Non-invasive optical imaging techniques

A major part of our research activity is concerned with the development, and validation, of novel, non-invasive optical imaging techniques to measure and assess cutaneous microvessels (small blood vessels).

Laser Doppler imaging (LDI) and related techniques

LDI and the related technique of laser speckle contract imaging (LSCI) have been used to assess blood vessel dysfunction in patients with systemic sclerosis, and to measure changes in blood flow in response to treatments prescribed during clinical trials.

We have also used LDI to reveal new information about the structure, blood flow distribution and treatment response of systemic sclerosis-related telangiectases, small dilated blood vessels near the surface of the skin.

Nailfold capillaroscopy

The capillaries at the base of the finger nail in the nailfold (nailfold capillaries) are often of abnormal shape and size in patients with systemic sclerosis.

In collaboration with the Centre for Imaging Sciences, we have developed a novel capillaroscopy system to produce high magnification panoramic images of nailfold capillaries, allowing measurement of capillary dimensions.

We currently have an active programme of research studying the application of capillarosopy in patients with Raynaud’s and systemic sclerosis.

Spectroscopy

Using this technique, we have demonstrated that it is possible to non-invasively measure an increase in skin fluorescence, representative of increased oxidative stress, in patients with systemic sclerosis in comparison to healthy controls.

Optical coherence tomography (OCT)

This light-based technique produces images similar to those of ultrasound but with a higher resolution. We currently use a commercial device to measure skin thickening in patients with systemic sclerosis.

Mobile phone imaging

We are currently investigating whether photographic images taken by patients using their mobile phones may be helpful in monitoring finger ulcers and Raynaud’s.

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Treatment

Patients attending Salford Royal Hospital are recruited into studies (these studies are often multicentre) assessing Raynaud’s and different aspects of the systemic sclerosis disease process.

Examples include:

European Scleroderma Observational Study (ESOS)

ESOS was a multinational study which compared the effectiveness of different immunosuppressant treatments for early diffuse cutaneous systemic sclerosis. Centres from Europe, North America and Australia took part.

ESOS also benchmarked the ‘disease burden’ of the early diffuse cutaneous variant of systemic sclerosis.

Prednisolone in early diffuse systemic sclerosis (PRedSS)

PRedSS is a multicentre UK study investigating whether or not patients with the early diffuse cutaneous subtype of systemic sclerosis should be treated with prednisolone.

Visit the PRedSS study site

Novel treatments

We have an ongoing programme investigating different aspects of systemic sclerosis treatment and, in particular, of Raynaud’s phenomenon, digital (finger and toe) ulceration, and telangiectases (small dilated blood vessels near the surface of the skin).

Intense pulsed light (IPL)

We have completed a clinical study comparing IPL and laser treatment of systemic sclerosis-related telangiectases and found that both treatments conferred benefit.

Multicentre studies

Patients attending Salford Royal Hospital are recruited into studies (these studies are often multicentre) assessing different aspects of the disease process and its features.

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Tissue bank

The Scleroderma and Raynaud’s Research Bank was set up in 2009 with the support of Salford Royal NHS Foundation Trust.

Consisting of DNA, serum, skin biopsies, calcinotic lumps and anonymised clinical and demographic data, this represents an important clinical resource in investigations of the cellular and molecular pathobiology and pathophysiology of systemic sclerosis and primary Raynaud’s phenomenon, including genetic studies to define genotypes (a person’s genetic makeup) that might be involved in pathogenesis (disease development).

The University of Manchester acts as the custodian of donated samples and data and issues such as consent, confidentiality and security of data are guided by the Salford Royal NHS Foundation Trust and the University research governance framework.

All samples and data are treated with respect, with total confidentiality and in accordance with donor consent.

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Clinical manifestations of systemic sclerosis

Digital ulcers in systemic sclerosis

Digital ulcers (on the fingers or toes) are a common manifestation of vascular abnormality in patients with systemic sclerosis but estimates of incidence and prevalence vary widely, and relatively little is known about the pathophysiology of active digital ulcers.

In 2013 we published our finding that at any one time, approximately 10% of patients with systemic sclerosis attending SRFT have at least one digital ulcers

We have an active programme of research into digital ulcers, including how to measure these.

Calcinosis

Approximately a quarter of patients with systemic sclerosis develop calcium containing lumps beneath the skin. These can be very painful, and can become infected and/or ulcerate through skin. We are researching why calcinosis occurs, how we can measure it, and also possible new approaches to therapy.

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Childhood scleroderma

Although childhood scleroderma is very rare, children can develop localised scleroderma and (extremely rarely) systemic sclerosis.

We have undertaken studies, in collaboration with Alder Hey Children’s Foundation Trust investigating childhood scleroderma. We have investigated the incidence and clinical features of childhood-onset scleroderma (both localised scleroderma and systemic sclerosis) in the UK and Ireland in conjunction with the British Paediatric Surveillance Unit.

More recently we have been undertaking a study examining non-invastive imaging methods of measuring areas of localised scleroderma in children.

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