Abstract
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. 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. 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 2nd and 3rd fingers. The correlation between the presence of connective tissue disease and the diagnosis of borderline SRP and SRP was significant (P=0.0001). 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.
Highlights
Acral perfusion disorders are relatively frequent diseases that are manifested by subjective feelings of cold hands or feet
We distinguish between primary Raynaud's phenomenon (PRP), which lacks further associated disease, and secondary Raynaud's phenomenon (SRP), which is the manifestation of another disease and can have a major impact on patients’ health[3,4,5] (Table 1)
The main conditions for inclusion of these patients were a history of RP symptoms characterised by feelings of cold hands, with anamnestic reporting of at least one colour change of fingers, and completion of capillaroscopic and infrared thermography (IRT) examinations in our lab
Summary
Acral perfusion disorders are relatively frequent diseases that are manifested by subjective feelings of cold hands or feet. Raynaud’s phenomenon is characterised by repeated attacks of colour changes of body extremities, mostly provoked by cold. A typical clinical picture of an attack of the disease is a so-called triphasic course of colour changes in the extremities. The initial phase is whitening, which is the most typical finding for RP and is caused by vasospasm This phase is followed by a cyanotic phase, which is induced by tissue hypoxia. A clinical picture of RP with a triphasic course of colour changes is typical for RP; without direct observation of such an attack, we must rely on patients’ anamnestic data, which can be rather distorted. Assessment of morphological changes of acral perfusion is possible with the use of capillaroscope[11,12,13]
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