The validity of Raynaud's phenomenon symptoms in HAVS cases

Abstract

Raynaud's phenomenon, a common manifestation of the hand-arm vibration syndrome (HAVS), is typically diagnosed by a subjective history provided by employees. This study evaluates the validity of the subjective history of Raynaud's phenomenon provided by individuals applying for compensation for HAVS. Thirty-six workers with a history of occupational hand-arm vibration exposure who were labelled as having Raynaud's phenomenon were asked to photographically document their finger symptoms before undergoing a detailed clinical assessment. Each individual was provided with a disposable camera and instructions. Returned photographs were reviewed for signs of Raynaud's phenomenon. The reliability of photograph interpretation was tested with three physicians and a non-physician. Inter and intra-rater reliability was very good, Kappa coefficient >0.80. Six individuals (17%) did not return cameras. Thirty individuals provided photographs and underwent a clinical evaluation. The photographs of 13 individuals (43%) did not show Raynaud's phenomenon and for four of these the diagnosis was not supported by careful symptom history. Seventeen individuals (57%) had photographic evidence of Raynaud's phenomenon. A presenting history of Raynaud's phenomenon in workers seeking compensation for HAVS may not be accurate since approximately half the cases are unable to provide objective photographic evidence of Raynaud's phenomenon.