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1.
Arch. argent. pediatr ; 122(5): e202310280, oct. 2024. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1571774

ABSTRACT

El fenómeno de Raynaud consiste en la contracción excesiva de los vasos sanguíneos en respuesta a diversos estímulos y, si bien suele comprometer las extremidades, existen otras localizaciones menos frecuentemente afectadas. Este trabajo se enfoca en describir las características de una serie de mujeres con fenómeno de Raynaud en el pezón. Mediante revisión de historias clínicas y comunicación directa con las pacientes, se recopilaron y analizaron los datos de 12 mujeres con Raynaud del pezón entre 2016 y 2023. Se evaluaron variables como edad, síntomas, desencadenantes, tratamientos y duración de los síntomas. En esta serie de casos, el fenómeno de Raynaud del pezón en mujeres lactantes se manifestó con mayor frecuencia en primigestas alrededor del décimo día posparto; el dolor fue intenso, en la mayoría mejoró con tratamientos locales y/o farmacológicos, y no limitó la duración de la lactancia materna.


Raynaud's phenomenon consists of excessive contraction of the blood vessels in response to various stimuli; although it usually affects the extremities, other locations are less frequently involved. This study focused on describing the characteristics of a series of women with Raynaud's phenomenon of the nipple. Through medical record review and direct communication with patients, data from 12 women diagnosed with Raynaud's phenomenon of the nipple between 2016 and 2023 were collected and analyzed. The following variables were assessed: age, symptoms, triggering factors, treatment, and duration of symptoms. In this case series, Raynaud's phenomenon of the nipple in breastfeeding women was more common among primiparous women around 10 days after delivery; pain was severe and, in most cases, improved with local and/or drug treatment, and did not limit the duration of breastfeeding.


Subject(s)
Humans , Female , Adult , Raynaud Disease/diagnosis , Raynaud Disease/etiology , Breast Feeding , Nipples/blood supply , Time Factors , Retrospective Studies
2.
Article in Chinese | WPRIM | ID: wpr-1024257

ABSTRACT

Objective:By analyzing the characteristics, diagnosis, and treatment process of anti-synthetase syndrome complicated by interstitial pneumonia and cardiac dysfunction, we aim to enhance general practitioners' understanding and diagnosis of this disease, thereby improving their level of diagnosis and treatment and reducing misdiagnoses and missed diagnoses.Methods:A patient with anti-synthase syndrome complicated by interstitial pneumonia and cardiac dysfunction, who was admitted to The First Affiliated Hospital of Xi'an Medical University in February 2020 due to limb weakness accompanied by paroxysmal cough for 2 years and aggravated symptoms for 10 days, was included in this study. The patient's clinical symptoms, physical signs, laboratory examination results, diagnosis and treatment process, and follow-up were retrospectively analyzed based on previous literature.Results:Through the general practitioner's SOAP consultation, physical examination, and imaging examination, the patient was diagnosed with anti-synthase syndrome complicated by interstitial pneumonia and cardiac dysfunction. Then rheumatology and immunology experts, respiratory medicine experts, and cardiovascular experts collaborated to provide a specialist diagnosis and treatment plan for the patient. Subsequently, the patient was referred to the department of rheumatology and immunology for specialized disease management. Finally, the patient was followed up in the general clinic. After the patient's condition stabilized, she gradually resumed her health.Conclusion:The multidisciplinary diagnosis and treatment scheme for anti-synthase syndrome can enhance general practitioners' understanding of the disease, make the diagnosis of the disease, and fully leverage the advantages of multi-disciplinary consultation and primary diagnosis in general medicine.

3.
Rev. Fac. Med. Hum ; 23(3)jul. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535201

ABSTRACT

Las entidadessineson poco comunes en reumatología. En la esclerosis sistémica progresiva, hay una variante de la forma cutánea limitada llamada esclerosis sistémicasineesclerodermia, cuya característica central es la falta de afectación cutánea, pero compromiso visceral presente. La positividad a los anticuerpos antitopoisomerasa o anticentromérico confirman el diagnóstico. El caso de este estudio es una mujer de 63 años con enfermedad intersticial pulmonar, afectación del tránsito intestinal y fenómeno de Raynaud, con ANA a títulos elevados con patrón centromérico y positividad para anticuerpos antitopoisomerasa. Ante un paciente con fenómeno de Raynaud, afectación visceral y ANA elevado, se le debe pedir anticuerpos específicos para diagnóstico de esclerosis sistémica en su variedadsine.


Sine entities are rare in rheumatology. In progressive systemic sclerosis there is a variant of the limited cutaneous form called systemic sclerosis sine scleroderma, whose central feature is the lack of skin involvement, but visceral involvement is present. Positive anti-topoisomerase or anti-centromere antibodies confirm the diagnosis. We present the case of a 63-year-old woman with interstitial lung disease, intestinal transit involvement and Raynaud's phenomenon, with high titers of ANA with a centromeric pattern and positivity for anti-topoisomerase antibodies. When faced with a patient with Raynaud's phenomenon, visceral involvement and elevated ANA, specific antibodies should be requested for the diagnosis of systemic sclerosis in its sine variety.

4.
Rev. colomb. reumatol ; 30(2): 137-149, abr..-jun. 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1576393

ABSTRACT

RESUMEN Introducción: El fenómeno de Raynaud (FR) es una respuesta vascular exagerada al frío o al estrés que se manifiesta por cambios de coloración de la piel; puede ser primario (RP) o secundario (RS). Objetivos: El objetivo de esta revisión sistemática de la literatura (RSL) es describir y ana lizar las principales diferencias para la detección de cambios vasculares en FR entre la capilaroscopia (NC) y la termografía infrarroja (TRI). Métodos: RSL siguiendo guías Prisma en las siguientes fuentes de información: Medline, Cochrane, Pubmed, ClinicalKey y ScienceDirect. Criterios de inclusión: artículos publicados hasta septiembre del 2020, observacionales o analíticos, que incluyeran población con FR (primario o secundario), con evaluación diagnóstica concomitante utilizando NC (micros cópica o videocapilaroscopia) y TRI. En la construcción de las ecuaciones de búsqueda se utilizaron términos MeSH («Thermography¼, «Microscopic angioscopy¼) y diferentes «Keywords¼ cruzadas a través de diferentes operadores booleanos. Se utilizó la herramienta «Joanna Briggs Institute Critical Appraisal Tools for Use in Systematic Reviews Checklist¼ para evaluar el riesgo de sesgo. Se siguió la guía SWiM para sintetizar y presentar los resultados. Resultados: Se identificaron 1.397 artículos, de los que luego de cribado y elegibilidad, se incluyeron cinco. Contemplaron poblaciones diferentes, evaluadas con equipos diferentes, dos artículos en niños y tres artículos en adultos. La población fue predominantemente caucásica y de género femenino, en total 403 individuos (79 menores de edad). Los dos estudios realizados en población pediátrica presentan resultados no concordantes y los estudios en población adulta presentan similitudes en sus resultados (NC técnica diagnóstica que mejor discrimina RP de RS), pero con patologías del tejido conectivo asociadas a RS diferentes. Conclusiones: A través de RSL se presentan hallazgos microvasculares de dos herramientas diagnósticas (NC y TRI) cuando se utilizan de manera concomitante en el FR. No se puede concluir a partir de los cinco artículos que existan diferencias claras o ventajas/desventajas en el uso preferente de una de las dos técnicas diagnósticas en el FR; el valor de la NC destaca para la diferencia entre RP y RS. Se requieren nuevos estudios para analizar diferencias entre las dos técnicas.


ABSTRACT Introduction: Raynaud's phenomenon (RP) is an exaggerated vascular response to cold or stress that is manifested by changes in skin colour. It can be primary (PR) or secondary (SR). Objectives: The objective of this systematic review of the literature (SLR) is to describe and analyse the main differences for the detection of vascular changes in RP between capillaroscopy (NC) and infrared thermography (IRT). Methods: An SLR following PRISMA guidelines in the following information sources: Medline, Cochrane, Pubmed, ClinicalKey and ScienceDirect. Inclusion criteria: observational or analytical articles published until September 2020, that included a population with RP (primary or secondary), with concomitant diagnostic evaluation using NC (microscopic or videocapillaroscopy) and IRT. In the construction of the search equations, MeSH terms («Thermography¼, «Microscopic Angioscopy¼) and different keywords crossed with different Boolean operators were used. The Joanna Briggs Institute Critical Appraisal tools for use in Systematic Reviews Checklist was used to assess the risk of bias. The SWiM guideline was followed to synthesize and present the results. Results: 1,397 articles were identified, of which, after screening and eligibility, five were included. They included different populations, evaluated with different equipment; two articles in children and three in adults. Predominantly Caucasian and female population, total of 403 individuals (79 minors). The two studies carried out in the paediatric population showed non-concordant results and the studies in the adult population showed similarities in their results (NC better discriminates PR from SR), but with different connective tissue pathologies associated with SR. Conclusiones: Microvascular findings from two diagnostic tools (NC and IRT) are presented through the SLR when used concomitantly in RP. Through the 5 articles, it is not possible to conclude that there are clear differences or advantages / disadvantages in the preferential use of one of the two diagnostic techniques in RP, highlighting the value of NC for differen tiating between PR and SR. Further studies are required to analyse differences between the two techniques.

5.
Rev. colomb. reumatol ; 30(1)mar. 2023.
Article in English | LILACS | ID: biblio-1536226

ABSTRACT

Introduction: Nailfold videocapillaroscopy is a non-invasive tool for the assessment of peripheral microcirculation, the main indication is the study of Raynaud's phenomenon, poorly standardized outside of this context. There is no clear information in real-life about the rea-sons for referral, the presence of clinical findings of autoimmune diseases, the frequency of patterns of autoantibodies, and specific capillaroscopic findings. Objective: The purpose of this survey is to describe the sociodemographic, clinical, paraclinical, and angioscopy findings of a cohort of subjects referred to a capillaroscopy service in North-western Colombia. Methods: A retrospective study was conducted, from 2015 to 2018. Categorical variables were expressed in frequency and percentage and quantitative variables in mean and standard deviation or median with interquartile range, depending on the distribution of the data. Results: A total of 318 capillaroscopies were performed for the first time. The main referral reason was Raynaud's phenomenon (n = 134; 42.1%). The most frequent baseline capillaroscopic pattern found was normal (n = 123; 38.7%). Of the 12 capillaroscopies that presented a non-specific pattern at a 6-month follow-up, only one (8.3%) progressed to a scleroderma pattern. In the subjects with systemic sclerosis, the most frequent clinical finding was sclerodactyly (n = 34; 37.8%), and 42/44 individuals (95.4%) had positive antinuclear antibodies; the most frequent pattern was centromere (n = 27; 64.3%) Conclusions: In a real-world setting, the main referral reason for capillaroscopy was Raynaud's phenomenon; more than a third of the subjects had normal capillaroscopic findings. Sclerodactyly was the most frequent clinical finding in patients with scleroderma capillaroscopic pattern.


Introducción: La videocapilaroscopia del lecho ungular es una herramienta no invasiva para la evaluación de la microcirculación periférica; la indicación principal es el estudio del fenómeno de Raynaud. Luego de una revisión de la literatura, no hay información clara sobre los motivos de remisión, presencia de hallazgos clínicos de enfermedades autoinmunes, frecuencia de patrones de autoanticuerpos y hallazgos capilaroscópicos específicos. Objetivo: Describir los hallazgos sociodemográficos, clínicos, paraclínicos y capilaroscópicos de sujetos remitidos a un servicio de capilaroscopia en el noroccidente colombiano. Métodos: Estudio retrospectivo de 2015 a 2018. Las variables categóricas se expresaron en frecuencias absolutas y porcentajes, y las variables cuantitativas en media y desviación estándar o mediana con rango intercuartílico, dependiendo de la distribución de los datos. Resultados: Se realizaron 318 capilaroscopias por primera vez. El principal motivo de remisión fue el fenómeno de Raynaud (n = 134; 42,1%). El patrón capilaroscópico basal más frecuente fue el normal (n = 123; 38,7%). De las 12 capilaroscopias que presentaron un patrón no específico en un seguimiento de seis meses, solo una (8,3%) progresó a un patrón de esclerodermia. En los sujetos con esclerosis sistémica, el hallazgo clínico más frecuente fue la esclerodactilia (n = 34; 37,8%), y 42/44 individuos (95,4%) tenían anticuerpos antinucleares positivos; el patrón más frecuente fue el centromérico (n = 27; 64,3%). Conclusiones: La razón principal de remisión para realizar una capilaroscopia fue el fenómeno de Raynaud; más de un tercio de los sujetos tenían hallazgos capilaroscópicos normales. La esclerodactilia fue el hallazgo clínico más frecuente en pacientes con patrón capilaroscópico de esclerodermia.


Subject(s)
Humans , Adolescent , Skin and Connective Tissue Diseases , Raynaud Disease , Scleroderma, Systemic , Thrombosis , Vascular Diseases , Cardiovascular Diseases , Connective Tissue Diseases , Diagnostic Techniques and Procedures , Microscopic Angioscopy , Diagnosis , Microscopy
6.
Rev. méd. Maule ; 37(2): 70-75, dic. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1428534

ABSTRACT

SPeripheral sympathectomy is a procedure which has shown high rates of decreasing ischemic pain, recover functionality and wound healing, preventing the progression of the disease and further complications. We present a female patient with severe Raynaud´s phenomenon secondary to localized cutaneous systemic sclerosis complicated who presented digital ulcer treated with a sympathectomy of the radial and ulnar artery at the wrist level, undergoing post-operative follow-up.


Subject(s)
Humans , Female , Middle Aged , Raynaud Disease/surgery , Sympathectomy/methods , Ulnar Artery/innervation , Osteomyelitis , Raynaud Disease/etiology , Regional Blood Flow/physiology , Scleroderma, Localized , Scleroderma, Systemic , Follow-Up Studies , Radial Artery/innervation
7.
Rev. colomb. reumatol ; 27(supl.1): 2-9, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1341319

ABSTRACT

ABSTRACT Background: Systemic sclerosis is an autoimmune and multisystemic disease characterized by vascular involvement and fibrosis that mainly affects the skin and internal organs; its morbidity and mortality are the highest of rheumatic diseases. Objective: To determine the sociodemographic, clinical, and paraclinical characteristics of adult patients with systemic sclerosis in a reference center in rheumatology in northwestern Colombia, between 2006 and 2016. Methods: A retrospective descriptive study was conducted. Information on sociodemographic, clinical, and paraclinical variables was collected from the review of medical records. The data were processed with the IBM SPSS 22 statistical package. The qualitative variables were expressed in absolute and relative frequencies and the quantitative variables in mean and standard deviation or median and interquartile range, according to their distribution. Results: 44 patients were included, predominantly women (90.9%), with an average age of 59 years; the most common variety was the limited (61.3%). One hundred percent of the subjects presented Raynaud's phenomenon and the most common compromised systems were: cutaneous (100%), musculoskeletal (59.1%), and gastrointestinal (50%). 95.5% of the patients fulfilled the diagnostic criteria ACR / EULAR 2013. Regarding the immunological profile, 72.7% of the individuals had positive antinuclear antibodies, of which 53.1% had a centromeric pattern. Conclusions: Sociodemographic, clinical and similar characteristics were found in this cohort, according to what was published in the literature. The most frequent extracutaneous systems involved were: musculoskeletal, gastrointestinal, and pulmonary, which cause a large part of the associated morbidity, as well as a decrease in quality of life.


RESUMEN Introducción: La esclerosis sistémica es una enfermedad autoinmune y multisistémica, caracterizada por vasculopatía y fibrosis que afecta principalmente la piel y órganos internos; su morbilidad y mortalidad son las más altas de las enfermedades reumatológicas. Objetivo: Determinar las características sociodemográficas, clínicas y paraclínicas de pacientes adultos con esclerosis sistémica en un centro de referencia en reumatología del noroccidente de Colombia, entre el 2006 y el 2016. Métodos: Estudio descriptivo retrospectivo. La información sobre las variables sociodemográficas, clínicas y paraclínicas se recogió de la revisión de registros médicos. Los datos se procesaron con el paquete estadístico IBM SPSS 22. Las variables cualitativas se expresaron en frecuencias absolutas y relativas y las cuantitativas en media y desviación estándar o mediana y rango intercuartílico, según su distribución. Resultados: Se incluyeron 44 pacientes, predominantemente mujeres (90,9%), con una edad promedio de 59 arios; la variedad más común fue la limitada (61,3%). El 100% de los sujetos presentaron el fenómeno de Raynaud y los sistemas comprometidos con mayor frecuencia fueron: cutáneo (100%), musculoesquelético (59,1%) y gastrointestinal (50%). El 95,5% de los pacientes cumplieron con los criterios diagnósticos ACR/EULAR 2013. Con respecto al perfil inmunológico, el 72,7% de los individuos tenía anticuerpos antinucleares positivos, de los cuales, un 53,1% tenía un patrón centromérico. Conclusiones: Se encontraron características sociodemográficas y clínicas similares en esta cohorte, de acuerdo a lo publicado en la literatura. Los sistemas extracutáneos más frecuentemente involucrados fueron: musculoesquelético, gastrointestinal y pulmonar, que causan una gran parte de la morbilidad asociada, así como una disminución en la calidad de vida.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Patients , Scleroderma, Systemic , Adult , Autoimmune Diseases , Epidemiology, Descriptive
8.
Rev. colomb. reumatol ; 27(supl.1): 170-174, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1341331

ABSTRACT

ABSTRACT Raynaud's phenomenon is a sentinel event in systemic sclerosis; it is generally long- lasting, and repeated attacks produce, ultimately, structural consequences and complications, such as digital ulcers. Nailfold videocapillaroscopy is a non-invasive tool that allows assessing accurately these changes. Digital ulcers are the most aggressive and frequent microvascular complication in this disease, causing severe pain and significant functional sequelae. This literature review focuses on Raynaud's phenomenon as a central event in systemic sclerosis, its peculiarities in this entity, the role of capillaroscopy as a biomarker in this vasculopathic phenomenon, as well as a on a clinical and pharmacological approach to digital ulcers in this illness.


RESUMEN El fenómeno de Raynaud es un evento centinela en la esclerosis sistémica, por lo general es de larga duración y los ataques repetidos producen, en última instancia, consecuencias estructurales y complicaciones tales como úlceras digitales. La videocapilaroscopia del lecho ungueal es una herramienta no invasiva que permite evaluar en forma precisa estos cambios. Las úlceras digitales son la complicación microvascular más agresiva y frecuente en esta enfermedad, causando dolor severo y secuelas funcionales importantes. Esta revisión de la literatura se centra en el fenómeno de Raynaud como evento central en la esclerosis sistémica, sus peculiaridades en esta entidad y el papel de la capilaroscopia como biomarcador para este fenómeno vasculopático, así como en un enfoque clínico y farmacológico de las úlceras digitales en esta enfermedad.


Subject(s)
Humans , Raynaud Disease , Scleroderma, Systemic , Microscopic Angioscopy , Ulcer , Connective Tissue
9.
Rev. Assoc. Med. Bras. (1992, Impr.) ; Rev. Assoc. Med. Bras. (1992, Impr.);65(10): 1314-1320, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041031

ABSTRACT

SUMMARY OBJECTIVE To review articles that evaluated the prevalence of Raynaud's phenomenon of occupational origin. METHODS The search for articles was carried out in the Medline (via PubMed), Embase, Web of Science, Scientific Electronic Library Online (SciELO), and Latin America and Caribbean Health Sciences Literature (Lilacs) databases. RESULTS 64 articles were obtained from the electronic search; 18 articles met the eligibility criteria. All studies discussed the exposure to vibrations in the upper limbs. In 6 of them, the thermal issue was directly or indirectly addressed. No studies have addressed exposure to vinyl chloride. CONCLUSIO In general, a higher prevalence of Raynaud's phenomenon was found among vibratory tool operators compared to non-exposed workers, with an increase in the number of cases the higher the level of vibration and the time of exposure. Cold is a triggering and aggravating factor of the Raynaud phenomenon and seems to play an important role in the emergence of vascular manifestations of the hand-arm vibration syndrome.


RESUMO OBJETIVO Realizar um estudo de revisão dos artigos que avaliaram a prevalência do fenômeno de Raynaud de origem ocupacional. MÉTODOS A busca pelos artigos foi realizada nas bases de dados Medline (via PubMed), Embase, Web of Science, Scientific Eletronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). RESULTADOS Sessenta e quatro artigos foram obtidos a partir da busca eletrônica, dos quais 18 cumpriram os critérios de elegibilidade. Todos os estudos discutiram sobre a exposição a vibrações localizadas em membros superiores. Em seis deles, a questão térmica foi direta ou indiretamente abordada. Nenhum estudo abordou a exposição ao cloreto de vinila. CONCLUSÃO De maneira geral, constatou-se maior prevalência do fenômeno de Raynaud entre operadores de ferramentas vibratórias em comparação aos não expostos, com aumento do número de casos quanto maior o nível de vibração e tempo de exposição. O frio é fator desencadeante e agravante do fenômeno de Raynaud e parece exercer papel importante para o surgimento das manifestações vasculares da síndrome de vibração de mãos e braços.


Subject(s)
Humans , Raynaud Disease/etiology , Occupational Exposure/adverse effects , Occupational Diseases/etiology , Raynaud Disease/epidemiology , Vinyl Chloride/adverse effects , Prevalence , Risk Factors , Cold Temperature/adverse effects , Hand-Arm Vibration Syndrome/complications , Occupational Diseases/epidemiology
10.
Rev. colomb. reumatol ; 25(3): 169-176, jul.-set. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-990946

ABSTRACT

Resumen Introducción: Entre un 15 y un 20% de los pacientes con fenómeno de Raynaud progresarán a una enfermedad autoinmune sistémica. La presencia de autoanticuerpos o alteraciones capilaroscópicas es fundamental para el diagnóstico temprano. Objetivos: Determinar las características de la videocapilaroscopia del lecho ungular y de los anticuerpos antinucleares en una cohorte de pacientes con enfermedad autoinmune sistémica. Materiales y métodos: Se realizó un estudio transversal en sujetos con fenómeno de Raynaud. Estos fueron evaluados con videocapilaroscopia y anticuerpos antinucleares. Las variables cualitativas se describieron con frecuencias absolutas y relativas; las variables cuantitativas, según la distribución de los datos, se reportaron como media o mediana, con desviación estándar y rango intercuartílico, respectivamente. Resultados: Se incluyeron 58 individuos; el 91,4% eran mujeres. La edad promedio fue 40,9 ± 14,1 arios. En 41 sujetos, los anticuerpos antinucleares fueron positivos; el patrón más común fue el moteado (41,5%), con una mediana de dilución de 1:640 (rango inter-cuartílico 1:320-1:1.280). Se encontró enfermedad autoinmune sistémica en 10 individuos (19,2%), 8 de ellos con esclerosis sistémica. Las alteraciones capilares más frecuentes fueron: megacapilares (n = 10), microhemorragias (n = 10) y zonas avasculares (n = 8). Conclusiones: En este grupo de pacientes con fenómeno de Raynaud sometidos a video-capilaroscopia, el diagnóstico de enfermedad autoinmune sistémica fue realizado en un porcentaje similar a lo reportado en la literatura. Se encontró una mayor dilución de anticuerpos antinucleares que la descrita.


Abstract Introduction: Between 15 and 20% of patients with Raynaud's phenomenon will progress to a systemic autoimmune disease. The presence of autoantibodies or capillaroscopy alterations are fundamental for early diagnosis. Objectives: To determine the characteristics of nailfold videocapillaroscopy and antinuclear antibodies in a cohort of patients with systemic autoimmune disease. Materials and methods: A cross-sectional study was conducted in subjects with Raynaud s phenomenon. These were evaluated with videocapillaroscopy and antinuclear antibodies. The qualitative variables were described with absolute and relative frequencies. The quantitative variables, according to the distribution of data, were reported as mean or median, with standard deviation and interquartile range, respectively. Results: The study included 58 individuals, of which 91.4% were women. The mean age was 40.9 ± 14.1 years. Antinuclear antibodies were positive in 41 subjects. The most common pattern was speckled (41.5%), with a median dilution of 1:640 (interquartile range 1:3201:1,280). A systemic autoimmune disease was found in 10 (19.2%) patients, 8 of them with systemic sclerosis. The most frequent capillary alterations were: mega-capillaries (n = 10), micro-haemorrhages (n = 10), and avascular zones (n = 8). Conclusions: In this group of patients with Raynaud's phenomenon subjected to videocapillaroscopy, a diagnosis of systemic autoimmune disease was made in a similar percentage to that reported in the literature. A higher dilution of antinuclear antibodies was found than that described.


Subject(s)
Humans , Raynaud Disease , Autoimmune Diseases , Early Diagnosis , Antibodies, Antinuclear , Microscopic Angioscopy
11.
An. bras. dermatol ; An. bras. dermatol;90(6): 837-840, Nov.-Dec. 2015. tab
Article in English | LILACS | ID: lil-769525

ABSTRACT

Abstract: BACKGROUND: Patients with systemic lupus erythematosus seem to belong to different serological and clinical subgroups of the disease. Genetic background can cause the appearance of these subgroups. OBJECTIVE: To determine whether Brazilian patients who have systemic lupus erythematosus and Raynaud's phenomenon differ from those who do not. METHODS: Retrospective analysis of 373 medical records of systemic lupus erythematosus patients studied for demographic, clinical and serological data. A comparative analysis was performed of individuals with and without RP. RESULTS: There was a positive association between Raynaud's phenomenon and age at diagnosis (p=0.02), presence of anti-Sm (p=0.01) antibodies and anti-RNP (p<0.0001). Furthermore, a negative association was found between Raynaud's phenomenon and hemolysis (p=0.01), serositis (p=0.01), glomerulonephritis (p=0.0004) and IgM aCL (p=0.004) antibodies. CONCLUSION: Raynaud's phenomenon patients appear to belong to a systemic lupus erythematosus subset with a spectrum of clinical manifestations located in a more benign pole of the disease.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Lupus Erythematosus, Systemic/physiopathology , Raynaud Disease/physiopathology , Antibodies, Antinuclear/analysis , Brazil , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/pathology , Medical Records , Retrospective Studies , Raynaud Disease/immunology , Raynaud Disease/pathology , Statistics, Nonparametric
12.
Article in English | WPRIM | ID: wpr-60230

ABSTRACT

BACKGROUND: Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire. METHODS: A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale. RESULTS: The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03). CONCLUSIONS: Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.


Subject(s)
Humans , Male , Cicatrix , Hand , Raynaud Disease , Sympathectomy , Transplants , Trees
13.
Rev. Fac. Med. (Bogotá) ; 62(3): 1-24, July-Sept. 2014. ilus
Article in Spanish | LILACS | ID: lil-726933

ABSTRACT

El fenómeno de Raynaud es una respuesta vascular exagerada al frío o al estrés que se manifiesta por cambios de coloración de la piel en diversas localizaciones; característicamente, presenta tres fases distintas que comprenden palidez, cianosis y rubor. Dependiendo de la ausencia o la presencia de enfermedad de base, el fenómeno se denomina como primario o secundario, siendo este último subtipo una manifestación importante de enfermedades graves, principalmente autoinmunes. El fenómeno de Raynaud primario tiene buen pronóstico y la posibilidad de manejo por médico primario; por el contrario, el secundario implica la necesidad de evaluación y manejo especializado. Es de importancia para el médico general conocer su clasificación, las bases del manejo para control de los signos y síntomas, además de identificar cuándo un paciente requiere valoración y manejo especializado de acuerdo con otras enfermedades de base que puedan coexistir.


Raynaud's phenomenon is an exaggerated vascular response to cold or stress manifested by skin colour changes at several locations, having three characteristic phases: pallor (white), cyanosis (blue) and rubor (red). When the cause is not known this phenomenon is termed primary Raynaud's phenomenon and secondary Raynaud's phenomenon when underlying disease is involved, autoimmune disease being the most frequent cause of the secondary form. Primary Raynaud's phenomenon has a good prognosis and can be treated medically without the need for specialist assessment, unlike secondary Raynaud's phenomenon which needs specialist assessment and treatment. A general practitioner needs to know the classification, the basis for treatment for signs and symptoms control and know when a patient requires specialist evaluation for treatment according to other diseases which may be present or coexist.

14.
Article in English | WPRIM | ID: wpr-216488

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Diagnosis, Differential , Fingers/physiology , ROC Curve , Raynaud Disease/diagnosis , Sensitivity and Specificity , Skin Temperature , Thermography , Toes/physiology
15.
Journal of Chinese Physician ; (12): 1340-1341,1345, 2014.
Article in Chinese | WPRIM | ID: wpr-601222

ABSTRACT

Objective To investigate the therapeutic efficacy and safety of stellate ganglion block (SGB) with ropivacaine to treat Renault's disease.Methods Thirty seven patients with Renault's disease were randomly assigned into two groups:the lidocainegroup (L group,18 patients) treated by SGB with 5 ml of 1% lidocaine,and the Ropivacaine-group (R group,19 patients) treated by SGB with 5 ml of 0.2% ropivacaine.The efficacy,adverse reactions,and the recurrence after 3 months of two groups were observed and compared.Results The total effective rate of 89.5 % in group R was significantly higher that 55.6% in group L (P < 0.05).There were less times(22 times) presenting no Homers'sign in group R compared to group L (43 times).The incidence of adverse reaction and the recurrence after 3 months in group R were not statistically significantly different form group L (P > 0.05).Conclu-sions SGB with 0.2% ropivacaine could obtain better efficacy compared to lidocaine,and had a higher security.

16.
Arch. méd. Camaguey ; 16(4): 490-500, jul.-ago. 2012.
Article in Spanish | LILACS | ID: lil-653813

ABSTRACT

Fundamento: la poliarteritis nodosa es una vasculitis de vasos medianos, caracterizados por inflamación o necrosis de los vasos sanguíneos que conducen a su oclusión y por tanto a la isquemia del tejido que irrigan. Caso clínico: paciente de 15 años de edad, color de piel blanca, masculino, con historia de cuadros febriles prolongados sin diagnóstico, por lo que tuvo múltiples ingresos en diferentes instituciones del país con la sospecha de inicio de una histiocitosis o enfermedad linfoproliferativa, para lo cual se le realizaron diversos estudios que incluyeron a la médula ósea sin infiltración y biopsia de ganglios, los resultados descartaron estas enfermedades. En uno de esos episodios y luego de tres años es remitido al servicio de reumatología pediátrica de la provincia de Camagüey, con historia de fiebre de hasta 38.5 ºC durante 16 días, una úlcera infectada en el brazo derecho con un estafilococo en cultivo de la misma. Al examinarlo además se constató fenómeno de Raynaud y livedo reticulares, lo que sugirió la posibilidad diagnóstica de una vasculitis. Conclusiones: se realizaron los anticuerpos antinucleares que fueron positivos y confirmaron el diagnóstico de la poliarteritis nodosa, el cual se efectuó luego de tres años de evolución; en estos momentos bajo tratamiento de inmunosupresión extrema, con altas dosis de esteroides y ciclofosfamida con evolución favorable del cuadro general, desaparición de la fiebre, pero se mantiene daño a nivel de los vasos coronarios, renales y en las regiones distales de las cuatro extremidades ya establecidos previamente.

17.
Rev. bras. reumatol ; Rev. bras. reumatol;52(1): 30-32, jan.-fev. 2012. tab
Article in Portuguese | LILACS | ID: lil-611468

ABSTRACT

OBJETIVO: Avaliar a ação do medicamento inibidor do receptor de leucotrieno CysLT1 (montelucaste) nas alterações vasculares das mãos em pacientes com fenômeno de Raynaud. MÉTODOS: Foram selecionadas pacientes com fenômeno de Raynaud secundário à doença inflamatória do tecido conjuntivo, excluindo tabagismo, hipertensão arterial e diabetes mellitus. As pacientes mantiveram a medicação prévia e iniciaram o uso de montelucaste 10 mg/dia por 60 dias. Foi realizada capilaroscopia periungueal dos dedos das mãos antes do uso da medicação e após 30 e 60 dias. A análise estatística foi feita por meio de porcentagem, média, desvio-padrão e teste exato de Fisher, com intervalo de confiança de 95 por cento. RESULTADOS: Foram estudadas cinco pacientes mulheres, brancas, com fenômeno de Raynaud secundário a doenças do tecido conjuntivo, das quais três apresentavam esclerodermia e duas apresentavam doença mista do tecido conjuntivo. A média de idade foi de 42,4 ± 12,4 anos, e a média de tempo de doença foi de 9,6 ± 4,8 anos. As pacientes estavam em uso de até 20 mg/dia de prednisona (pacientes com doença mista do tecido conjuntivo), nifedipina, pentoxifilina. As medicações foram mantidas. Após o uso de inibidor de receptor de leucotrieno por dois meses, o controle com capilaroscopia ungueal demonstrou diminuição do edema e da palidez e normalização do número, tamanho e distribuição dos capilares. CONCLUSÃO: O uso do montelucaste modificou as alterações capilares observadas na capilaroscopia periungueal de pacientes com fenômeno de Raynaud.


OBJECTIVE: To assess the effect of the leukotriene receptor inhibitor (montelukast) on vascular alterations in fingers of patients with Raynaud's phenomenon. METHODS: Patients with Raynaud's phenomenon of the hands secondary to inflammatory connective tissue disease were selected, and those with the following characteristics were excluded: smokers, arterial hypertension, and diabetes mellitus. All patients maintained their previous medications and started the use of montelukast, 10 mg/day, for 60 days. Naifold capillaroscopy of fingers was performed before the use of medication and after 30 and 60 days. Statistical analysis was performed with percentage, media, standard deviation, Fisher exact test, with 95 percent of confidence interval. RESULTS: The study assessed five Caucasian, female patients with Raynaud's phenomenon secondary to inflammatory connective tissue disease (three with scleroderma and two with mixed connective tissue disease), aged 42.4 ± 11.5 years, and with 9.6 ± 4.8 years of disease duration. Patients were on nifedipine and pentoxifylline, and those with mixed connective tissue disease were also on prednisone. The medications were maintained. After using montelukast for two months, nailfold capillaroscopy showed a reduction in edema and pallor, and normalization of capillary number, size, and distribution. CONCLUSION: The use of montelukast modified the capillary abnormalities observed on nailfold capillaroscopy of patients with Raynaud's phenomenon.


Subject(s)
Adult , Female , Humans , Acetates/therapeutic use , Leukotriene Antagonists/therapeutic use , Microscopic Angioscopy , Quinolines/therapeutic use , Raynaud Disease/diagnosis , Raynaud Disease/drug therapy , Receptors, Leukotriene/drug effects , Prospective Studies
18.
Article in English | WPRIM | ID: wpr-227533

ABSTRACT

A 54-year-old female was suffering from cold-induced Raynaud's attacks in her both hands with symptoms most severe in her left hand. As the patient did not respond to previous medical treatments and endoscopic thoracic sympathectomy, we performed percutaneous bipolar radiofrequency thoracic sympathicotomy at the left T3 vertebral level. After the procedure, the patient obtained a long duration of symptom relief over 3 years. Percutaneous bipolar radiofrequency T3 sympathicotomy is minimally invasive and effective technique by creating large continuous strip lesion.


Subject(s)
Female , Humans , Middle Aged , Hand , Raynaud Disease , Stress, Psychological , Sympathectomy
19.
Article in Chinese | WPRIM | ID: wpr-424669

ABSTRACT

ObjectiveTo investigate the clinical and laboratory characteristics of systemic sclerosis (SSc) patients with digital ulcer(DU) in China.MethodThe data of 166 consecutive SSc patients in EUSTAR DATABASE in Peking Union Medical Colloge Hospital from February 2009 to August 2010 were prospectively collected,and patients with DU were compared with those without DU.All patients fulfilled the ACR classification criteria for SSc in 1980.Results① Forty-nine patients (29.5%) had DU in 166 SSc patients.The disease onset age was(36±12) years(8.1-61.7 years) for those patients with DU.All had Raynaud's phenomenon(RP).② Demographic data:there were significant differences between patients with and without DU in sex (F/M 40/9 vs 112/5,P=0.005),age [(40±12) years old vs(46±12) years old,P=0.005],the onset age of RP [(33±12) years vs(39±13) years,P=0.005] and the duration from RP to the first non-RP presentaion[ (18±15) months vs(115±307) months,P=0.002 ].③ Clinical manifestations and laboratory findings:there were more diffuse SSc patients and more esophageal involvement in patients with DU (P<0.05).ConclusionsDU in SSc patients is common,especially in man and patients with diffuse SSc.SSc patients with DU usually are younger when RP onsets and the non-RP manifestations usually present earlier when compared with those patients without DU.

20.
Rev. venez. cir. ortop. traumatol ; 43(1): 73-79, jun. 2011. ilus
Article in Spanish | LILACS | ID: lil-618729

ABSTRACT

El Síndrome de Raynaud (SR) se define como una entidad, que afecta los vasos sanguíneos de las porciones dístales del cuerpo (dedos, orejas, nariz) y cuya característica clínica es la presencia de ataques episódicos de vasoespasmo, se explica por una hipersensibilidad local de las arterias digitales al frío, con una intensificación de esta anormalidad por la estimulación simpática normal, que generan isquemia tisular; aunque es una entidad de presentación alarmante, es importante reconocer el comportamiento benigno de ésta. Actualmente se han reconocido varios factores que influyen en la presentación del síndrome y que han permitido enfocar el manejo de estos pacientes. La simpatectomía periférica peri arterial es una alternativa para el manejo de estos pacientes sintomáticos que no responden con tratamiento conservador.


Raynaud’s syndrome is defined as an entity that affects the blood vessels of the distal portions of the body (fingers, ears, nose) and whose clinical feature is the presence of episodic attacks of vasospasm can be explained by a local hypersensitivity digital arteries to cold, with an intensification of this abnormality by normal sympathetic stimulation, which generates tissue ischemia, although a filing entity alarming, it is important to recognize this benign behavior. Have now been recognized several factors that influence the presentation of the syndrome, which allowed focus on the management of these patients. Periarterial peripheral sympathectomy is an alternative for the management of symptomatic patients who do not respond to conservative treatment.


Subject(s)
Humans , Female , Raynaud Disease/diagnosis , Raynaud Disease/etiology , Sympathectomy/methods , Vasospasm, Intracranial/pathology , Blood Vessels/injuries
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