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Vascular responsiveness in the microcirculation of patients with systemic lupus erythematosus is not impaired

Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, University Medical Center, Groningen, The Netherlands k.de.leeuw{at}int.umcg.nl

J Blaauw

Division of Obstetrics and Gynaecology, Department of Internal Medicine, University Medical Center, Groningen, The Netherlands

AJ Smit

Division of Vascular diseases, Department of Internal Medicine, University Medical Center, Groningen, The Netherlands

CG Kallenberg

Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, University Medical Center, Groningen, The Netherlands

M Bijl

Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, University Medical Center, Groningen, The Netherlands

As endothelial dysfunction is one of the earliest signs of atherosclerosis, which is accelerated in systemic lupus erythematosus (SLE), we assessed whether vascular responses of the cutaneous microcirculation are disturbed in SLE patients and influenced by Raynaud's phenomenon (RP). Laser Doppler fluxmetry (LDF) was used in combination with iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), an endothelium-dependent and endothelium-independent vasodilator respectively. 42 SLE patients with inactive disease, 12 of whom had RP and 19 age- and sex-matched controls were included. Furthermore, traditional and non-traditional risk factors for cardiovascular disease (CVD) were assessed, and markers of inflammation and endothelial activation were measured. Vascular responses of SLE patients without RP did not differ from controls. However, SLE patients with RP exhibited decreased vasodilatation compared with controls. SLE patients with RP also had longer arrival times of ACh and SNP than controls. Markers of inflammation and von Willebrand factor were increased in SLE patients. Smoking, the presence of SLE and RP were negatively associated with vascular responses in univariate analysis. In multivariate analyses, the only independent variable of vascular responses to ACh and SNP was the presence of RP. Despite signs of endothelial activation, SLE patients with inactive disease do not have altered vascular responses in the microcirculation compared with controls. In SLE patients with RP, cutaneous vascular responses to both ACh and SNP are impaired. Therefore, LDF of the microcirculation seems not to be the appropriate method to distinguish those SLE patients with an increased risk to develop CVD.

Key Words: endothelial function • laser Doppler fluxmetry • Raynaud's phenomenon • systemic lupus erythematosus

Lupus, Vol. 17, No. 11, 1010-1017 (2008)
DOI: 10.1177/0961203308091968


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