used. As well as being a potent vasodilator, iloprost inhibits platelet aggregation and is thought also to have vascular remodeling properties6. A key issue is whether IV prostanoids might prevent or even reverse SSc-related microvascular changes; if so, this would be an indication to use these drugs more widely, especially in patients with early disease, in whom microvascular changes are more likely to be reversible than in those with well established problems. We performed a pilot study to investigate whether administration of IV iloprost was associated with structural changes in the digital microvasculature as quantified by nailfold videocapillaroscopy.
Nine patients with SSc (7 …
Address correspondence to Dr. Herrick; E-mail: ariane.herrick{at}manchester.ac.uk