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Alenzi F, D’Cruz DP. Reversible Cerebral Vasoconstriction Syndrome and Raynaud's Phenomenon: Is There a Link between the Pathogeneses of Their Underlying Complex Etiology? A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:2951. [PMID: 37761318 PMCID: PMC10528332 DOI: 10.3390/diagnostics13182951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) typically manifests as a sudden, severe thunderclap headache due to narrowing of the cerebral arteries. Symptoms usually resolve within three months. An imbalance in cerebral vascular tone, an abnormal endothelial function, and a decreased autoregulation of cerebral blood flow are thought to be involved in the pathogenesis of RCVS. However, the precise origin of this condition is not yet fully understood. Symptoms of Raynaud's phenomenon (RP) include vasospasm of arterioles of the digits. The pathophysiology of RP includes interactions between the endothelium, smooth muscle, and autonomic and sensory neurons that innervate arteries to help maintain vasomotor homeostasis. RP may occur before the clinical manifestation of a rheumatic condition. RCVS is rare in patients with autoimmune rheumatic disease. We describe a 54-year-old female who had a history of Raynaud's phenomenon affecting her fingers and toes since the age of 12 years. The patient was diagnosed with RCVS in 2012. She described RCVS precipitants, including the regular use of cannabis, cocaine, and amphetamine and tobacco smoking. In 2021, she presented with oral ulcers, intermittent swallowing difficulties, and Raynaud's phenomenon. Clinical examination revealed early sclerodactyly, and abnormal nail-fold capillaroscopy showed multiple giant capillaries, dilated capillary loops, and areas of capillary hemorrhage with capillary drop-out. The investigation revealed positive ANA, strongly positive SRP antibodies, and Ro60 antibodies. Our case report indicates that there may be a correlation between RCVS and Raynaud's phenomenon, and a potential connection between RCVS and autoimmune rheumatic diseases. Hence, physicians must be aware of the red flags and subtle differences in neurological abnormalities, such as headaches, in patients with autoimmune rheumatic diseases who have an inactive clinical status to improve patient care and outcomes.
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Affiliation(s)
- Fahidah Alenzi
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - David P D’Cruz
- Louise Coote Lupus Unit, Guy’s Hospital, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust, London SE1 9RT, UK
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2
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Hatem NA, Denicol TL, Dagostini CM, Pasqualotto AC. Cyanotic Raynaud's phenomenon induced by amphotericin B deoxycholate: A case report. Med Mycol Case Rep 2023; 41:20-21. [PMID: 37706049 PMCID: PMC10495380 DOI: 10.1016/j.mmcr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 09/15/2023] Open
Abstract
A 59-year-old male patient with chronic headache was admitted to the emergency department due to cryptococcal meningitis. His past medical history was marked by liver transplant 18 months prior to admission. Induction therapy with amphotericin B deoxycholate was initiated and the patient developed cyanotic Raynaud's phenomenon related to the infusion. The antifungal treatment was switched to liposomal amphotericin B, with complete resolution of the phenomenon.
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Affiliation(s)
- Nayla A. Hatem
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Taís L. Denicol
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Alessandro C. Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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3
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Brown CR, Crouser NJ, Speeckaert AL. Considerations for Hand Surgery in Patients With Scleroderma. Hand (N Y) 2023; 18:32-39. [PMID: 34053315 PMCID: PMC9806536 DOI: 10.1177/15589447211017211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Systemic sclerosis (scleroderma, SSc) is an autoimmune disease that causes significant dysfunction to multiple organ systems, including the musculoskeletal system. It poses significant challenges to the hand surgeon, including calcinosis, ischemic changes, Raynaud phenomenon, tendinopathies, synovitis, and joint contractures. Patients with SSc also suffer from multiorgan dysfunction, which makes them high-risk surgical patients. The hand surgeon must understand the pathophysiology, treatment strategies, and special operative considerations required in this population to avoid complications and help maintain or improve hand function.
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Quantitative Scintigraphy Imaging of Lingual Raynaud’s Phenomenon Using 3-Dimensional-Ring Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography/Computed Tomography. Tomography 2022; 8:2042-2048. [PMID: 36006069 PMCID: PMC9414660 DOI: 10.3390/tomography8040171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Perfusion scintigraphy with the acquisition of planar blood flow and pool images of bilateral hands has been used to aid diagnosis and to evaluate treatment response to Raynaud’s phenomenon (decreased blood flow to hand or foot). However, because of the difficulty in imaging the tongue area with a conventional gamma camera, perfusion scintigraphy imaging of patients with lingual Raynaud’s phenomenon has yet to be reported. Here, we report the case of a 59-year-old man with lingual Raynaud’s phenomenon in which blood pool imaging of the tongue was performed using three-dimensional (3D)-ring cadmium-zinc-telluride (CZT) single-photon emission computed tomography/computed tomography (SPECT/CT). During follow-up, the patient’s lingual symptoms had worsened, and follow-up blood pool SPECT/CT images also revealed decreased blood pool uptake of the tongue, showing a decreased blood pool of more than 25% on quantitative analysis. This case suggests that blood pool imaging of the tongue using 3D-ring CZT SPECT/CT has clinical significance in evaluating patients with lingual Raynaud’s phenomenon.
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Maciejewska M, Sikora M, Maciejewski C, Alda-Malicka R, Czuwara J, Rudnicka L. Raynaud's Phenomenon with Focus on Systemic Sclerosis. J Clin Med 2022; 11:jcm11092490. [PMID: 35566614 PMCID: PMC9105786 DOI: 10.3390/jcm11092490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Raynaud’s phenomenon is a painful vascular condition in which abnormal vasoconstriction of the digital arteries causes blanching of the skin. The treatment approach can vary depending on the underlying cause of disease. Raynaud’s phenomenon can present as a primary symptom, in which there is no evidence of underlying disease, or secondary to a range of medical conditions or therapies. Systemic sclerosis is one of the most frequent causes of secondary Raynaud’s phenomenon; its appearance may occur long before other signs and symptoms. Timely, accurate identification of secondary Raynaud’s phenomenon may accelerate a final diagnosis and positively alter prognosis. Capillaroscopy is fundamental in the diagnosis and differentiation of primary and secondary Raynaud’s phenomenon. It is helpful in the very early stages of systemic sclerosis, along with its role in disease monitoring. An extensive range of pharmacotherapies with various routes of administration are available for Raynaud’s phenomenon but a standardized therapeutic plan is still lacking. This review provides insight into recent advances in the understanding of Raynaud’s phenomenon pathophysiology, diagnostic methods, and treatment approaches.
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Affiliation(s)
- Magdalena Maciejewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
- Correspondence:
| | - Cezary Maciejewski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Rosanna Alda-Malicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
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Vanlancker T, Stragier B, De Bock M. Paraneoplastic Raynaud's phenomenon as sign of progression: a case report on a patient with breast cancer. Acta Clin Belg 2022; 77:122-125. [PMID: 32578512 DOI: 10.1080/17843286.2020.1782055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paraneoplastic Raynaud's phenomenon is a rare complication occurring in patients with advanced cancer. METHODS We present a case of a patient with breast cancer and presenting with acrocyanosis evolving into necrosis as a paraneoplastic phenomenon in progressive breast cancer. RESULTS Unless a multidisciplinary approach was taken, improvement of the symptoms was only seen with prostacyclin analogs, and cancer treatment needed to be changed because of rapidly progressing disease. CONCLUSION Paraneoplastic Raynaud's phenomenon is a rare but severe presentation of advanced and progressive cancer. Treatment with intravenous prostacyclin analogs should be considered and a multidisciplinary approach is necessary.
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Affiliation(s)
- Tine Vanlancker
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Barbara Stragier
- Department of Medical Oncology, AZ Delta Roeselare, Roeselare, Belgium
| | - Marlies De Bock
- Department of Medical Oncology, AZ Delta Roeselare, Roeselare, Belgium
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Akimoto T, Kobayashi T, Maita H, Osawa H, Kato H. A case of Raynaud's phenomenon of toes induced by whole‐body warm stimulation. J Gen Fam Med 2021; 23:113-115. [PMID: 35261861 PMCID: PMC8888806 DOI: 10.1002/jgf2.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
Raynaud's phenomenon, induced by cold stimulation and emotional stress, is also induced by whole‐body warm stimulation. A 74‐year‐old man was referred to our department because of nocturnal toe pain from 2 years prior and immediate color change of the toes from 1 year prior when submerging himself into a warm bath. Physical examination and blood tests revealed no abnormal findings suggestive of secondary Raynaud's phenomenon. Two years later, the signs and symptoms persisted. When physicians confirm Reynaud's phenomenon, they should check for the possibility of secondary Reynaud's phenomenon. Additional research on Reynaud's phenomenon induced by warm stimulation is needed.
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Affiliation(s)
- Takashi Akimoto
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Tadashi Kobayashi
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Hiroki Maita
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Hiroshi Osawa
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Hiroyuki Kato
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Hirosaki Japan
- General Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
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8
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Frech TM, Murtaugh MA, Amuan M, Pugh MJ. The frequency of Raynaud's phenomenon, very early diagnosis of systemic sclerosis, and systemic sclerosis in a large Veteran Health Administration database. BMC Rheumatol 2021; 5:42. [PMID: 34649624 PMCID: PMC8518247 DOI: 10.1186/s41927-021-00209-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We describe Raynauds phenomenon (RP), potential very early diagnosis of systemic sclerosis (VEDOSS), and systemic sclerosis (SSc) in Veterans deployed in support of Post-9/11 operations. We sought to describe the military occupation specialty, clinical features, and vasodilator use across the three diagnoses. METHODS Individual Veterans medical records were assessed for RP (ICD-9443.0), VEDOSS with swelling of hands (ICD-9729.81) and RP (ICD-9443.0), and SSc (ICD-9710.1). The distribution of sociodemographic, military service branch, job classification, vasodilator use, and comorbidities were examined across the three classifications of disease. The chi-squared test and Fisher's exact compared frequency of these categorical variables. Logistic regression assessed the likelihood of characteristics of the three classifications. RESULTS In this population of 607,665 individual Veteran medical records, 857 had RP, 45 met possible VEDOSS criteria, and 71 had a diagnosis of SSc. The majority of RP, potential VEDOSS and SSc cases were white males. Those in craftworks, engineering or maintenance, and healthcare had a greater likelihood of RP. Less than half of RP and VEDOSS patients were on vasodilators. The most common comorbidities in this population were the diagnostic code for pain (highest in the potential VEDOSS group [81.6%]), followed by depression in all groups. CONCLUSION This is a unique Veteran population of predominately-male patients. Our data suggests that vasodilator medications are potentially being under-utilized for RP and potential VEDOSS. Our data highlights mood and pain management as an important aspect of SSc care.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah and Salt Lake Veterans Affair Medical Center, 1900 E 30 N, SOM 4b200, Salt Lake City, UT, 84132, USA.
| | - Maureen A Murtaugh
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
| | - Megan Amuan
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
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Sampaio AL, Bressan AL, Vasconcelos BN, Gripp AC. Skin manifestations associated with systemic diseases - Part I. An Bras Dermatol 2021; 96:655-671. [PMID: 34544638 PMCID: PMC8790165 DOI: 10.1016/j.abd.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
The skin demonstrates what is happening in the body in many diseases, as it reflects some internal processes on the surface. In this sense, skin as an organ, goes beyond its protective and barrier functions, as it provides clues for the identification of some systemic diseases. The dermatologist then raises diagnostic hypotheses for conditions related to all systems and refers them to the appropriate specialty. With easy access to examination by trained eyes and biopsies, the skin can present specific or non specific alterations on histopathology. In the first case this combination establishes the diagnosis of the disease itself. Non specific manifestations can occur in a variety of contexts and then histopathology is not specific of a particular disease. This article is divided into two parts that will cover large groups of diseases. In this first part, cutaneous manifestations of the main rheumatologic diseases are described, which are the ones with the greatest interface with dermatology. The authors also talk about vascular manifestations and granulomatous diseases. In the second part, endocrinological, hematological, oncological, cardiovascular, renal, gastrointestinal diseases, pruritus and its causes are discussed, and finally, the dermatological manifestations of SARS-CoV-2 coronavirus infection. The authors’ intention is that, by using direct and easily accessible language, aim to provide practical material for consultation and improvement to all dermatologists who recognize the importance of a comprehensive assessment of their patients.
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Affiliation(s)
- Ana Luisa Sampaio
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Aline Lopes Bressan
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Barbara Nader Vasconcelos
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alexandre Carlos Gripp
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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10
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Lieber A, Scheuermann-Poley C. Incomplete Description. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118I processed the file.I'm waiting for feedback tomorrow:604. [PMID: 34789377 DOI: 10.3238/arztebl.m2021.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Rosen J, Miteva M. SnapshotDx Quiz: April 2021. J Invest Dermatol 2021. [PMID: 33752813 DOI: 10.1016/j.jid.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jordan Rosen
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mariya Miteva
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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12
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Potluri TK, Lee FG, Song E, Wallace SJ, Miller N. Use of Botulinum Toxin A to Treat Chemotherapy-Induced Raynaud's Phenomenon. Cureus 2021; 13:e12511. [PMID: 33564517 PMCID: PMC7863048 DOI: 10.7759/cureus.12511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Raynaud’s phenomenon (RP) is a vasospastic disorder of the digital blood vessels leading to pain, paresthesias, and pallor in response to cold or stress. RP can develop secondary to a number of pathologies or factors, including the use of chemotherapy agents. Typical first-line therapies for secondary RP may be contraindicated in patients with certain comorbidities. Here, we discuss a case in which botulinum toxin A (BTX-A) was used to treat chemotherapy-induced RP in a patient with non-small cell lung cancer (NSCLC). We provide a review of the existing literature on the clinical course and treatment modalities, including the use of BTX-A, for patients with secondary RP. A 56-year-old female with NSCLC received treatment with bevacizumab and pemetrexed. Her initial symptoms included progressive discoloration and pain in her fingertips, which hastily progressed to ischemia and subsequent dry gangrene. She was diagnosed with chemotherapy-induced RP, but traditional management options were complicated by acute congestive heart failure. BTX-A injections were administered at key locations on the wrist and hand, significantly improving her symptoms and slowing the progression of the gangrenous changes. RP can develop as sequelae of chemotherapy regimens. Clinical management may be complicated by underlying pathology and/or patient symptoms. BTX-A injections are an excellent non-operative therapeutic option for patients with secondary RP in cases where mainstay therapies may be contraindicated, thus decreasing pain, improving patient quality of life, and slowing the progression of gangrenous changes.
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Affiliation(s)
- Thrisha K Potluri
- Department of Plastic Surgery and Reconstructive Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Frank G Lee
- Department of Plastic Surgery and Reconstructive Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Ethan Song
- Department of Plastic Surgery and Reconstructive Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Sean J Wallace
- Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Nathan Miller
- Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
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13
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Affiliation(s)
- Philip O Anderson
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, California, USA
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14
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Sternbersky J, Tichy M, Zapletalova J. Infrared thermography and capillaroscopy in the diagnosis of Raynaud's phenomenon. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:90-98. [PMID: 32686771 DOI: 10.5507/bp.2020.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Raynaud's phenomenon (RP) is a relatively common disease. There are two distinct forms of RP - primary (PRP), where no other associated diseases are present, and secondary (SRP), where RP is associated with other diseases. It can be challenging to differentiate between RP and other diseases through medical history alone, due to the episodic nature of RP. Objective analysis of anamnestic data was performed in our study using infrared thermography (IRT) and a cold pressor test (CPT). Capillaroscopy was performed to assess morphological changes in the acral circulation. METHODS Patients with a history of cold hands were included in the study. IRT was performed before and after the CPT, and then capillaroscopy was performed. The results (including epidemiologic data) were statistically evaluated. RESULTS A total of 150 patients were included in the study. Summarisation of the results from the IRT and capillaroscopy determined the final diagnosis - 4.7% acrocyanosis, 10.7% physiologic findings, 31.3% PRP, 29.3% borderline SRP and 24% SRP. The coldest fingers following the CPT were, in most patients, the 2nd and 3rd fingers. The correlation between the presence of connective tissue disease and the diagnosis of borderline SRP and SRP was significant (P=0.0001). CONCLUSIONS Using the combination of the IRT and capillaroscopy in the diagnostic algorithm for RP has its justification. IRT distinguishes healthy patients from patients with RP, and capillaroscopy can then be used to differentiate PRP from SRP. IRT can also detect which fingers are more affected, and then these can direct the focus of capillaroscopy.
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Affiliation(s)
- Jan Sternbersky
- Department of Dermatology and Venereology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martin Tichy
- Department of Dermatology and Venereology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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15
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Miller TJ, Lin WC, Safa B. Radial Artery Occlusion in a Patient With Lupus, Antiphospholipid Syndrome, and Raynaud Phenomenon: A Multimodal Approach. J Hand Surg Am 2020; 45:664.e1-664.e5. [PMID: 31585746 DOI: 10.1016/j.jhsa.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/09/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023]
Abstract
Radial artery occlusion (RAO) is a known complication of transradial catheterization for cardiac procedures. The transradial approach has decreased bleeding complications compared with the transfemoral approach, but risks provoking hand ischemia. We present a case of a 29-year-old peripartum woman with a history of lupus, antiphospholipid syndrome, and Raynaud phenomenon who developed RAO with hand-threatening ischemia despite therapeutic anticoagulation. Given the patient's medical history, a multimodal approach was applied including thrombectomy, arterial bypass, venous arterialization, and onobotulinum toxin A sympathectomy. The patient's ischemia improved after the procedure, and she regained normal use of the hand.
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Affiliation(s)
- Travis J Miller
- The Buncke Clinic, San Francisco, CA; Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA.
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16
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Hislop-Jambrich JL, Troupis JM, Littlejohn G, Kuganesan A. Dynamic CTA and MRA in a case of severe Raynaud's phenomenon. Clin Imaging 2020; 66:133-136. [PMID: 32480268 DOI: 10.1016/j.clinimag.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
Raynaud's phenomenon (RP) is a condition where arterial spasm, usually in the fingers, causes episodes of reduced blood flow. The condition is either idiopathic (primary) or related to a connective tissue disorder or drug response (secondary). We present a case of severe RP where we performed a novel-sequenced CTA and MRA during a prolonged active episode of peripheral vasospasm. Real-time multidisciplinary consultation resulted in appropriate therapy with symptoms alleviation within hours of presentation.
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Affiliation(s)
- Jacqueline L Hislop-Jambrich
- Centre for Medical Research and Development, Canon Medical, Building C, 12-24 Talavera Road, North Ryde, NSW 2113, Australia.
| | - John M Troupis
- Medical Imaging Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Geoffrey Littlejohn
- Rheumatology Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Ahilan Kuganesan
- Medical Imaging Department, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
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17
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Targeted high concentration botulinum toxin A injections in patients with Raynaud's phenomenon: a retrospective single-centre experience. Rheumatol Int 2020; 41:943-949. [PMID: 32447423 DOI: 10.1007/s00296-020-04606-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 01/22/2023]
Abstract
Raynaud's phenomenon is a vasospastic condition affecting hands and feet which may lead to rest pain, ischemic ulcers and gangrene. Botulinum toxin A has been shown to improve peripheral circulation and relieve vasospastic symptoms. Our aim was to assess our treatment outcomes following Botulinum toxin A injections in patients with Raynaud's phenomenon and to explore the importance of toxin concentration and injection sites. Retrospective chart review of patients with primary and secondary Raynaud's syndrome treated with Botulinum toxin A injections and a literature review was conducted. The toxin dose, injection sites, symptom relief, healing of ulcers and complications were assessed. A total of 30 treatment episodes over a 7½ year period were included. All patients had failed medical management. Botulinum toxin A injection was injected primarily in the vicinity of the palmar digital neurovascular bundle. The average total Botulinum toxin A dose injected was 156 U and the concentration was 50 U/ml. All patients reported an improvement in symptoms and healing of digital ulcers. One patient reported a temporary muscle weakness. Six patients had a single treatment episode with long term benefit. Systemic sclerosis patients had an average of 6-month interval between treatment episodes. Higher doses of Botulinum toxin A has been well tolerated with no long term adverse effects. Our study shows that targeted low volume higher concentration Botulinum toxin A injections are effective in treating Raynaud's phenomenon.
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Raynaud's phenomenon of the nipple: Ensuring timely diagnosis. J Am Assoc Nurse Pract 2020; 33:271-277. [DOI: 10.1097/jxx.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
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Tapia-Haro RM, García-Ríos MC, Toledano-Moreno S, Casas-Barragán A, Castro-Sánchez AM, Aguilar-Ferrándiz ME. The complementary effects of galvanic current electrical stimulation associated with conservative treatment to increase vasodilation in patients with Raynaud's phenomenon: a randomized trial. Clin Rehabil 2020; 34:595-606. [PMID: 32141306 DOI: 10.1177/0269215520907652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the effectiveness of an electrotherapy intervention with galvanic current on symptoms associated with Raynaud's phenomenon. DESIGN Single-blind randomized controlled trial, parallel design (1:1 ratio) and intention-to-treat analysis. SETTING Virgen de las Nieves Hospital, Granada, Spain. SUBJECTS Thirty-four participants with Raynaud's phenomenon, with a mean (SD) age of 43.43 (17.62) years. INTERVENTIONS The patients were randomly assigned to a control group with conservative treatment (anti-inflammatory, vasodilatory and analgesic drugs) or an intervention group that received conservative treatment and vasodilatory electrical stimulation during seven weeks, three times/week for a total of 20 sessions. MAIN MEASURES The primary outcome was the number of attacks. Secondary outcomes were pain, peripheral blow flow, oxygen saturation, upper limb disability, central sensitization, pain catastrophizing and temperature recovery. All outcomes were assessed at baseline, posttreatment and at two months of follow-up. RESULTS The galvanic current electrotherapy group showed significantly greater improvements in the number of attacks (mean difference = 26.3, 95% confidence interval (CI) = 14.4 to 38.3), pre-cold stress pain (95% CI = 0.6 to 2.4), radial artery blood flow (95% CI = -7.8 ⩾ x ⩽ 1.3), ulnar artery blood flow (95% CI = -8.63 to 0.60), oxygen saturation (95% CI = -1.7 ⩾ x ⩽ -0.29), upper limb disability (95% CI = 1.1 to 22.3), central sensitization (95% CI = 6.7 to 18.2) and temperature recovery (95% CI = -5.7 ⩾ x ⩽ -0.32) than the conservative treatment group. CONCLUSION This study suggests that a complementary treatment with galvanic current in combination to conservative approach is superior to conservative applied as isolate, in reducing the clinical manifestations and disability in Raynaud's phenomenon.
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Affiliation(s)
- Rosa María Tapia-Haro
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | - Mª Carmen García-Ríos
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | - Sonia Toledano-Moreno
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | - Antonio Casas-Barragán
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | | | - María Encarnación Aguilar-Ferrándiz
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
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Kobak S. Secukinumab-induced Raynaud's phenomenon: first report in the literature. Ther Adv Drug Saf 2020; 11:2042098620905976. [PMID: 32128108 PMCID: PMC7036488 DOI: 10.1177/2042098620905976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/20/2020] [Indexed: 11/21/2022] Open
Abstract
Secukinumab is an IL-17A antagonist that has proven efficacy in the treatment of
patients with ankylosing spondylitis (AS) and psoriatic arthritis. Side effects
of the drug include infections, skin rashes, and allergic reactions. Raynaud’s
phenomenon (RP), a vasospastic syndrome and an important feature of different
connective tissue diseases, is not an expected finding in AS patients. This
article reports the development of secukinumab-related RP in a 35-year-old
female patient with AS. Treatment with secukinumab was continued and RP was
treated with low-dose aspirin and a calcium-channel blocker.
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Affiliation(s)
- Senol Kobak
- Department of Rheumatology, LIV Hospital, Istinye University Faculty of Medicine, Canan sokak No: 5, Ulus/Istanbul, 34340, Turkey
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Wang CM, Hu MC, Huang MS. Possible piracetam-induced Raynaud's phenomenon in a male patient. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Gorski S, Bartnicka M, Citko A, Żelazowska-Rutkowska B, Jablonski K, Gorska A. Microangiopathy in Naifold Videocapillaroscopy and Its Relations to sE- Selectin, Endothelin-1, and hsCRP as Putative Endothelium Dysfunction Markers among Adolescents with Raynaud's Phenomenon. J Clin Med 2019; 8:jcm8050567. [PMID: 31027378 PMCID: PMC6572411 DOI: 10.3390/jcm8050567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to analyze the relationship between the qualitative abnormalities on nailfold videocapillaroscopy (NVC), and the concentrations of selected biomarkers (sE-selectin, endothelin-1, high-sensitivity c-reactive protein (hsCRP)) and lipid metabolism parameters in children and adolescents with Raynaud’s phenomenon (RP). Raynaud’s phenomenon, to assess whether nailfold capillary changes may reflect the degree of systemic blood vessel abnormalities. The study group included 66 patients (34 undifferentiated—uRP and 32 secondary—sRP) aged 6–19 years and the control group. In both groups, NVC was performed and the selected biomarkers were measured (sE-selectin, endothelin-1, hsCRP) and lipid profile. Endothelin-1, sE-selectin and hsCRP concentrations in patients from both RP groups were significantly higher; concentration of HDL fraction was significantly lower compared with the control group. The analysis of multiple linear regression demonstrated that megacapillaries most strongly determine the sE-selectin value (p = 0.04) and hsCRP (p = 0.03). Both the total cholesterol and low-density lipoprotein (LDL) fraction concentrations were determined by the presence of avascular areas (p = 0.02). In conclusion, specific pathologic NVC changes were associated with higher endothelial damage biomarkers concentration and adverse changes in the lipid profile.
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Affiliation(s)
- Stanislaw Gorski
- Department of Medical Education, Jagiellonian University Medical College, 31-530 Krakow, Poland.
| | - Marta Bartnicka
- Department of Family Medicine, Medical University of Bialystok, 15-054 Bialystok, Poland.
| | - Anna Citko
- Outpatient Clinic, Bialystok Children's Clinical Hospital of L. Zamenhof, Medical University of Bialystok, 15-274 Bialystok, Poland.
| | - Beata Żelazowska-Rutkowska
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, 15-276 Bialystok, Poland.
| | - Konrad Jablonski
- Department of Medical Education, Jagiellonian University Medical College, 31-530 Krakow, Poland.
| | - Anna Gorska
- Department of Family Medicine, Medical University of Bialystok, 15-054 Bialystok, Poland.
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, Rheumatology Outpatient Clinic, Medical University of Bialystok, 15-276 Bialystok, Poland.
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23
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Acharya G, Acharya M. Hands as cold as ice. Postgrad Med J 2018; 95:48. [PMID: 30573558 DOI: 10.1136/postgradmedj-2018-136084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/15/2018] [Accepted: 10/27/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Geeta Acharya
- Department of Radiology, The Royal London Hospital, London, UK
| | - Metesh Acharya
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
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Affiliation(s)
- Drew Kurtzman
- Division of Dermatology, St. Elizabeth Physicians, University of Louisville School of Medicine, 7370 Turfway Road, Suite 370, Florence, KY 41042.
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