Cold extremities: investigation and management of Raynaud's phenomenon.

Since Raynaud's description in 1862 of triphasic color changes in the digits, little progress has been made in diagnosis and treatment of this entity. Recent technologic advances such as laser Doppler fluxmetry and isolated cold stress testing offer promise in diagnosis and measuring response to various drugs. We review the pathophysiology and the clinical and laboratory evaluation of Raynaud's phenomenon, as well as medical and nondrug management.

Dermatomyositis with normal muscle enzyme concentrations. A single-blind study of the diagnostic value of magnetic resonance imaging and ultrasound.

BACKGROUND AND METHODS: It is well documented that the cutaneous lesions of dermatomyositis may precede clinical myositis or may occur in the absence of any muscle disease detectable by current diagnostic criteria. In this single-blind study, we used magnetic resonance imaging (MRI) and ultrasound to evaluate five patients who presented with classical clinicopathologic dermatomyositis, but with normal levels of serum muscle enzymes. This patients group has not been previously studied with these techniques. Patients who served as positive and negative control subjects were also examined. RESULTS: Ultrasonography revealed hyperechogenicity, and MRI revealed high signals on T2-weighted images in several muscle groups of the patient with active myositis (positive control). Increased echogenicity was also noted in the deltoid region of one patient who had previously had a normal muscle biopsy finding. In the same patient, MRI revealed inflammatory changes in the lumbar paraspinal muscles. Another patient, with all previous study results being normal, had MRI evidence of T2 high signals in the gluteus minimus. CONCLUSIONS: Noninvasive examinations such as MRI and ultrasound are beneficial as adjunctive means of examination in the evaluation of patients with dermatomyositis sine myositis or dermatomyositis. Future studies may suggest additional uses for these tests, including serial evaluation of patients, noninvasive confirmation of diagnosis in pediatric patients, or in directing muscle biopsy, thus increasing sensitivity. Ultrasound appears to be the more cost-effective and simple test; but MRI, although more expensive, may be more sensitive and specific.

Current principles of rehabilitation for patients with rheumatoid arthritis.

Rehabilitation is rooted in the comfort and palliation that sufferers of rheumatic symptoms have sought from physical modalities throughout history. In recent decades, several of these empiricisms have been tested scientifically. Furthermore, function has joined comfort as a desirable and measurable outcome. This article highlights some of the more substantive information as it relates to rheumatoid arthritis. It is clear that such information facilitates more effective and efficient programs of intervention. It is equally clear that the therapeutic perspective of rehabilitation for rheumatoid arthritis is more appropriately applied throughout the course of the disease in an ongoing program of habilitation than held in reserve as a form of salvage.

Photosensitivity and anti-Ro (SS-A) antibodies in black patients with systemic lupus erythematosus (SLE).

Ninety-two patients with SLE, 36 black and 56 white, were studied prospectively for photosensitivity and anti-Ro (SS-A) and anti-La (SS-B) antibodies. Photosensitivity was found in 19% of black patients, compared to 71% of white patients (p = 0.001). Anti-Ro antibodies were found in 69% of black and 54% of white patients (p = 0.013). Photosensitivity was present in 87% of Ro-positive white patients and in 54% of Ro-negative white patients (p = 0.007). However, in black patients with SLE there was a strong negative association: 4% of Ro-positive patients were photosensitive while 55% of Ro-negatives were photosensitive (p = 0.001). This suggests that black SLE patients may possess a factor which 'blocks' photosensitivity, perhaps by preventing local tissue damage caused by the interaction of Ro antibodies and ultraviolet light.