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Clinical Rheumatology Oct 2021The aim at the current study was to investigate the clinical characteristics and risk factors of Raynaud's phenomenon (RP) in patients with primary Sjögren's syndrome...
OBJECTIVE
The aim at the current study was to investigate the clinical characteristics and risk factors of Raynaud's phenomenon (RP) in patients with primary Sjögren's syndrome (pSS).
METHODS
Retrospective analysis of the medical records of 333 new-onset pSS patients was performed. Demographic, clinical, and serological data were compared between individuals with and without RP. Logistic regression analysis was used to identify risk factors.
RESULTS
RP was present in 11.41% of the pSS patients. pSS-RP patients were younger (49.74±14.56 years vs. 54.46±13.20 years, p=0.04) and exhibited higher disease activity (11 [5.75-15] vs. 7 [4-12], p=0.03) than those without. The prevalence of lung involvement was significantly higher in pSS patients with RP (60.53% vs. 17.29%; p<0.001). A significantly higher proportion of patients with pSS-RP tested positive about antinuclear (ANA), anti-RNP, and anti-centromere antibodies (ACA) compared to those without (p=0.003, <0.001, and 0.01, respectively). Multivariate analysis identified lung involvement (odds ratio [OR]=8.81, 95% confidence interval [CI] 2.02-38.47; p=0.04), anti-RNP positive status (OR=79.41, 95% CI 12.57-501.78; p<0.0001), as well as ACA (OR=13.17, 95% CI 2.60-66.72; p=0.002) as prognostic factors for pSS-RP.
CONCLUSION
The presence of RP defined a subset of pSS with a unique phenotype, manifesting as increased lung involvement and a higher frequency of anti-RNP antibodies and ACA, as well as greater disease activity. These results suggest that RP has clinical and prognostic value of pSS patients. Further prospective studies with a larger number of subjects are warranted to confirm our findings and assess the prognostic and treatment implications of RP in pSS patients. Key Points • Raynaud's phenomenon (RP) was present in 38 (11.41%) of 333 patients with primary Sjögren's syndrome (pSS), with patients with RP exhibiting a younger age and higher disease activity. • The presence of RP indicates a subset of pSS with a unique phenotype, with manifestations including increased lung involvement and a higher frequency of anti-RNP antibodies and anti-centromere antibodies. • Patients with pSS and RP need close follow-up and long-term observation (including assessment of microangiopathy), with specific attention paid to the possible development of clinical features of systemic sclerosis.
Topics: Humans; Prospective Studies; Raynaud Disease; Retrospective Studies; Risk Factors; Sjogren's Syndrome
PubMed: 33914202
DOI: 10.1007/s10067-021-05749-w -
British Journal of Industrial Medicine Jun 1986
Topics: Humans; Muscular Diseases; Occupational Diseases; Peripheral Nervous System Diseases; Raynaud Disease; Vibration; Wounds and Injuries
PubMed: 3013276
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jul 1993
Topics: Humans; Occupational Diseases; Occupational Health; Raynaud Disease; Syndrome; United Kingdom; Vibration
PubMed: 8343729
DOI: 10.1136/bmj.307.6896.79 -
British Medical Journal (Clinical... Jul 1986
Topics: Humans; Raynaud Disease
PubMed: 3089429
DOI: 10.1136/bmj.293.6539.88 -
British Medical Journal (Clinical... May 1981
Topics: Diagnosis, Differential; Humans; Occupational Diseases; Raynaud Disease; Reference Standards; Syndrome; Vibration
PubMed: 6786598
DOI: No ID Found -
Vascular Medicine (London, England) Jun 2015
Topics: Humans; Raynaud Disease; Risk Factors
PubMed: 25878215
DOI: 10.1177/1358863X15579122 -
Rheumatology (Oxford, England) Sep 2017RP is an exaggerated vasospastic response to cold or emotion. Randomized, double-blind, placebo-controlled trials with either parallel group or cross-over trials should... (Review)
Review
RP is an exaggerated vasospastic response to cold or emotion. Randomized, double-blind, placebo-controlled trials with either parallel group or cross-over trials should be mainly considered. Cross-over design, which is good for early phase trials of immediate or very short-term outcomes, is important in a condition as heterogeneous as RP: a wash-out period between treatment arms should always be included to minimize the possibility of a period (carry-over) effect. Duration of RP trials is usually constrained by the need to complete these over a single season, usually winter when the weather is colder. For cross-over trials, each treatment arm tends to be 4 weeks or less. Frequency and duration of attacks, and the Raynaud's Condition Score are widely used outcome measures. There is increasing interest in physiological laboratory endpoints, for example laser Doppler imaging at least for early phase trials.
Topics: Clinical Trials as Topic; Humans; Raynaud Disease; Scleroderma, Systemic
PubMed: 28992170
DOI: 10.1093/rheumatology/kex199 -
Journal of Vascular Surgery Jul 2011Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of... (Review)
Review
BACKGROUND
Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia.
METHODS
We reviewed the English literature between 1980 and 2010. Our analysis included reports with the clinical end points of relief, recurrence of symptoms or healing of ulcers, or both. Primary Raynaud disease (PRD) and secondary Raynaud phenomenon (SRP) were analyzed separately.
RESULTS
An initial postoperative positive effect was reported in 92% of PRD patients and in 89% of SRP patients. Long-term beneficial effect was 58% for PRD and 89% for SRP. Ulcer healing or improvement was achieved in 95%.
CONCLUSIONS
The available evidence suggests that thoracic sympathectomy has a role in the treatment of severe PRD and SRP, albeit with better results in SRP patients than in PRD patients. In case of digital ulceration, thoracic sympathectomy may maximize tissue preservation or prevent amputation.
Topics: Evidence-Based Medicine; Fingers; Humans; Ischemia; Raynaud Disease; Skin Ulcer; Sympathectomy; Thoracic Nerves; Time Factors; Treatment Outcome; Wound Healing
PubMed: 21652164
DOI: 10.1016/j.jvs.2011.01.069 -
Biomedical Papers of the Medical... Mar 2021Raynaud's phenomenon (RP) is a relatively common disease. There are two distinct forms of RP - primary (PRP), where no other associated diseases are present, and...
AIMS
Raynaud's phenomenon (RP) is a relatively common disease. There are two distinct forms of RP - primary (PRP), where no other associated diseases are present, and secondary (SRP), where RP is associated with other diseases. It can be challenging to differentiate between RP and other diseases through medical history alone, due to the episodic nature of RP. Objective analysis of anamnestic data was performed in our study using infrared thermography (IRT) and a cold pressor test (CPT). Capillaroscopy was performed to assess morphological changes in the acral circulation.
METHODS
Patients with a history of cold hands were included in the study. IRT was performed before and after the CPT, and then capillaroscopy was performed. The results (including epidemiologic data) were statistically evaluated.
RESULTS
A total of 150 patients were included in the study. Summarisation of the results from the IRT and capillaroscopy determined the final diagnosis - 4.7% acrocyanosis, 10.7% physiologic findings, 31.3% PRP, 29.3% borderline SRP and 24% SRP. The coldest fingers following the CPT were, in most patients, the 2 and 3 fingers. The correlation between the presence of connective tissue disease and the diagnosis of borderline SRP and SRP was significant (P=0.0001).
CONCLUSIONS
Using the combination of the IRT and capillaroscopy in the diagnostic algorithm for RP has its justification. IRT distinguishes healthy patients from patients with RP, and capillaroscopy can then be used to differentiate PRP from SRP. IRT can also detect which fingers are more affected, and then these can direct the focus of capillaroscopy.
Topics: Adult; Female; Humans; Infrared Rays; Male; Microscopic Angioscopy; Middle Aged; Raynaud Disease; Thermography
PubMed: 32686771
DOI: 10.5507/bp.2020.031 -
Rheumatology (Oxford, England) May 2022
Topics: Humans; Lung Diseases, Interstitial; Microscopic Angioscopy; Nails; Raynaud Disease
PubMed: 35199140
DOI: 10.1093/rheumatology/keac102