Heating of the neck or elbows alleviates Raynaud's phenomenon but has different effects on different types of patients with systemic sclerosis.

OBJECTIVES: We previously reported that heating of the neck or elbows alleviated Raynaud's phenomenon in patients with systemic sclerosis and upregulated capillary extension factor angiopoietin-1 (Angpt-1) in the fingertips. Here, we investigated which cases responded better to the effect of heating of the neck or elbows. METHODS: The pre- to post-heating change in the visual analogue scale for Raynaud's phenomenon (ΔVAS) was examined for correlation with age, disease duration, autoantibodies, disease types, corticosteroid dose, capillaroscopic nailfold capillary damage, fingertip Angpt-1 concentrations at baseline, and increased rate of Angpt-1 concentration. RESULTS: The ΔVAS for elbow heating correlated positively with the baseline Angpt-1 concentration, whereas the opposite correlation was observed for neck heating. The other items were not significantly correlated with the ΔVAS; however, the ΔVAS for elbow heating tended to be larger in patients with advanced capillary damage, whereas the opposite trend was observed for neck heating. CONCLUSIONS: Elbow and neck heating alleviated Raynaud's phenomenon to a similar extent, but their mechanism was different. Heating the elbows had a greater effect on patients with advanced capillary damage and lower fingertip Angpt-1 concentrations.

Proximal heat stress up-regulates angiopoietin-1 in fingers and reduces the severity of Raynaud's phenomenon in systemic sclerosis: a single-centre pilot study.

OBJECTIVES: Raynaud's phenomenon (RP) is a peripheral vascular disorder that frequently occurs in systemic sclerosis (SSc). Although therapeutic heating seems reasonable given that RP is elicited by cold stimuli, the effects of heating are still unclear. We examined the effects of heating applied on various body parts in SSc patients with RP of fingers. METHODS: Fourteen SSc patients heated their neck, elbows, and wrists with disposable heating pads for 1 week each. The visual analogue scale (VAS) for RP during each heating period was compared with that of each 1-week pre-treatment interval. On the day after the expiration of each heating period, their finger temperature, the finger blood flow, and angiogenesis-related factors (vascular endothelial growth factor, endostatin, angiopoietin-1, and angiopoietin-2) obtained from the cubital vein and fingertip were measured. RESULTS: The mean VAS was significantly reduced during the heating of the neck and elbows. Fingertip blood samples showed significantly increased angiopoietin-1 after each of the heating periods and increased endostatin after wrist heating. After the termination of heating, changes in finger temperature or blood flow could not be detected. CONCLUSIONS: Heating the neck or elbows can alleviate RP in SSc. The heat up-regulates angiopoietin-1 in the fingers.