Raynaud's phenomenon is a symptom complex manifested as intermittent fingertip ischemia caused by cold or other sympathetic drivers. Secondary Raynaud's phenomenon is often more severe and could even lead to finger ulceration, making it particularly complicated to treat. We describe a case of severe Raynaud's phenomenon secondary to subclinical hypothyroidism lasting for more than 6 hours in a 65-year-old woman. The patient was also diagnosed with hypothyroidism, epilepsy, and secondary soft tissue infection of the right middle and ring fingers. After careful multidisciplinary consultation and discussion, the patient received vasodilation, anticoagulation, thyroxine supplementation, stellate ganglion block, hyperbaric oxygen therapy and debridement. The patient responded well to the medication, avoiding amputation or obviously dysfunction. Multidisciplinary team gathering the doctors from different departments proposes appropriate strategies for patients with severe Raynaud's phenomenon and could improve the prognosis and satisfaction of patient effectively.
Female ; Humans ; Aged ; Hypothyroidism/complications* ; Raynaud Disease/diagnosis*

Although it is difficult to reach a diagnosis in patients who complain of pain or sensitivity to cold in their hands, Raynaud's phenomenon is most often suspected in such cases. Symptoms of Raynaud's phenomenon include pallor, cyanosis, and redness following cold exposure. Glomus tumors can also increase patients' sensitivity to cold. In this case, our patient complained of symptoms indicative of Raynaud's phenomenon. Although treatment of Raynaud's phenomenon improved the symptoms, pain persisted in the fourth finger of the left hand. We diagnosed the patient with a glomus tumor and, after surgical treatment, the patient's symptoms improved. Here, we have also reviewed and discussed a number of reports of glomus tumors associated with Raynaud's disease. Diagnosing a glomus tumor in the hand may take some time, and the diagnosis could be further delayed if accompanied by Raynaud's phenomenon. Although glomus tumors are rare, we suggest that clinical awareness is important for early diagnosis and treatment.
Cyanosis ; Diagnosis ; Early Diagnosis ; Fingers ; Glomus Tumor* ; Hand* ; Humans ; Pallor ; Raynaud Disease*

OBJECTIVE: Raynaud's phenomenon is a vascular disorder characterized by reversible spasm of arteries of fingers. It is the first symptom in 70% of partlents with systemic sclerosis. The more systemic involvment the worse prognosis is expected in patients with systemic sclerosis. A more reliable indication of systemic sclerosis is the microvascular involvement by the disease (characteristic patterns of capillary abnormality in the nail-fold). Our puroses were to evaluate the significance of the degree of nailfold capillary abnormlitry in making the diagnosis fo systemic sclerosis, and in determining organ involvement in patients with systemic sclerosis. METHODS: Twenty-six patients with Raynaud's phenomenon whose diagnosis were systemic sclerosis(10 patients), SLE(10 patient), Raynaud's disease(6 patients) were observed for nailfold capillary abnormalities by widefield microscopy. RESULTS: Capillary abnormalities were seen in 100% of the systemic sclerosis (10 patients), 30% of the SLE (3 patients) and 50% of the Raynaud's disease (3 patients). A significant correlation between degree of finger lesions (r=0.718) or organ involvement (X2=20.4, p=0.015) and capillary abnormality class was found although a significant correlation was not found between the duration of the disease and the degree of capillary abnormality in patients with systemic sclerosis (r=0.32). CONCLUSIONS: Nailfold capillary abnormality can easily be observed and could be used as an assistive tools for the diagnosis and prediction of prognosis and extent of organ involvement in patients with Raynaud's phenomenon especially in patients with systemic sclerosis.
Arteries ; Capillaries* ; Connective Tissue Diseases ; Diagnosis ; Fingers ; Humans ; Microscopy ; Prognosis ; Raynaud Disease ; Scleroderma, Systemic ; Spasm

OBJECTIVES: To confirm the HAVS in workers exposed to hand-arm vibration with using the objective diagnostic methods METHODS: Several tests were used to help substantiate a clinical diagnosis of HAVS. Some other diseases were excluded by a medical interview, hematologic assessment, urinalysis, X-rays. The hand-arm vibration acceleration level of the grinder was evaluated for considering HAVS. Peripheral vascular changes were examined by a cold provocation test. An electromyography was implemented to ascertain the peripheral neural changes. RESULTS: 8 workers with symptoms in hands & fingers, exposed to hand-arm vibration were examined. Some other diseases(primary Raynauds disease, secondary Raynauds disease in not occupational origin) were excluded by a medical interview, hematologic assessment, urinalysis, X-rays. The hand-arm vibration acceleration level of the grinder was 7. 9 m/sec2. The recovery time of a skin temperature followed finger cooling was significantly prolonged in 6 workers with HAVS. The nerve conduction velocity was reduced in 6 workers with HAVS. CONCLUSIONS: So we report 6 cases of HAVS in grinding workers exposed to hand-arm vibration diagnosed objectively by an exclusion of some other disease, handarm vibration acceleration level, cold provocation test, electromyography.
Acceleration ; Diagnosis ; Electromyography ; Fingers ; Hand* ; Hand-Arm Vibration Syndrome* ; Neural Conduction ; Raynaud Disease ; Skin Temperature ; Urinalysis ; Vibration*

BACKGROUND: Cold-stress test is used for the objective diagnosis of Raynaud's disease and phenomenon, and the value of such test based on detection of recovery time of finger skin temperature, finger systolic blood pressure and finger color. We evaluate the finger skin temperature of recovery time after cold-stress test for Raynaud's disease and nonspecific cold sensitive patients. METHODS: Thirty-six subjects participated in the study: 9 Raynaud's disease (group 1), 13 nonspecific cold-sensitive patients (group 2) and 14 healthy adults (group 3). Subjects were adapted for 10 min in the test room, temperature 22-24degrees C, prior to measurements. Thermistor probe were attached to tips of both middle phalanges. After recording the baseline temperature, both hands were immersed to the level of the wrist in water controlled at 4degrees C. After 1 min immersion, both hands were removed from the water, recording the skin temperature at 5 min interval. RESULTS: Group 1 had the two types of recovery pattern. One; group 1 (-) was delayed recovery and the other; group 1 (+) was early recovery and hyperemic response. Group 2 showed delayed recovery. Recovery time to preimmersion temperature in group 3 were 20 min. CONCLUSIONS: Unlike results of prior report, some of Raynaud's disease (44%) with typical tricolor change had early recovery and hyperemic response after cold stress test in our study. It is suggested that Raynaud's disease has a different pathophysiology from nonspecific cold-sensitive patients. And appropriate check time is 20 min after cold immersion for the evaluation of vascular dysfunction of cold sensitive patients.
Adult ; Blood Pressure ; Diagnosis ; Exercise Test ; Fingers* ; Hand ; Humans ; Immersion ; Raynaud Disease* ; Skin Temperature* ; Skin* ; Water ; Wrist

OBJECTIVETo investigate the clinical manifestations, diagnosis and interventions of pulmonary hypertension (PAH) in patients with systemic lupus erythematosus (SLE).

METHODSFrom January 2001 to December 2007, 798 SLE patients without prior diagnosis were admitted in our hospital, among whom 39 were identified to have concomitant PAH defined by echocardiography. The clinical data of the 39 cases were analyzed retrospectively.

RESULTSThe incidence of PAH was 4.9% in these cohort of SLE patients. The 39 SLE patients with concomitant PAH included 5 men and 34 women with a mean age of 34-/+12 years. Positive correlations were found between the occurrence of PAH and the Raynaud phenomenon, fingertip vasculitis, anti-u1RNP antibody positivity, antiphospholipid antibody positivity, pericardial effusion, and interstitial pneumonia (P < 0.05). Patients with higher scores for SLE Disease Activity Index were liable to PAH. The presence of Raynaud phenomenon, fingertip vasculitis, anti-u1RNP antibody positivity, antiphospholipid antibody positivity, pericardial effusion, and interstitial pneumonia is correlated to greater severity PAH with poor prognosis.

CONCLUSIONPAH is not a rare concomitant disease in SLE patients. The presence of Raynaud phenomenon, fingertip vasculitis, anti-u1RNP antibody positivity, antiphospholipid antibody positivity, pericardial effusion, and interstitial pneumonia all suggest the likeliness of PAH in SLE patients, and echocardiographic examination may help derive an early diagnosis.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Early Diagnosis ; Echocardiography ; Female ; Humans ; Hypertension, Pulmonary ; complications ; diagnosis ; epidemiology ; Lupus Erythematosus, Systemic ; complications ; diagnosis ; Male ; Middle Aged ; Raynaud Disease ; complications ; Retrospective Studies

Raynaud's phenomenon (RP) is characterized by reversible digital vasospasm triggered by exposure to cold or emotional stress. It manifests with unique 'triphasic' (pallor, cyanosis, erythema) or 'biphasic' (white, blue) color change. Clinically, RP is classified as primary RP, which does not have an underlying associated cause with a relatively benign course, and secondary RP, which predates various cause such as systemic connective tissue disease (CTD). Therefore, RP must be differentiated for detection of emerging CTD such as systemic sclerosis (SSc), systemic lupus erythematosus, and mixed conective tissue disease, ect. Nailfold capillaroscopy (NFC) is a non-invasive morphological study used routinely with antinuclear antibodies for parallel of secondary RP. A recent study showed NFC to be the best predictor of transition from a primary RP to secondary RP. The well-established role of NFC for early diagnosis of SSc, and potential for monitoring disease progression and predictive clinical complication makes NFC an important tool in research and clinical practice. In this paper, I present a recent update with emphasis on its possible role as a reliable diagnostic tool and biomarker in secondary RP.
Antibodies, Antinuclear ; Connective Tissue Diseases ; Cyanosis ; Disease Progression ; Early Diagnosis ; Humans ; Lupus Erythematosus, Systemic ; Microscopic Angioscopy* ; Raynaud Disease ; Scleroderma, Systemic ; Stress, Psychological

The aim of this study was to determine whether skin temperature measurement by digital thermography on hands and feet is useful for diagnosis of Raynaud's phenomenon (RP). Fifty-seven patients with RP (primary RP, n = 33; secondary RP, n = 24) and 146 healthy volunteers were recruited. After acclimation to room temperature for 30 min, thermal imaging of palmar aspect of hands and dorsal aspect of feet were taken. Temperature differences between palm (center) and the coolest finger and temperature differences between foot dorsum (center) and first toe significantly differed between patients and controls. The area under curve analysis showed that temperature difference of the coolest finger (cutoff value: 2.2degrees C) differentiated RP patients from controls (sensitivity/specificity: 67/60%, respectively). Temperature differences of first toe (cutoff value: 3.11degrees C) also discriminated RP patients (sensitivity/specificity: about 73/66%, respectively). A combination of thermographic assessment of the coolest finger and first toe was highly effective in men (sensitivity/specificity : about 88/60%, respectively) while thermographic assessment of first toe was solely sufficient for women (sensitivity/specificity: about 74/68%, respectively). Thermographic assessment of the coolest finger and first toe is useful for diagnosing RP. In women, thermography of first toe is highly recommended.
Adult ; Diagnosis, Differential ; Female ; Fingers/*physiology ; Humans ; Male ; Middle Aged ; ROC Curve ; Raynaud Disease/*diagnosis ; Sensitivity and Specificity ; Skin Temperature ; *Thermography ; Toes/*physiology

OBJECTIVES: To investigate the clinical findings upon initial diagnosis and extraglandular manifestations in Korean patients with primary Sjogren's syndrome (pSS). METHODS: We collected clinical and laboratory data from 238 pSS patients enrolled at Seoul National University Hospital, Seoul National University Bundang Hospital and Seoul Medical Center from March 2011 to December 2014. All patients met the American-European Consensus Group criteria for pSS. RESULTS: Upon initial diagnosis, sicca symptoms (xerophthalmia or xerostomia) as the chief complaint were only observed in 129 (54.2%) pSS patients, while extraglandular manifestation was more common as the chief complaint in male patients or those with younger age (<40 years) than female or older patients (both p<0.05). Extraglandular manifestations were found in 178 (74.8%) patients, with musculoskeletal manifestations being most common (53.8%). Peripheral neuropathy in pSS patients was associated with Raynaud phenomenon and elevated serum total immunoglobulin G (IgG) levels (both p<0.05). Serum beta2-microglobulin (beta2-M) levels were significantly correlated with European League against Rheumatism (EULAR) Sjogren's syndrome disease activity index, erythrocyte sedimentation rate and serum total IgG (all p<0.001), and were higher in patients with extraglandular manifestations than those without (p<0.05). Serum C3 levels were decreased in patients with extraglandular manifestation, compared to those without (p<0.05). Malignant lymphoma was found in Korean pSS patients (1.7%) and associated with elevated serum beta2-M levels (p<0.0001). CONCLUSION: Extraglandular manifestations were common in pSS patients and may be a diagnostic tool for male or younger pSS patients. Serum beta2-M levels can be useful markers for monitoring pSS patients.
beta 2-Microglobulin ; Consensus ; Diagnosis ; Erythrocyte Indices ; Female ; Humans ; Immunoglobulin G ; Lymphoma ; Male ; Peripheral Nervous System Diseases ; Raynaud Disease ; Rheumatic Diseases ; Seoul ; Sjogren's Syndrome*

Systemic sclerosis (SSc) is a chronic systemic disease that affects the skin, lungs, heart, gastrointestinal tract, kidneys, and musculoskeletal system. Although up to 90% of patients with scleroderma have been estimated to have gastrointestinal involvement, liver disease has been reported only rarely. A 51-year-old woman was hospitalized due to esophageal variceal bleeding. Her serum was positive for anti-nuclear antibody and anti-centromere antibody. Sclerodactyly was noted on both hands, and she had recently developed Raynaud's syndrome. Punch biopsy of the hand showed hyperkeratosis, regular acanthosis, and increased basal pigmentation in the epidermis, and thick pale collagenous bundles in the dermis. Liver biopsy showed chronic active hepatitis with bridging fibrosis. Consequently, she was diagnosed with liver cirrhosis due to autoimmune hepatitis (AIH) combined with SSc. AIH had subsided after administration of prednisolone at 40 mg per day. She received 5-10 mg/day of prednisolone as an outpatient, and her condition has remained stable. Patients with either AIH or SSc should be monitored for further development of concurrent autoimmune diseases. The early diagnosis of AIH combined with SSc will be helpful in achieving optimal management.
Anti-Inflammatory Agents/therapeutic use ; Antibodies, Antinuclear/blood ; Esophageal and Gastric Varices ; Female ; Gastrointestinal Hemorrhage ; Hepatitis, Autoimmune/complications/*diagnosis/drug therapy ; Humans ; Liver Cirrhosis/*diagnosis/etiology/pathology ; Middle Aged ; Prednisolone/therapeutic use ; Raynaud Disease/diagnosis ; Scleroderma, Systemic/complications/*diagnosis ; Skin/pathology