AB0933 RAYNAUD´S PHENOMENON AND RELATED SYNDROMES CLINIC: CHARACTERIZATION OF NEWLY REFERRED PATIENTS AND DIFFERENCES BETWEEN PRIMARY AND SECONDARY RAYNAUD´S PHENOMENON

Abstract

BackgroundThe Raynaud´s Phenomenon (RP) and Related Syndromes Clinic was created in the Rheumatology Department at Hospital de Braga in order to provide differentiated health care to the population with RP, emerging as a unique outpatient clinic in the country. The aim of this Clinic is to evaluate patients who present with this clinical manifestation in a prompt and multidisciplinary approach, considering the differential diagnosis between the primary and secondary etiology. In this way, adequate monitoring can be carried out, such as performing a Nailfold Videocapillaroscopy (NVC) and early and targeted therapy instituted.ObjectivesCharacterize the individuals evaluated in first RP and Related Syndromes Clinic appointments and determine predictive factors allowing to distinguish primary and secondary RP.MethodsRetrospective, single center study, including patients who were evaluated in first RP and Related Syndromes appointments between February 2021 and December 2022. Sociodemographic variables, clinical data and the results of the complementary study such as anti-nuclear antibodies (ANA) profile and NVC pattern were analyzed. Statistical analysis of the data was performed using SPSS, using the Chi-square and the t-Test independent samples tests, as appropriate. A p value < 0.05 was considered statistically significant.ResultsFifty four patients were included (female 88,89%, male 11,11%; mean age 52,48±17,06 years), referred to this clinic with the following main reasons: suspected RP (64,82%), suspected connective tissue disease (CTD) (31,48%) and laboratory tests changes (3,7%). Among these patients, 43 patients had RP: primary in 12 (27,91%) and secondary in 31 (72,09%). A total of 42 NVC were performed: normal pattern in 30,95%; nonspecific changes in 28,57%; early scleroderma pattern in 21,43% and active scleroderma pattern in 19,05%. The diagnosis established in the 54 patients evaluated were: acrocyanosis (1,85%), erythema pernio (7,41%), frostbite (1,85%), Achenbach Syndrome (1,85%), Systemic Sclerosis (SSc) (31,48%) - 11,76% Very Early Diagnosis Of SSc; 5,88% SSc diffuse cutaneous form; 82,35% SSc limited cutaneous form -, undifferentiated CTD (3,70%), primary RP (22,22%) and secondary RP non-CTD (22,22%) - includes patients with RP secondary to tobacco, betablockers, SARS-Cov2 infection or autoimunne thyroiditis. 7,42% of the patients didn´t have RP or a rheumatic disease. Ten patients were discharged, with the remaining patients being followed regularly. Table 1 summarizes the characterization of patients with primary and secondary RP. Comparing patients with primary RP with patients with secondary RP, we found that older age, ANA´s positivity, taking betablockers and an altered NVC pattern was statistically significantly associated with the diagnosis of a secondary RP.ConclusionWith this work, we emphasize the importance of RP investigation in order to establish a definitive diagnosis and an adequate follow up, showing a higher probability of secondary RP in patients with older age, positive ANA´s and who were taking betablockers. It reinforces, as well, the importance of NVC in the evaluation of patients with RP, as significant differences are found between primary and secondary RP, with scleroderma pattern raising the hypothesis of a secondary RP.Table 1.Characterization of patients with primary and secondary RP and p-value of statistical tests used to compare patients with primary RP and secondary RP for each variable in study.Primary RP (n=12)Secondary RP (n=31)p-valueAge (years)43.92 (±18.38)58.68 (±13.29)0.006Sex0.300Feminine1226-Masculine05-RP duration (years)11.888.510.453Active smoking271.000Beta-blockers0100.040RP symmetry0.500Symmetric816-Assymetric415-History of digital ulcers060.163ANA<0.001Negative116-Positive125-NVC Pattern<0.001Normal102-Inespecific chages28-Early stage scleroderma09-Active stage scleroderma08-REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.