The frequency of Raynaud's phenomenon, very early diagnosis of systemic sclerosis, and systemic sclerosis in a large Veteran Health Administration database

Cold Finger: Raynaud Phenomenon Following Snakebite Envenoming by Nikolsky's Viper (Vipera berus nikolskii)

A field biologist was bitten by a female Nikolsky's viper (Vipera berus nikolskii) in Kharkiv Oblast, Ukraine. Two months later, the patient began to experience cold-induced vasospasm of the affected digit diagnosed as acquired Raynaud phenomenon. The patient had more than 30 occurrences during the single winter following the bite, but the signs and symptoms of Raynaud phenomenon disappeared with the end of winter. This report describes the case and puts it into context with the literature on the topic of toxin-induced peripheral vasospastic disorders and their potential importance in snakebite envenoming.

Predictors of progression to systemic sclerosis: Analysis of Very Early Disease of Systemic Sclerosis (VEDOSS) in a large single cohort

OBJECTIVE

This study analyzed the Very Early Disease of Systemic Sclerosis (VEDOSS) characteristics in a group of 217 patients with Raynaud phenomenon (RP) and at least one manifestation of systemic sclerosis (SSc) in search of predictors for the progression to SSc.

METHODS

This is a cross-sectional single-center analysis of patients presenting RP with a specific SSc clinical manifestation or SSc autoantibody or SD pattern at nailfold capillaroscopy (SD-NFC), without skin involvement, who attended a scleroderma outpatient clinic between 2010 and 2019. The performance of VEDOSS and the importance of the combination of VEDOSS characteristics to predict the progression to SSc were evaluated.

RESULTS

Among 217 patients, 153 (70.5%) were classified as SSc, including 65 (30%) in the first investigation; 69.3% of the SSc patients met VEDOSS criteria, compared with 6.3% of patients who did not progress to SSc. The combinations most associated with progression to SSc were RP + puffy fingers (PF) + positive antinuclear antibodies (ANA) + (SD-NFC and/or SSc specific antibody) (VEDOSS level 2), with an odds ratio (OR) of 19.52 (95%CI 4.48-85.06; p< 0.001) and RP + PF + positive ANA (VEDOSS level 1; "red flags") (OR = 15.45; p< 0.001), while combinations without non-Raynaud clinical symptoms, as RP + SD-NFC (OR = 0.03; p< 0.001) and RP + anticentromere + SD-NFC (OR = 0.06; p= 0.006) were associated with non-progression to SSc.

CONCLUSION

Among patients with RP with at least one manifestation of SSc, without skin involvement, combinations of VEDOSS characteristics were the strongest predictors of progression to SSc at a median follow-up of 4 years.