Abstract
The pathogenesis of secondary Raynaud's phenomenon (SRP) associated with connective tissue diseases (CTD) is not entirely understood. Nervous system dysfunction and microangiopathy are considered to be causes of this pathology. Peripheral and autonomic nervous system function, the stage of microangiopathy, and the relationships between these in patients with SRP were analyzed. In the study, 20 patients with CTD-related SRP and 30 healthy controls were subject to capillaroscopy, standard conduction velocity tests and conduction velocity distribution (CVD) tests in ulnar and peroneal nerves, heart rate variability (HRV), and sympathetic skin response (SSR) tests. There were no significant differences in the standard motor and sensory conduction velocity tests, or in CVD tests in the ulnar and peroneal nerves in SRP patients compared with the controls. The patients with SRP had a significantly lower SSR amplitude and longer latency in hands and feet. The patients with CTD-related SRP had a significantly lower mean HRV with higher low frequency (LF) values in the spectral analysis and expiration/inspiration ratio (E/I) during deep breathing. There was no correlation between the stage of microangiopathy and neurophysiological test results. Correct standard conduction velocity and CVD testing in patients with SPR suggest that vasomotor disturbances may occur in CTD regardless of peripheral neuropathy. The lack of relationship between SSR and microangiopathy could confirm that these 2 processes occur independently in patients with CTD-related SRP. Autonomic nervous system impairment together with normal peripheral nerve function suggest the central origin of CTD-related SRP.
Highlights
Raynaud’s phenomenon (RP) occurs as recurrent episodes of the discoloration of fingers and/or toes in the course of reversible vasospasm in response to cold or to emotional stress.[1]
There were no significant differences in the standard motor and sensory conduction velocity tests, or in conduction velocity distribution (CVD) tests in the ulnar and peroneal nerves in secondary Raynaud’s phenomenon (SRP) patients compared with the controls
Correct standard conduction velocity and CVD testing in patients with SPR suggest that vasomotor disturbances may occur in connective tissue diseases (CTD) regardless of peripheral neuropathy
Summary
Raynaud’s phenomenon (RP) occurs as recurrent episodes of the discoloration of fingers and/or toes in the course of reversible vasospasm in response to cold or to emotional stress.[1]. Secondary Raynaud’s phenomenon (SRP) is associated with different underlying diseases. SRP is a characteristic – not specific – symptom of connective tissue diseases (CTD). SRP can overtake the development of the underlying disease by as much as several years, and, requires special observation. SRP occurs in 80% of patients with scleroderma, 10–35% of those with systemic lupus erythematosus, and 30% of dermatomyositis patients; it is the 1st symptom of the disease in about 33% of systemic connective tissue diseases (CTD).[2,3,4,5,6]. The pathogenesis of secondary Raynaud’s phenomenon (SRP) associated with connective tissue diseases (CTD) is not entirely understood. Nervous system dysfunction and microangiopathy are considered to be causes of this pathology
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