Primary Raynaud's Phenomenon of the Tongue.

Raynaud's phenomenon is a condition characterized by intermittent vasoconstriction of arteries in the fingers and skin, triggered by cold temperatures or emotional stress, aimed at conserving body heat. This condition is classified into primary and secondary forms, with secondary Raynaud's often linked to connective tissue diseases, medications, infections, and occupational exposures. A notable clinical case involves a 51-year-old male experiencing episodes of painful, white discoloration of the tongue, which were managed through a comprehensive diagnostic process, including rheumatological and cardiological evaluations, to rule out connective tissue diseases and cardiac dysfunction. We highlight the complex pathophysiology of Raynaud's, involving vascular, neurogenic, and immune mechanisms. Management strategies focus on lifestyle modifications and pharmacologic treatments, such as calcium channel blockers, to reduce attack frequency and severity. For refractory cases, advanced therapies, including phosphodiesterase inhibitors, intravenous prostaglandins, and surgical sympathectomy, may be considered. Effective diagnosis and individualized treatment are crucial for preventing complications and improving patient outcomes.

Clinically relevant differences between primary Raynaud's phenomenon and secondary to connective tissue disease.

OBJECTIVES: Raynaud's phenomenon (RP) is a symptom complex associated with digital vascular compromise. Our aim was to examine for clinically relevant differences between primary RP (PRP) and secondary RP (SRP) to connective tissue disease. METHODS: We report cross-sectional results from the Patient Survey of experiences of Raynaud's Phenomenon (PASRAP), which aimed to explore the broad-ranging impact of RP. The survey was widely distributed online including via social medial. Participation was voluntary and responses were anonymous. RESULTS: 1229 respondents completed PASRAP with self-reported RP: PRP 218 (17.7 %) and SRP 1011 (82.3 %) of which 903 (92.9 %) Systemic Sclerosis. The mean (SD) age was significantly lower in respondents with PRP (41.7 [11.8] vs 54.2 [12.4] years, P<0.0001). During attacks, more subjects with SRP reported cyanotic colour changes (92.2 % vs 86.5 %, P=0.0089). Patients with PRP experienced more pain (72.1 % vs 55.9 %, P<0.0001), numbness (80.3 % vs 69.4 %, P=0.0016), stinging/throbbing (93.4 % vs 80.8 %, P<0.0001), and tingling (84.0 % vs 77.5 %, P=0.0345). Only half of respondents' symptoms were adequately controlled by their current medication(s), more commonly in SRP (55.2 % vs 45.2 %, P=0.0084). There were important differences in the triggers, number, and seasonal variation of RP attacks. CONCLUSION: There are clinically relevant differences between PRP and SRP concerning the multifaceted lived patient experience of RP. Neurosensory symptoms are more common in PRP. Patients with SRP are older and present with more colour changes, overrepresented by cyanosis, and with less complete resolution of symptoms between attacks. These data provide novel insights for future RP clinical trial design.

Re-evaluation of nailfold capillaroscopy in discriminating primary from secondary Raynaud's phenomenon and in predicting systemic sclerosis: a randomised observational prospective cohort study.

BACKGROUND: Primary Raynaud's phenomenon (pRP) is difficult to distinguish from secondary (sRP). Although nailfold capillaroscopy (NFC) may detect early alterations, no universal criteria yet discriminate between pRP from sRP. OBJECTIVES: To create and validate two NFC scores that could distinguish pRP from sRP and that could predict systemic sclerosis (SSc), respectively. METHODS: We performed NFC on two separate cohorts with isolated RP, and recorded number of capillaries per field, enlarged/giant capillaries, crossed/bizarre patterns, microhemorrhages, neoangiogenesis, rarefaction, edema, blood flow velocity, stasis. By multivariate regression analysis, we evaluated the adjusted prognostic role of these features in a derivation cohort of 656 patients. Results were used to construct algorithm-based prognostic scores (A and B). These scores were then tested on a confirmation cohort of 219 patients. RESULTS: Score A was unable to discriminate sRP from pRP (low negative predictive values with high positive predictive values for any cut-point); score B was unable to discriminate progression to SSc or a SSc-spectrum disorder (low positive predictive values with high negative predictive values for lower cut-points). CONCLUSION: NFC patterns, believed as specific, showed low discriminatory power and on their own are unable to reliably discriminate sRP from pRP or predict evolution to SSc.

Capillaroscopic analysis of the microvascular status in mixed versus undifferentiated connective tissue disease.

INTRODUCTION: Raynaud phenomenon (RP), typically, precede the clinical onset of systemic manifestations in several connective tissue diseases (CTDs). These autoimmune disorders usually share a microvascular damage whose alterations can be detected by nailfold videocapillaroscopy (NVC). The aim of the study was to compare the NVC microvascular status in Mixed Connective Tissue Disease (MCTD) versus the Undifferentiated Connective Tissue Disease (UCTD), and to search correlations between NVC findings and specific autoantibodies in UCTD patients. METHODS: Clinical data and NCV patterns were retrospectively obtained from the files of 46 MCTD patients, 47 stable UCTD patients and 51 individuals with primary RP (PRP) as controls collected in a central database (VideoCap®, DS Medica, Milan, Italy). ANA and ENA Abs were tested respectively by indirect immunofluorescence and enzyme-linked immunosorbent assay. RESULTS: "Scleroderma-like" (SSc-like) NVC pattern was significantly more frequent in MCTD than in UCTD patients (48% vs 11%, p < 0.001). Giant capillaries, abnormal shapes (i.e. neoangiogenesis) and lower capillary density were predominantly detected among MCTD versus UCTD patients (48% vs 11%, 49% vs 13%, 52% vs 9%, respectively, p < 0.001). The absolute number of capillaries was significantly lower in MCTD versus UCTD patients (mean 7 ± 1.7 SD vs mean 9.2 ± 1.3 SD, respectively, p < 0.001). Fully normal NVC pattern and non-specific NVC alterations were respectively observed in 6% and 46% of MCTD and in 6% and 83% of UCTD. Moreover, PRP patients showed normal NVC pattern and non-specific capillary abnormalities in 23% and in 77%, respectively. No statistically significant correlations were observed between NVC patterns and ANA patterns/specific ENA-Abs among the UCTD patients. CONCLUSIONS: The significant presence of the SSc-like NVC pattern and reduced number of capillaries seem the most typical NVC findings in MCTD in comparison to UCTD patients, suggesting a reflection of more complex and severe disease in MCTD ones.

Raynaud Phenomenon and Other Vasospastic Disorders.

Vasospastic disorders are prevalent in the general population and can affect individuals of any age. Primary (or idiopathic) vasospastic disorders often have a benign course; treatment focuses on the control of symptoms. Secondary vasospastic disorders occur owing to an underlying condition and have an increased risk of complications, including tissue loss and digital ulcerations; treatment should focus on the underlying condition. In this review, we discuss the pathophysiology, clinical presentation, diagnosis, and management of vasospastic disorders, including Raynaud syndrome, acrocyanosis, livedo reticularis, and pernio.

Hallazgos capilaroscópicos y características clínicas en pacientes con fenómeno de Raynaud primario y secundario / Capillaroscopic findings and clinical characteristics in patients with primary and secondary Raynaud's phenomenon

Objetivos: describir hallazgos de videocapilaroscopía (VCP) en pacientes con fenómeno de Raynaud primario (FRP) y secundario (FRS); comparar características demográficas y clínicas entre ambos. Materiales y métodos: estudio observacional, analítico, transversal. Se documentaron edad, ocupación, tiempo de evolución del FR, enfermedad del tejido conectivo (ETC) y características capilaroscópicas. Las VCP se informaron como patrón normal, inespecífico o SD temprano, activo y tardío. Se realizó estadística descriptiva. Para variables categóricas se empleó Chi² o test exacto de Fisher; para variables continuas, t test o Man Whitney, considerando estadísticamente significativa p<0,05. Resultados: se realizaron 290 VCP. En pacientes con FRP (n:122), 18% (n:23) fue normal y 81% (n:99) con patrón inespecífico. En pacientes con FRS (n:168), 8% fue normal, 42% con patrón inespecífico y 51% con patrón SD (25% temprano, 44% activo, 31% tardío). Se hallaron diferencias estadísticamente significativas: tiempo de evolución de FR en meses (12 vs 36, p<0,01), VCP normal (18,85% vs 7,4%, p<0,01), patrón inespecífico (81,14% vs 41%, p<0,01) en pacientes con FRP vs. FRS. Conclusiones: en pacientes con FRS predominó el patrón SD, mientras que en aquellos con FRP fue superior el patrón normal e inespecífico. El FRS se asoció a mayor tiempo de evolución.

Objectives: to describe videocapillaroscopy (VCP) findings in patients with primary Raynaud's phenomenon (PRP) and secondary (SRP); compare demographic and clinical characteristics between both. Materials and methods: observational, analytical, cross-sectional study. Age, occupation, evolution time of RP, connective tissue disease (CTD) and capillaroscopic characteristics were documented. The VCP were reported as normal, nonspecific or early, active, and late SD pattern. Descriptive statistics were performed. Chi² or Fisher's exact test were used for categorical variables; for continuous variables t test or Man Whitney, considering statistically significant p<0.05. Results: 290 VCP were performed. In patients with PRP (n:122), 18% (n:23) were normal and 81% (n:99) non-specific. In patients with SRP (n:168), 8% were normal, 42% non-specific and 51% with SD pattern (25% early, 44% active, 31% late). We found statistically significant differences: time of evolution of RP in months (12 vs. 36, p<0.01), normal VCP (18.85% vs 7.4%, p<0.01), non-specific pattern (81.14% vs 41%, p<0.01) in patients with PRP vs SRP. Conclusions: in patients with FRS predominated the SD pattern, while in those with FRP the normal and nonspecific pattern was superior. FRS was associated with a longer evolution time.

Characteristic Features of Infrared Thermographic Imaging in Primary Raynaud's Phenomenon.

Raynaud's phenomenon (RP) is characterized by the episodic whitening of the fingers upon exposure to cold. Verification of the condition is crucial in vibration-exposed patients. The current verification method is outdated, but thermographic imaging seems promising as a diagnostic replacement. By investigating patients diagnosed with RP, the study aimed at developing a simple thermographic procedure that could be applied to future patients where verification of the diagnosis is needed. Twenty-two patients with primary RP and 58 healthy controls were examined using thermographic imaging after local cooling of the hands for 1 min in water of 10°C. A logistic regression model was fitted with the temperature curve characteristics to convey a predicted probability of having RP. The characteristics time to end temperature and baseline temperature were the most appropriate predictors of RP among those examined (p = 0.004 and p = 0.04, respectively). The area under the curve was 0.91. The cut-off level 0.46 yielded a sensitivity and specificity of 82% and 86%, respectively. The positive and negative predictive values were 69% and 93%, respectively. This newly developed thermographic method was able to distinguish between patients with RP and healthy controls and was easy to operate. Thus, the method showed great promise as a method for verification of RP in future patients. Trial registration: ClinicalTrials.gov NCT03094910.

Effectiveness of Chinese herbal medicine for primary Raynaud's phenomenon: a systematic review and Meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness of Chinese herbal medicine for primary Raynaud's phenomenon (PRP). METHODS: The Cochrane Central Register of Controlled Trials, PubMed, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database were searched up to February 13, 2018. Randomized controlled trials (RCTs) on treatment of PRP with Chinese herbal medicine compared with placebo, blank control, lifestyle changes, or calcium antagonists were identified and reviewed. The quality of included trials was assessed using a risk of bias tool. RESULTS: Eight RCTs involving 674 participants were included. The methodological quality of the included trials was generally poor. Meta-analysis of two trials showed that Buyang Huanwu Tang plus Danggui Sini Tang produced greater improvement in global symptoms than nifedipine. One trial showed that Danggui Sini Tang and a self-composed Chinese herbal medicine decoction, respectively, produced greater improvement in global symptoms than nifedipine alone. In one trial, modified Danggui Sini Tang showed greater improvement in global symptoms and arterial peak systolic velocity compared with nifedipine. One trial showed that Jiejing Tongmi Tang produced greater improvement in global symptoms, plasma endothelin, and plasma nitric oxide than cinepazide maleate injection. However, Jiejing Tongmi Tang did not produce a significant difference in skin temperature and peripheral artery blood stream drawing after cold pressor testing compared with cinepazide maleate injection. None of the trials reported frequency of attacks, duration of attacks, participant preference scores, or adverse events. CONCLUSION: Chinese herbal medicine may have a positive effective on PRP. However, owing to weak methodology, the benefits of Chinese herbal medicine for PRP are inconclusive. More rigorously designed studies are needed to confirm these findings.

Effectiveness and safety of Suxiao Jiuxin pill in treating acute coronary syndrome: a systematic review and Meta-analysis.

OBJECTIVE: To evaluate the effectiveness and safety of Suxiao Jiuxin pill (SX) in acute coronary syndrome (ACS) treatment. METHODS: An extensive search of four English databases (Medline/PubMed, Cochrane Library, Embase, and World Health Organization International Clinical Trials Registration Platform) and four Chinese databases (Chinese National Knowledge Infrastructure, Wanfang, China Science and Technology Journal, and Chinese Biomedical Literature Service System) was performed. Randomized, controlled trials (RCTs) involving SX combined with conventional therapy versus conventional therapy were included. The extracted data included populations, interventions, outcomes, and risk of bias. The cardiovascular events served as the primary outcome. Review Manager 5.3 software was used for data analysis. Relative risks (RRs) with 95% confidence intervals (CIs) were the effect measure. RESULTS: A total of eight RCTs with 979 patients were included. There were 559 patients with unstable angina (UA) in six RCTs and 420 patients with acute myocardial infarction (AMI) in two RCTs. Our review showed that SX plus conventional therapy might reduce the incidence of the total endpoint (RR: 0.34, 95% CI: 0.17, 0.68, P = 0.002), with no obvious adverse events (RR: 1.29, 95% CI: 0.60, 2.77, P = 0.52) compared with conventional therapy for patients with UA. Additionally, SX plus conventional therapy also reduced the incidence of the total endpoint (RR: 0.35, 95% CI: 0.18, 0.68, P = 0.002) compared with conventional therapy in patients with AMI. SX plus conventional therapy also reduced the incidence of ventricular fibrillation (RR: 0.23, 95% CI: 0.10, 0.57, P = 0.001) compared with conventional therapy in patients with AMI. CONCLUSION: Our results suggest that SX is beneficial for treating patients with UA or AMI. However, our findings should be treated with caution because of the poor methodological quality of the included trials. Therefore, more multicenter, large-sample, high-quality RCTs are required to provide high-quality evidence.

A serious case of primary Raynaud's phenomenon in an infant.

We present a case of severe Raynaud phenomenon (RP) in an infant. The current strategy of RP treatment is incomplete; excluding secondary Raynaud phenomenon is vital as well. This case aims to help those with similar symptoms in the future by gathering data on cases.

Impairment of microcirculation and vascular responsiveness in adolescents with primary Raynaud phenomenon.

BACKGROUND: Raynaud's phenomenon (RP) is a functional vascular disease, presenting with recurrent episodes of ischemia of extremities in response to cold and emotional stress. Investigating cutaneous microcirculation is an important tool in understanding the complex neuro-immuno-vascular interactions in its pathophysiological mechanisms. Since there is no available data on vascular responsiveness in RP in the paediatric population, we investigated skin perfusion and heat-induced hyperaemia in comparison with clinical severity and laboratory parameters of the disease. METHODS: Fifty two adolescents (27 patients with primary RP and 25 age-matched healthy controls) were investigated in the study. Patients were divided into two groups according to the symptoms existing within the previous 2 months. Following baseline microcirculation measurement with Laser Doppler flowmetry (Periflux 5000 system), all subjects underwent local heating test at 42 °C and 44 °C. Besides routine laboratory parameters, immune-serological tests and the vasoactive sensory neuropeptides somatostatin and pituitary adenylate-cyclase activating polypeptide (PACAP) were measured. RESULTS: Baseline perfusion measured in perfusion units (PU) at 32 °C was significantly lower in symptomatic RP patients (97.6 ± 22.4 PU) compared with both healthy volunteers (248.3 ± 23.5 PU, p < 0.001) and RP patients without symptoms (187.4 ± 24.9 PU, p < 0.05). After local heating to 42 °C maximum blood flow was significantly reduced in primary RP participants with current symptoms (358.6 ± 43.9 PU, p < 0.001), but not in asymptomatic ones (482.3 ± 28.7 PU, p > 0.05) when compared with healthy subjects (555.9 ± 28.2 PU). Both the area under the response curve and the latency to reach the maximum flow were significantly increased in both RP groups (symptomatic 164.6 ± 7.4 s, p < 0.001, asymptomatic 236.4 ± 17.4 s, p < 0.001) when compared with the control group (101.9 ± 4.7 s). The heat-induced percentage increase from baseline to maximal blood flow was significantly greater in symptomatic RP adolescents in comparison with healthy ones. Laboratory parameters and neuropeptide plasma levels were not altered in any groups. CONCLUSION: To our knowledge this is the first study in paediatric population to show altered heat-induced cutaneous hyperaemia responses in relation with the clinical severity and symptomatology.

Capillaroscopic Findings in Primary Fibromyalgia.

INTRODUCTION: Although Raynaud's Phenomenon (RP) is observed in a significant proportion of patients with primary fibromyalgia, the available data on capillaroscopic findings in primary fibromyalgia are scarce. OBJECTIVE: The purpose of the study was to assess the capillaroscopic pattern in patients with primary fibromyalgia. PATIENTS AND METHODS: 26 patients with primary fibromyalgia (25 women and 1 man) were included in the study. Mean age was 55±10 years. As control groups were examined 31 patients with primary RP and 35 healthy volunteers. Capillaroscopic examination was performed with a videocapillaroscope Videocap 3.0 (DS Medica), magnification 200x with analysis of the main capillaroscopic parameters as follows: capillary distribution, shape, mean capillary diameters and length, mean capillary density, visibility of the subpapillary plexus; presence of avascular areas, microhaemorrhages and neoangiogenic capillaries. RESULTS: Symptoms of RP were observed in 65% (17/26) of the cases with primary fibromyalgia. At capillaroscopic examination, the most frequent finding in patients with primary fibromyalgia was the presence of capillary dilation in 85% (22/26) of the patients - both in cases with and without RP. However, the mean arterial and venous capillary diameters were significantly higher in the subgroup of fibromyalgia patients with clinical symptoms of RP. Of note, microvascular abnormalities characteristic of connective tissue diseases could not be observed in primary fibromyalgia patients. Analogous changes - presence of dilated capillaries - were found in 96.6% (29/30) of patients with primary RP. CONCLUSION: In our study, the most frequent capillaroscopic finding in patients with primary fibromyalgia was the presence of dilated capillary loops analogous to primary RP. Capillaroscopic signs suggestive of connective tissue disease could not be found in primary fibromyalgia patients.

Primary Raynaud's phenomenon and nailfold videocapillaroscopy: age-related changes in capillary morphology.

This study aimed to detect by nailfold videocapillaroscopy (NVC) the presence of age-related capillary morphological patterns in a large cohort of subjects affected by primary Raynaud's phenomenon (PRP). NVC was performed in 877 patients affected by PRP, divided into three age groups: <35, 35-55 and >55 years. The following qualitative parameters were assessed and compared in the three groups of patients: apical dilations, irregular (non-homogeneous) dilations, venous branch dilations, microhaemorrhages, tortuosities and subpapillary venous plexus visibility. Patients with either irregular dilations or venous branch dilations were found significantly younger than those without (p < 0.0001). The presence of either irregular or venous branch dilations seems to exclude the presence of apical dilations. Patients with microhaemorrhages were found significantly younger than those without (p = 0.05), and 81 % of patients without microhaemorrhages did not show irregular and venous branch dilations. The subpapillary venous plexus seems more visible in subjects with age < 35, as well as in those with age > 55 years (p < 0.0001). A statistically significant negative correlation was found between presence of apical and irregular dilations (p < 0.0001), apical dilations and venous branch dilations (p = 0.02), apical dilations and tortuosities (p = 0.0005), microhaemorrhages and tortuosities (p < 0.0001) and venous branch dilations and tortuosities (p = 0.02). Finally, a statistically significant positive correlation was found between irregular and venous branch dilations (p < 0.0001), irregular dilations and microhaemorrhages (p < 0.0001) and venous branch dilations and microhaemorrhages (p < 0.0001). In conclusion, our study detected different age-related morphological capillary changes mainly in younger patients with PRP, as well as statistically significant correlations between the presence of different capillary variables.

Abnormal amplitude and kinetics of digital postocclusive reactive hyperemia in systemic sclerosis.

OBJECTIVES: Postocclusive reactive hyperemia is mediated by two major mediators: sensory nerves and endothelium-derived hyperpolarizing factors. We hypothesized that the skin microvascular response to 5 min ischemia would differ depending upon the hand location in patients with systemic sclerosis (SSc), primary Raynaud's phenomenon (PRP) and healthy controls. METHODS: Fifteen patients with SSc, 15 sex- and age-matched patients with PRP and healthy controls were enrolled. Their right hands were subjected to 5 min ischemia followed by a postocclusive hyperemia test, with local microcirculation monitoring by laser speckle contrast imaging on the dorsal face of the hand. RESULTS: Postocclusive reactive hyperemia was abnormal in terms of peak and area under the curve (AUC) on all fingers except the thumb in patients with SSc and PRP compared with controls. In contrast, the kinetics of the response was longer only in SSc patients, with mean (SD) time to peak on the index, middle and ring finger were respectively 72 (58), 73 (51) and 67 (47) s for SSc; 40 (20), 40 (20) and 36 (19) s for PRP; and 34 (30), 34 (30) and 29 (24) s for controls (P=0.009 for interaction). CONCLUSIONS: We observed decreased distal digital microvascular perfusion following 5 min of ischemia in patients presenting with PRP or SSc, while the kinetics was prolonged only in SSc. A dynamic assessment of digital skin blood flow using laser speckle contrast imaging following 5 min ischemia could be used as a tool to assess microvascular abnormalities in patients with Raynaud's phenomenon secondary to SSc.

International consensus criteria for the diagnosis of Raynaud's phenomenon.

Vasoconstriction accompanied by changes in skin color is a normal physiologic response to cold. The distinction between this normal physiology and Raynaud's phenomenon (RP) has yet to be well characterized. In anticipation of the 9th International Congress on Autoimmunity, a panel of 12 RP experts from 9 different institutes and four different countries were assembled for a Delphi exercise to establish new diagnostic criteria for RP. Relevant investigators with highly cited manuscripts in Raynaud's-related research were identified using the Web of Science and invited to participate. Surveys at each stage were administered to participants via the on-line SurveyMonkey software tool. The participants evaluated the level of appropriateness of statements using a scale of 1 (extremely inappropriate) through 9 (extremely appropriate). In the second stage, panel participants were asked to rank rewritten items from the first round that were scored as "uncertain" for the diagnosis of RP, items with significant disagreement (Disagreement Index > 1), and new items suggested by the panel. Results were analyzed using the Interpercentile Range Adjusted for Symmetry (IPRAS) method. A 3-Step Approach to diagnose RP was then developed using items the panelists "agreed" were "appropriate" diagnostic criteria. In the final stage, the panel was presented with the newly developed diagnostic criteria and asked to rate them against previous models. Following the first two iterations of the Delphi exercise, the panel of 12 experts agreed that 36 of the items were "appropriate", 12 items had "uncertain" appropriateness, and 13 items were "inappropriate" to use in the diagnostic criteria of RP. Using an expert committee, we developed a 3-Step Approach for the diagnosis of RP and 5 additional criteria for the diagnosis of primary RP. The committee came to an agreement that the proposed criteria were "appropriate and accurate" for use by physicians to diagnose patients with RP.

[Methylphenidate and secondary Raynaud's phenomenon]. / Metilfenidato y fenómeno de Raynaud secundario.

Raynaud's phenomenon is a clinical disease characterized by episodic attacks of vasoconstriction of the arteries and arterioles of the extremities such as fingers and toes, sometimes the ears and nose, in response to cold or emotional stimuli. A classic attack is the pallor of the distal extremity, followed by cyanosis and redness, accompanied by paresthesia, usually as heat. When it occurs without apparent cause is called primary Raynaud's phenomenon. When associated with other disease, is called secondary Raynaud's phenomenon. The secondary table is associated with increased frequency of rheumatic diseases of collagen. They can also present certain drugs that cause vasoconstriction, such as ergotamine, beta-adrenergic antagonists, contraception and sympathomimetic drugs. Regarding the latter, we present a case of Raynaud's phenomenon secondary to methylphenidate in a 14 years.

Relationship between the Attacks of Raynaud's Phenomenon and Air Temperature. A Long-term observation on the subjects with Raynaud's phenomenon in a mountain area and in a plain area / 日本温泉気候物理医学会雑誌

The attack of Raynaud's phenomenon (RP) is characterized by finger blanching in response to cold or emotional stimuli.<br>To clarify the relationship between the attack of RP and air temperature, certain inhabitants of mountain village “T” (N₁=23) who had primary RP (PRP) were observed every day from August 20, 1990 to May 31, 1991 and those in town “K” (N₂=20) were observed from November 1, 1990 to May 31, 1991. One hundred and sixty-seven attacks of RP among 6 subjects in T Village and 89 attacks among 8 subjects in K Town were observed.<br>In T Village, the frequency of attacks was high in the morning, and the minimum and mean air temperatures in the days when some of the subjects had attacks (“attack days”) were significantly lower than those in the days when there was no attack on any subject (“non-attack days”). In K Town the frequency of attacks was high both in the morning and in the evening. In addition, the, mean and maximum air temperatures on the “attack days” were significantly lower than those on the “non-attack days.” The threshold temperature to cause RP attacks differed from one subject to another (5.2 to 17.6°C) in K Town during the period from November through February. The minimum air temperature which caused an attack of RP on any subject in T Village from August 20 to December 31 was 17.8°C.<br>These results suggest that cooling of the whole body in daily life promotes the onset of attacks of RP. When the minimum air temperature becomes lower than 18°C from autumn to winter, the whole body must be protected against cold to prevent the onset of RP.