Raynaud's Phenomenon Patients Research Articles

The Value of Nailfold Capillaroscopy in the Classification and Differential Diagnosis of Raynaud's Phenomenon in Rheumatology.

Among instrumental techniques, nailfold capillaroscopy plays a leading role in the assessment of Raynaud's phenomenon (RP) patients because it is the only method that provides opportunities for morphological assessment of capillaroscopic findings in the nailfold area, with proven diagnostic and prognostic significance in rheumatology. The discussion about updating the classification of RP in rheumatology is interesting given the current understanding of capillaroscopic findings in rheumatic diseases and improvements in immunological diagnostics. The presence of dilation of the "true" capillary diameters in primary RP could be observed. There are some cases of primary RP where the capillaroscopic pattern is completely normal and there are no dilated capillaries present, which could be related to the duration and severity of the symptoms. It is possible that longer duration and greater severity are associated with the appearance of capillary dilations, but more research is needed to confirm it. Rarely, pathological capillaroscpic features of microangiopathy could be observed in RP patients in whom clinical, laboratory and immunological findings are compatible with the diagnosis "primary RP". These cases should be defined as "suspected secondary RP" and require closer follow-up for the assessment of symptom evolution. Abnormal "scleroderma" type capillaroscopic pattern has been established as a new classification criterion for systemic sclerosis (SSc) in 2013. Similar changes ("scleroderma-like" pattern) could be observed in other rheumatic diseases, i.e., undifferentiated connective tissue disease (UCTD), systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, including without evidence of overlap with scleroderma. The appearance of such microvascular abnormalities at disease presentation is less well studied in diseases different from SSc. However, "scleroderma-like" microangiopathy has also been reported as an initial sign in some systemic rheumatic diseases, such as UCTD and systemic lupus erythematosus. Thus, interpretation of capillaroscopic findings is performed in overall context, including clinical findings and laboratory and immunological test results.

Capi-score: a quantitative algorithm for identifying disease patterns in nailfold videocapillaroscopy.

The European Alliance of Associations for Rheumatology (EULAR) supports the use of nailfold videocapillaroscopy (NVC) to identify disease patterns (DPs) associated with systemic sclerosis (SSc) and Raynaud's phenomenon (RP). Recently, EULAR proposed an easy-to-manage procedure, a so-called Fast Track algorithm, to differentiate SSc from non-SSc patterns in NVC specimens. However, subjectivity among capillaroscopists remains a limitation. Our aim was to perform a software-based analysis of NVC peculiarities in a cohort of samples from SSc and RP patients and, subsequently, build a Fast Track-inspired algorithm to identify DPs without the constraint of interobserver variability. NVCs were examined by 9 capillaroscopists. Those NVCs whose DPs were consensually agreed (≥2 out of 3 interobservers) were subsequently analysed with an in-house developed software. Each variable's results were grouped according to the consensually agreed DPs in order to identify useful hallmarks to categorise them. Eight-hundred and fifty-one NVCs (21 957 images) whose DPs had been consensually agreed were software-analysed. Appropriate cut-offs set in capillary density and percentage of abnormal and giant capillaries, tortuosities and hemorrhages allowed DP categorization and the development of the CAPI-Score algorithm. This consisted of 4 rules: Rule 1, SSc vs non-SSc, accuracy 0.88; Rules 2 and 3, SSc-early vs SSc-active vs SSc-late, accuracy 0.82; Rule 4, non-SSc normal vs non-SSc non-specific, accuracy 0.73. Accuracy improved when the analysis was limited to NVCs whose DPs had achieved full consensus among interobservers. The CAPI-Score algorithm may become a useful tool to assign DPs by overcoming the limitations of subjectivity.

The utility of USB microscope for assessment of Raynaud’s phenomenon patients in rheumatology practice

The aim of the study was to assess the utility of USB microscope (DinoLite) for evaluation of patients with primary and secondary Raynaud’s phenomenon (RP) in rheumatic diseases, , using magnification 200x.
 Methods: The study represents retrospective analysis of capillaroscopic images of 53 patients with RP – primary and secondary in the context of systemic sclerosis (SSc) or other rheumatic diseases i.e., undifferentiated connective tissue disease (UCTD), prescleroderma and systemic lupus erythematosus (SLE). Capillaroscopic images are obtained from 8 fingers (II÷V bilaterally) using USB microscope (DinoLite) at magnification 200x. Capillary diameters were measured (arterial, venous and apical loop) as well as the number of capillaries per millimeter and capillary length. The capillaroscopic images were categorized into the following groups i.e., 1. absence of microangiopathy: i) normal pattern, ii) nonspecific changes; 2. presence of microangiopathy i.e., “scleroderma/ scleroderma-like” pattern.
 Results: Images suitable for analysis with good visibility that permit analysis of the major capillaroscopic parameters were available in all patients (100%). Among 53 included patients, 14 patients were with SSc, 12 cases with primary RP, and 27 patients with secondary RP in other connective tissue diseases (22 patients with UCTD, 1 – with prescleroderma and 4 patients with SLE). „Scleroderma“ pattern was detected in 11 patients with SSc and in all these cases the capillaroscopic images were classifiable into one of the three distinct validated phases i.e., “early”, ”active” and ”late”. Presence of microvascular changes type “scleroderma-like” pattern was detected also in 17 among 27 patients with other connective tissue diseases. In primary RP patients, capillaroscopy revealed either normal pattern or nonspecific findings, but without features of microangiopathy.
 Conclusion: Capillaroscopic images of good quality, which could be analyzed and interpreted, are usually obtained using USB microscope. This permits evaluation of the major capillaroscopic parameters including quantitative measurement of the capillary diameters, capillary density and length. Assessment of the degree of microvascular changes i.e., staging of microangiopathy is also applicable and was possible in all cases with microangiopathy. The available software although less sophisticated vs those of videocapillaroscopes, providess the opportunity for adequate analysis of capillaroscopic parameters. The images obtained via USB microscope using magnification 200x are easily classified into “scleroderma”/“scleroderma-like” pattern, non-specific changes and normal findings using also the software of the device. Thus, USB microscopes using standard, 200x magnification could be suggested as an alternative of videocapillaroscopes in every day rheumatology practice especially in low-budget cases.

Capillaroscopic findings in undifferentiated connective tissue disease with Raynaud’s phenomenon

Background: Undifferentiated connective tissue disease (UCTD) is characterized with presence of clinical signs and immunological findings suggestive of connective autoimmune disease, but the criteria for a definite rheumatic disease are not fulfilled. Raynaud’s phenomenon (RP) could be found in approximately 50% of cases with UCTD and about half of patients with UCTD and RP exhibit “scleroderma-like” pattern.
 The aim of the study: To assess the characteristics of capillaroscopic changes in early UCTD.
 Patients and methods: Inclusion criterion for the study was newly diagnosed by rheumatologist, early UCTD in patients with RP. 26 patients were included in the study – 24 females and 2 males, mean age 38±14 years (range 19 – 66 years). Capillaroscopic examination was performed in all patients using USB microscope Dino-Lite. Follow-up was perfomed for a period between 1 and 3.5 years.
 Results and discussion: At the time of the initial diagnosis, “scleroderma-like” pattern, “early” phase (giant capillaries, presence of hemorrhages in some cases, preserved distribution, normal capillary density) was found in 17 patients (65%). More advanced capillaroscopic changes including devascularization and derangement were not observed. In 4 patients nonspecific capillaroscopic findings were present (dilated capillaries, hemorrhages, increased tortuousity, elongated capillaries,) and in 5 cases – normal capillaroscopic picture was found. During the follow-up in one patient the diagnosis was revised to systemic lupus erythematous due to newly appeared clinical, laboratory and immunological findings. The normal capillaroscopic pattern was changed to nonspecific findings in this case. Two patients fulfilled the criteria for prescleroderma during the follow-up without skin and visceral involvement. In the rest patients clinical diagnosis and capillaroscopic findings remained unchanged.
 Conclusion: In conclusion, “scleroderma” type microangiopathy, “early” phase is a common finding in UCTD with RP, while more advanced microvascular pathology is not usually observed. Stable capillaroscopic pattern during the follow-up correlates with the stable clinical course. Capillaroscopy is a key technique for assessment of RP patients in rheumatology and for early diagnosis of UCTD with peripheral vascular syndrome.

ID: 210803 High-Resolution-Doppler-Ultrasound as an Objective Outcome Parameter of ECAP-Controlled Closed-Loop SCS in Patients With Raynaud Phenomenon

Raynaud's phenomenon (RP) is an episodically occurring vasospasm of the peripheral arteries that causes cyanosis, erythema, pain, paresthesia, and sometimes ulceration of the fingers and/or toes [1]. In severe cases, RP patients have physical and functional impairments that substantially affect their ability to work. There are few reports, mostly case series, on the utility of spinal cord stimulation (SCS) to treat RP [2]–[9]. However, there is a lack of objective evidence on the physiological effects (e.g., vasodilation) of SCS in this condition. Here, we present clinical outcomes of severe RP patients treated with evoked compound action potential (ECAP)-controlled closed-loop SCS.

AB1680 BIOMARKERS IN PATIENTS WITH VIBRATION INDUCED RAYNAUD’S PHENOMENON AND IN REFERENTS

BackgroundSecondary Raynaud’s phenomenon (RP) due to occupational exposure to hand-held vibrating tools is a well-recognized part of the Hand arm vibration syndrome (HAVS) [1]. Different pathophysiological mechanisms for HAVS-induced RP have been proposed, e.g., localized structural vascular and neuronal injuries as well as systemic inflammatory processes by increased oxidative stress [2-5]. Elevated plasma levels of thrombomodulin (TM), a marker for endothelial damage, have been shown in vibration-exposed workers [6, 7] with equal levels as in collagen diseases [7]. Von Willebrand factor (vWF) has been suggested as biomarkers for vibration induced RP [8]. Elevated levels of vWF have been found in RP patients who subsequently develop scleroderma or other connective tissue diseases, even in the absence of capillaroscopic abnormalities [9]. It is however still not clear whether the mechanisms for vibration related RP are similar to those for other forms of RP. Biomarkers for vascular injuries may shed light on this.ObjectivesTo investigate serum levels of TM and vWF in patients with HAVS, with or without RP.MethodsBlood samples were collected in the morning from 92 patients with HAVS. Forty-five (49%) of these had RP, 47 (51%) did not. Serum was removed and stored at -80 °C until analysis. TM and vWF were measured by using commercially available ELISA assays. Distributions were compared with Mann-Whitney U tests.ResultsHigher values of TM were found in HAVS patients with RP (median 6.1 ng/ml; range 2.7 – 30), compared to those without RP (5.2 ng/ml; 2.3 – 39; p = 0.02). Further higher levels of vWF were found in HAVS patients with RP (18 µg/ml; 6.2 – 33) compared to without RP (14 µg/ml; 6.9 – 34; p = 0.008).ConclusionAs in patients with RP due to connective tissue disorders higher levels of biomarkers for endothelial damage were shown in HAVS patients with RP. Increased serum levels of TM have been shown in previous studies on vibration injured patients [8, 9] but in one of the studies, no significant difference was shown between patients with RP and those without RP [9]. Our data indicates that RP symptoms is required to detect a significant change in the biomarker TM in vibration injured patients. Our data strengthen earlier findings that biomarkers of endothelial damage could be a useful tool in the assessment of vibrational induced injuries.

Audiovestibular Manifestations in Patients with Primary Raynaud's Phenomenon and Raynaud's Phenomenon Secondary to Systemic Sclerosis.

To address the prevalence of audiovestibular disorders in patients with primary Raynaud's Phenomenon (RP). A series of patients with primary RP and secondary RP in the context of systemic sclerosis (SSc) were compared with healthy controls. A prospective multicenter observational cross-sectional study was conducted in several Otolaryngology and Rheumatology Divisions of tertiary referral hospitals, recruiting 57 patients with RP and 57 age- and gender-matched controls. Twenty patients were classified as primary RP when unrelated to any other conditions and 37 patients who met the 2013 ACR/EULAR classification criteria for SSc were classified as having secondary RP associated with SSc. Audiometric and vestibular testing (vHIT), clinical sensory integration and balance testing (CTSIB), and Computerized Dynamic Posturography (CDP) were performed. As significant differences were found in the age of the two study groups, primary and secondary RP, no comparisons were made between both groups of RP but only with their control groups. No sensorineural hearing loss (SNHL) was recorded in any of our patients with primary RP and no differences were found in the voice audiometry tests with respect to controls. Four of 37 (10.8%) secondary RP patients presented SNHL. Those with SNHL were 7.03 times more likely to have a secondary RP than controls (p < 0.001). The audiometric curve revealed high-frequency hearing loss in 4 patients with RP secondary to SSc, and statistically significant differences were achieved when RP secondary was compared to controls in vHIT gain, caloric test, CTSIB, and CDP. Unlike patients with RP secondary to SSc, patients with primary RP do not show audiovestibular abnormalities. Regarding audiovestibular manifestations, primary RP can be considered a different condition than secondary RP.

Peripheral Macrovascular Involvement in Systemic Sclerosis: A Cohort Study by Color and Spectral Doppler Ultrasonography.

Systemic sclerosis (SSc) is a disease characterized by diffuse sclerosis of skin and organs and small vessel vasculopathy. Despite it, large vessels can also be involved with ulnar artery vasculopathy, revealing as a more frequent feature of SSc. The aim of this paper is to assess the macrovascular involvement of SSc patients through an ultrasound (US) evaluation of radial and ulnar arteries. Radial and ulnar resistance indices (RIs) and peak systolic velocity (PV) (cm/s) together with clinical features of SSc patients were evaluated. Raynaud phenomenon (RP) and healthy control (HC) groups were used for comparison. Forty-three SSc patients were evaluated. Twelve patients (28%) had ulnar artery occlusions (UAOs). In nine cases (75%), UAOs were bilateral. A high UAO prevalence (42%) was found in SSc patients with late nailfold-video-capillaroscopy (NVC) pattern (p = 0.0264). Patients with UAOs had digital ulcers (DUs) in 10 cases (83.3%). Radial and ulnar PVs were lower in SSc and RP patients than the HC group. Radial and ulnar RIs were higher in SSc and RP patients than the HC group. A decision tree analysis led to the classification of 70% of SSc patients with an ulnar RI > 0.82 and ulnar PV > 2.8 cm/s. The most influential variables on UAO development were interstitial lung disease (ILD) (p = 0.002) and NVC pattern (p = 0.002). A positive correlation was shown between modified Rodnan skin score (mRSS) and ILD (p = 0.283; r = 0.033), mRSS and DU (r = 0.344; p = 0.012) and DU and ILD (r = 0.303; p = 0.024). Male sex was associated with increased UAO frequency (p = 0.042). UAO is a peculiar feature of severe SSc present in 28% of the cases, particularly associated with the presence of ILD and late NVC pattern. In 75% of the cases, UAOs are bilateral. DUs are very frequent in patients with UAOs (83%). The RI evaluated by US could be useful to distinguish SSc from HC patients. US could be a useful tool for assessing high-risk DU development in patients.

External clinical validation of automated software to identify structural abnormalities and microhaemorrhages in nailfold videocapillaroscopy images.

Automated systems to analyse nailfold videocapillaroscopy (NVC) images are needed to promptly and comprehensively characterise patients with systemic sclerosis (SSc) or Raynaud's phenomenon (RP). We previously developed, and validated in-house, a deep convolutional neural network-based algorithm to classify NVC-captured images according to the presence/absence of structural abnormalities and/or microhaemorrhages. We present its external clinical validation. A total of 1,164 NVC images of RP patients were annotated by 5 trained capillaroscopists according to the following categories: normal capillary; dilation; giant capillary; abnormal shape; tortuosity; microhaemorrhage. The images were also presented to the algorithm. Matches and discrepancies between algorithm predictions and those annotations obtained by consensus of ≥3 or ≥4 interobservers were analysed. Consensus among ≥3 capillaroscopists was achieved in 86.9% of images, 75.8% of which were correctly predicted by the algorithm. Consensus among ≥4 experts occurred in 52.0% of cases, in which 87.1% of the algorithm's results matched with those of the expert panel. The algorithm's positive predictive value was >80% for microhaemorrhages and unaltered, giant or abnormal capillaries. Sensitivity was >75% for dilations and tortuosities. Negative predictive value and specificity were >89% for all categories. This external clinical validation suggests that this algorithm is useful to assist in the diagnosis and follow-up of SSc or RP patients in a timely manner. It may also be helpful in the management of patients with any pathology presenting with microvascular changes, as the algorithm has been designed to also be useful for research aiming at extending the usage of nailfold capillaroscopy to more conditions.

PO263 / #744 PERIPHERAL CIRCULATION ASSESSMENTS TO INVESTIGATE ECAP-CONTROLLED CLOSED-LOOP SCS PATIENT OUTCOME IN RAYNAUD PHENOMENON: E-POSTER VIEWING

Raynaud's phenomenon (RP) is an episodically occurring vasospasm of the peripheral arteries that causes cyanosis, erythema, pain, paresthesia, and sometimes ulceration of the fingers and/or toes [1]. In severe cases, RP patients have physical and functional impairments that substantially affect their ability to work. There are few reports, mostly case series, on the utility of spinal cord stimulation (SCS) to treat RP [2]–[9]. However, there is a lack of objective evidence on the physiological effects (e.g., vasodilation) of SCS in this condition.

Understanding the value of non-specific abnormal capillary dilations in presence of Raynaud’s phenomenon: a detailed capillaroscopic analysis

BackgroundNailfold videocapillaroscopy (NVC) non-specific abnormalities may be present in subjects with isolated Raynaud’s phenomenon (RP) before the potential transition to systemic sclerosis (SSc) specific microvascular alterations (‘scleroderma pattern’). This study...

Detailed videocapillaroscopic microvascular changes detectable in adult COVID-19 survivors.

ObjectiveCOVID-19 is a multisystem disease that causes endothelial dysfunction and organ damage. Aim of the study was to evaluate the microvascular status in COVID-19 survivors with past different disease severity, in comparison with age and sex-matched primary Raynaud's phenomenon (PRP) patients and control subjects (CNT), including possible effects of concomitant therapies.MethodsSixty-one COVID-19 survivors (mean age 58 ± 13 years, mean days from disease onset 126 ± 53 and mean days from recovery 104 ± 53), thirty-one PRP patients (mean age 59 ± 15 years, mean disease duration 11 ± 10 years) and thirty CNT (mean age 58 ± 13 years) underwent nailfold videocapillaroscopy (NVC) examination. The following capillaroscopic parameters were searched and scored (0–3): dilated capillaries, giant capillaries, isolated microhemorrhages, capillary ramifications (angiogenesis) and capillary number, including absolute capillary number per linear millimeter at the nailfold bed.ResultsThe mean nailfold capillary number per linear millimeter was significantly lower in COVID-19 survivors when compared with PRP patients and CNT (univariate and multivariate analysis p < 0.001). On the contrary, COVID-19 survivors showed significantly less isolated microhemorrhages than PRP patients and CNT (univariate and multivariate analysis, p = 0.005 and p = 0.012, respectively). No statistically significant difference was observed between COVID-19 survivors and control groups concerning the frequency of dilated capillaries and capillary ramifications. COVID-19 selective therapies showed a promising trend on preserving capillary loss and deserving further investigations.ConclusionsSARS-CoV-2 seems to mainly induce a significant loss of capillaries in COVID-19 survivors at detailed NVC analysis in comparison to controls. The presence of a significant reduced score for isolated microhaemorrhages in COVID-19 survivors deserves further analysis.

The frequency of Raynaud\u2019s phenomenon, very early diagnosis of systemic sclerosis, and systemic sclerosis in a large Veteran Health Administration database

BackgroundWe describe Raynauds phenomenon (RP), potential very early diagnosis of systemic sclerosis (VEDOSS), and systemic sclerosis (SSc) in Veterans deployed in support of Post-9/11 operations. We sought to describe the military occupation specialty, clinical features, and vasodilator use across the three diagnoses.MethodsIndividual Veterans medical records were assessed for RP (ICD-9443.0), VEDOSS with swelling of hands (ICD-9729.81) and RP (ICD-9443.0), and SSc (ICD-9710.1). The distribution of sociodemographic, military service branch, job classification, vasodilator use, and comorbidities were examined across the three classifications of disease. The chi-squared test and Fisher’s exact compared frequency of these categorical variables. Logistic regression assessed the likelihood of characteristics of the three classifications.ResultsIn this population of 607,665 individual Veteran medical records, 857 had RP, 45 met possible VEDOSS criteria, and 71 had a diagnosis of SSc. The majority of RP, potential VEDOSS and SSc cases were white males. Those in craftworks, engineering or maintenance, and healthcare had a greater likelihood of RP. Less than half of RP and VEDOSS patients were on vasodilators. The most common comorbidities in this population were the diagnostic code for pain (highest in the potential VEDOSS group [81.6%]), followed by depression in all groups.ConclusionThis is a unique Veteran population of predominately-male patients. Our data suggests that vasodilator medications are potentially being under-utilized for RP and potential VEDOSS. Our data highlights mood and pain management as an important aspect of SSc care.

Abnormality Detection in MRI as a Diagnostic Tool for Raynaud's Phenomenon

Background Raynaud's phenomenon (RP), a disorder of episodic vasospasms found in the digits, is triggered by exposure to cold or stress. Typically, RP presents as a triphasic color pattern from pallor to cyanosis to rubor. Current diagnostic tools include nailfold capillaroscopy, thermography, color doppler ultrasound, cold stimulation test, and clinical findings. Due to expense, lack of availability, and reproducibility of results, there is no present universal, gold standard diagnostic method. Magnetic Resonance Imaging (MRI) has been used for diagnosis or prognosis, with associated abnormalities in RP patients. This research analyzes the potential use of MRI as an accurate and universal diagnostic tool for RP. Methods A search of PubMed and Google Scholar databases was conducted using the search terms: “Abnormal MRI, Raynaud's”, “MRI, Raynaud's Syndrome”, “Magnetic resonance, Raynaud's”, “Magnetic resonance angiography, Raynaud's”. A total of 13 papers were found, including 99 cases of Raynaud's patients, for analysis and incorporation into this review. Articles presenting cases of Raynaud's symptoms secondary to tumors or cysts were excluded. Results 99 patients (average age = 39.58 years old, age range = 18-80; gender = 54 female, 12 male, 33 unspecified), presented with RP with 98 MRIs completed. 30 patients presented with Primary Raynaud's Syndrome (PRS) and 69 presented with Secondary Raynaud's Syndrome (SRS). 88.78% of MRIs were abnormal. 84.06% of SRS patients had abnormal MRI results. SRS patients with normal results were limited to scans of the brain (3 with underlying systemic lupus erythematosus; 8 with systemic sclerosis). 100% of the PRS patients had abnormal MRI results. Conclusion Majority of MRIs identified abnormalities associated with RP, suggesting its potential as a diagnostic tool for RP. Abnormal MRI results were more accurate in identifying RP for PRS (100%) compared to SRS (84.06%). MRIs were found to be applicable in large patient populations, non-restrictive of age or gender. A limitation to the study included multiple, overlapping terms (RP, Raynaud's disease and Raynaud's syndrome) found in manuscripts, which contribute to confounding of results. Additionally, the various MRI locations (eg., extremity, heart, brain) could impact findings.

Convolutional Neural Networks for Differential Diagnosis of Raynaud’s Phenomenon Based on Hands Thermal Patterns

Raynaud’s phenomenon (RP) is a microvessels’ disorder resulting in transient ischemia. It can be either primary or secondary to connective tissue diseases, such as systemic sclerosis. The differentiation between primary and secondary to systemic sclerosis is of paramount importance to set the proper therapeutic strategy. Thus far, thermal infrared imaging has been employed to accomplish this task by monitoring the finger temperature response to a controlled cold challenge. A completely automated methodology based on deep convolutional neural network is here introduced with the purpose of being able to differentiate systemic sclerosis from primary RP patients by relying uniquely on thermal images of the hands acquired at rest. The classification performance of such a method was compared to that of a three-dimensional convolutional neural network model implemented to classify thermal images of the hands recorded during rewarming from a cold challenge. No significant differences were found between the two procedures, thus ensuring the possibility to avoid the cold challenge. Moreover, the convolutional neural network models were compared with standard feature-based approaches and showed higher performances, thus overcoming the limitations related to the feature extraction (e.g., biases introduced by the operator). Such automated procedures can constitute promising tools for large scale screening of primary RP and secondary to systemic sclerosis in clinical practice.

Clinical relevance of combining Thermography with Nailfold Capillaroscopy to improve differentiation between primary and secondary Raynaud’s Phenomenon

Objectives: Early microvascular damage and dysfunction are clinically mirrored in Raynaud’s phenomenon (RP). Currently, nailfold capillaroscopy (NC) is applied to differentiate between primary RP (PRP) and secondary RP (PRP), associated with connective tissue disease. However, abnormal morphology can also be caused due to age-related changes and cardiovascular disease. Thermography (TG) is a non-invasive technique which enables quantification of cutaneous vascular function. An approach using both NC and TG could improve the differentiation between PRP and SRP. Methods: Thirty RP patients (PRP, n = 21; SRP, n = 9) underwent nailfold capillaroscopy and thermography. Morphologic features were scored and patients were categorized according to the guidelines of EULAR Study group on Microcirculation in Rheumatic Diseases. TG of the hand was performed before, directly and ten minutes after a cold challenge test. Baseline images and rewarming curves were analyzed. Results: Capillary abnormalities with NC were found in all SRP patients (9/9) and in 48% (10/21) of PRP patients. Out of 10 PRP patients with altered capillary morphology, 9 (90%) had a cardiovascular disease. For all patients mean temperature was significantly higher 10 minutes after cold induction than before (p &lt; 0,01). The gradient of the rewarming curve was significantly lower in patients with SRP compared to PRP patients (p = 0.015). Conclusions: Nailfold capillaroscopy and thermography can reliably be used to measure microvascular damage and dysfunction. Additional thermography can assist in differentiating between PRP and SRP, especially in elderly patients or in presence of a cardiovascular disease. Keywords: Raynaud’s phenomenon; Nailfold capillaroscopy; Thermography

Design of Electro-Thermal Glove with Sensor Function for Raynaud's Phenomenon Patients.

Raynaud’s phenomenon (RP) is a disease that mainly affects human fingertips during cold weather. It is difficult to treat this disease using medicine, apart from keeping the body in a warm environment. In this research, conductive knitted fabrics were fabricated to help relax the vessels of the patient’s fingertips by providing proper heat, and also serving as a sensor to detect finger motion after relaxation of the blood vessels of patients. Four different structures, termed plain, purl, interlock, and rib were produced using conductive silver/PE (polyethylene) yarn and wool yarn, with a computerized flat knitting machine. The effect of knitted structure on the electro-thermal behavior, sensitivity, and stability of resistance change (∆R/R) under different tensile forces was investigated. By comprehensive comparison, the purl structure was identified as the preferred structure for the heating glove for RP patients, owing to superior electro-thermal behavior. Additionally, the purl structure had a greater capacity to detect different motions with stable resistance change. This potential electro-thermal glove could be used for functional, as well as aesthetic (fashion) purposes, and could be worn at any time and occasion with complete comfort.

Raynaud’s Phenomenon Impact on Quotidian Quality of Life

&lt;strong&gt;Objective: &lt;/strong&gt;To gain further understanding into the needs of Raynaud’s phenomenon (RP), patient questionnaires were conducted in England, UK 2017 at an SRUK patient conference and Porto, Portugal 2018 at Central Hospital Universitário Porto (CHUP). The questions focused on daily activities and experience. &lt;strong&gt;Method&lt;/strong&gt;: Sixty-four participants answered questions on their daily experience with RP, specific and general. Analysis grouped results into topics quantified by number and %.&lt;strong&gt; Results:&lt;/strong&gt; Although many tasks trigger RP episodes, some are more problematic than others, e.g. peeling vegetables; for many, the pain (46.9%) is not the worst part, but instead the hinderance in function, inability (73.4%) especially regarding hands and fingers. &lt;strong&gt;Conclusion:&lt;/strong&gt; A Design Specification (DS) criteria for RP patients’ hands is formed through the listed activities. The key needs identified for RP patients fingers and hands are maintenance of: Dexterity, Tactility and Comfort whilst cohering to aesthetic needs &amp;amp; wellbeing.

Raynaud Phenomenon: Diagnosis and Management

ABSTRACT&#x0D; Raynaud’s phenomenon (RP) is a chronic episodic attack of digital ischemia provoked by exposure to cold or emotional stres. This phenomenon affects 3-5% of the population, with female ratio more than men and is categorized into a primary and secondary form. Primary form of RP is idiopathic, meanwhile the secondary form is associated with underlying diseases and other condition such as connective tissue disease, obstructive arterial disease, neurologic disorders, drugs and toxin, hyperviscosity disorders, infections, endocrine disturbance, neoplasms, and occupation or environmental exposure. Until today, to classified and build the diagnosis of RP is still a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy are mandatory. A combination of conservative measures and medications can help in the management of RP. The approach to the RP patients requires therefore a coordinated care of specialists including dermatology.

PLASMA ATHEROGENIC INDEX IS AN INDEPENDENT INDICATOR AND PROGNOSTIC VALUE IN RAYNAUD’S PHENOMENON?

Objective: Raynaud’s phenomenon (RP) is characterized by cold induced temporary ischaemia of the fingers or toes and an inflammatory autoimmune disease of connective tissues. Plasma atherogenic index (PAI) is a valuable marker for the cardiovascular disease and cardiac risk. The aim of this study was to evaluate the role and clinical use of PAI in RP patients.&#x0D; Materials and Methods: In this retrospective-cohort study, we examined the clinical value count blood cells in 55 patients with RP and 14 clinical controls admitted Konya Training and Research Hospital Department of Cardiovascular Surgery between January 2016-March 2019 were investigated retrospectively screened. PAI was measured as a logarithmic value of triglyceride to high-density cholesterol ratio. PAI levels &lt;0.11 is accepted as low risk, 0,11-0,21 intermediate risk, and 0.21 &gt;increased risk. PAI was measured as a logarithmic value of triglyceride to high-density cholesterol ratio. The lipid and other biochemical parameters of patient and control groups were examined and measured.&#x0D; Results: The study consisted of 29 females (42.03%) and 40 males (57.97%). There was a significant difference between differences between PAI level groups. There was no significant difference in PAI results between genders (p&gt;0.355).We also found disagreement in biochemical parameters and PAI between controls and patients.&#x0D; Conclusion: When we evaluated PAI in the patients with RP and controls, it was determined that there was no significant difference in either parameter. However, PAI levels have showed that significant elevated between groups so It can be a simple, economic and non invasive marker to identify for future studies.&#x0D; Keywords: Raynaud’s phenomenon, Plasma atherogenic index, Blood lipid components