Abstract
Symptoms of Raynaud’s phenomenon (RP) are common in fibromyalgia syndrome (FMS). We compared symptom characteristics and objective assessment of digital microvascular function using infrared thermography (and nailfold capillaroscopy where available) in patients with FMS (reporting RP symptoms) and primary RP. We retrospectively reviewed the outcome of microvascular imaging studies and RP symptom characteristics (captured using patient-completed questionnaire at the time of assessment) for patients with FMS (reporting RP symptoms) and patients with primary RP referred for thermographic assessment of RP symptoms over a 2-year period. Of 257 patients referred for thermographic assessment of RP symptoms between 2010 and 2012, we identified 85 patients with primary RP and 43 patients with FMS. There were no differences in RP symptom characteristics between FMS and primary RP (p > 0.05 for all comparisons). In contrast, patients with FMS had higher baseline temperature of the digits (32.1 vs. 29.0 °C, p = 0.004), dorsum (31.9 vs. 30.2 °C, p = 0.005) and thermal gradient (temperature of digits minus temperature of dorsum; +0.0 vs. −0.9 °C, p = 0.03) compared with primary RP. Significant differences between groups persisted following local cold challenge. In primary RP, patient reporting “blue” digits, bi-phasic and tri-phasic RP was associated with lower digital perfusion. In contrast, no associations between skin temperature and RP digital colour changes/phases were identified in FMS. Our findings suggest that symptoms of RP in FMS may have a different aetiology to those seen in primary RP. These findings have potential implications for both the classification of RP symptoms and the management of RP symptoms in the context of FMS. Digital colour changes reported by patients might reflect the degree of digital microvascular compromise in primary RP.
Highlights
Raynaud’s phenomenon (RP) describes intermittent excessive vasoconstriction of digital vessels in response to cold exposure and emotional stress [1]
We retrospectively assessed RP symptom characteristics and microvascular imaging study findings in patients with a clinician diagnosis of either fibromyalgia syndrome (FMS) or primary RP referred for assessment of RP symptoms over a 2-year period
We received written confirmation from the National Research Ethics Service confirming that Research Ethics Committee approval was not required for a retrospective review of data obtained under normal clinical practice [under UK-wide Governance Arrangements for Research Ethics Committees (GAfREC)]
Summary
Raynaud’s phenomenon (RP) describes intermittent excessive vasoconstriction of digital vessels in response to cold exposure and emotional stress [1]. Attacks of RP are typically associated with digital cutaneous colour changes including a “white” phase (vasoconstriction), a “blue” phase (cyanosis) and a “red” phase (reactive hyperaemia) [1]. A history of increased sensitivity to cold and the presence of two digital colour changes are considered sufficient to make a “definite” diagnosis of RP [2]. No studies have compared and contrasted RP symptom characteristics and outcome of microvascular imaging studies in FMS (reporting RP symptoms) and primary RP. We retrospectively assessed RP symptom characteristics and microvascular imaging study findings (infrared thermography ± nailfold capillaroscopy [NC]) in patients with a clinician diagnosis of either FMS or primary RP referred for assessment of RP symptoms over a 2-year period
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