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Hintergrund Das primäre Raynaud-Syndrom ist eine weit verbreitete Gefäßerkrankung, die die Lebensqualität der ansonst zumeist im Wesentlichen gesunden Betroffenen stark einschränkt. Bis heute sind die genauen Auslöser unklar, wobei von einer multifaktoriellen Genese ausgegangen wird. Für die Diagnostik, die zurzeit auf dem Ausschlussprinzip beruht, und die Therapie der Krankheit wäre es wichtig, die Pathogenese besser zu verstehen. Daher geht diese Studie der Frage nach, ob der Lipidstoffwechsel, speziell das LDL, in Zusammenhang mit dem primären Raynaud-Syndrom steht und möglicherweise ein ausschlaggebender Faktor für die Entstehung der Beschwerden ist. Ziel In dieser Arbeit soll beantwortet werden, ob es einen Zusammenhang zwischen erhöhten Blutfettwerten, insbesondere LDL, und dem primären Raynaud-Syndrom gibt. Des Weiteren soll mittels Kapillarmikroskopie nachgewiesen werden, ob die Patient*innen auffällige Muster bzw. Veränderungen aufweisen, die mit den erhöhten LDL-Spiegeln in Verbindung gebracht werden können. Methodik Bei dieser explorativen Datenanalyse umfasst das Patientenkollektiv 120 Patient*innen mit klinischem primären Raynaud-Syndrom. Diese hatten im Zeitraum von 2018 bis 2022 eine Erstuntersuchung auf der Raynaud Ambulanz im AKH Wien, die ein Anamnesegespräch, eine körperliche Untersuchung, eine Blutabnahme mit labordiagnostischer Auswertung, oszillographische Untersuchungsmethoden und eine Kapillarmikroskopie umfasste. Bei der statistischen Auswertung wurde die Korrelation der Lipidstoffwechselparameter mit den kapillarmikroskopischen Parametern analysiert. Ergebnisse Es zeigte sich, dass das grundsätzlich schlanke Patientenkollektiv erhöhte Cholesterin- und LDL-Werte aufwies. Darüber hinaus konnte die statistische Analyse einen deutlichen Zusammenhang zwischen dem LDL-Spiegel und zwei kapillarmikroskopischen Veränderungen, den Torquierungen und den Dilatationen, nachweisen. Bei einem erhöhten LDL lag vermehrt die Kombination aus vorhandenen Torquierungen und fehlenden Dilatationen vor. Schlussfolgerung In Anbetracht der Ergebnisse lässt sich ein Zusammenhang zwischen erhöhten Blut-fettwerten und dem primären Raynaud-Syndrom vermuten. Auf welche Art der erhöhte Lipidstoffwechsel die peripheren Blutgefäße und deren vasospastische Aktivität genau beeinflussen könnte, sollte in weiterführenden Studien untersucht werden. Background Primary Raynaud's phenomenon is a widespread vascular disease that severely limits the quality of life of otherwise essentially healthy patients. To date, the exact triggers are unclear, although a multifactorial genesis is assumed. For diagnosis, which is currently based on the exclusion principle, and therapy of the disease, it would be important to better understand the pathogenesis. Therefore, this study investigates whether the lipid metabolism, specifically LDL, is related to primary Raynaud's phenomenon and may be a determining factor in the development of the symptoms. Objective The aim of this study is to answer the question if there is an association between elevated blood lipid levels, especially LDL, and primary Raynaud's phenomenon. Furthermore, capillaroscopy will be used to determine whether the patients show abnormal patterns or changes that can be associated with elevated LDL levels. Methods In this exploratory data analysis, the patient population included 120 patients with clinical primary Raynaud's phenomenon. These had an initial examination at the Raynaud ambulance at Vienna General Hospital from 2018 to 2022, which included a medical history interview, physical examination, blood draw with laboratory diagnostic evaluation, and capillaroscopy. Statistical evaluation analyzed the correlation of lipid metabolism parameters with capillaroscopic parameters. Results It was observed that the basically lean patient population had elevated cholesterol and LDL levels. Furthermore, statistical analysis demonstrated a clear correlation between LDL levels and two capillaroscopic changes, tortuosed and dilated capillaries. With elevated LDL, the combination of existing torsions and absent dilations was more prevalent. Conclusion In view of the results, an association between elevated blood lipid levels and primary Raynaud's phenomenon can be confirmed. The exact way in which an increased lipid metabolism might affect peripheral blood vessels and their vasospastic activity should be investigated in further studies.

The objective findings of phalangeal T2-weighted hyperintense and T1-weighted hypointense bone marrow signal on MRI without features of seronegative arthropathy or osteomyelitis may assist clinicians in making a diagnosis in the appropriate clinical context.

Case report - Introduction Waldenström’s macroglobulinemia (WM) is a rare haematological malignancy accounting for 2% of blood cancers. It is characterised by an immunoglobulin M (IgM)-associated lymphoplasmacytic lymphoma and usually follows an indolent disease course. Most patients present with nonspecific constitutional symptoms, commonly fatigue secondary to anaemia. Cryoglobulins are found in approximately 15% of WM patients but are symptomatic in less than 5% of cases. Symptoms range from Raynaud’s phenomenon to skin ulcers. We present a 56-year-old presenting with episodic blue discoloration of the ears and face, associated with cold exposure. Investigation revealed a diagnosis of WM with symptomatic cryoglobuloinaemia. Case report - Case description A 56-year-old female was referred to the rheumatology clinic with symptoms of Raynaud’s phenomenon. Further questioning revealed that she had been having Raynaud’s symptoms for many years, however over the last 18 months she experienced blue discolouration of her face, neck and ears when exposed to the cold. The lesions were itchy but non-tender and settled promptly on re-warming. There was no skin blistering or ulceration. She had also noted a reduced exercise tolerance. She was previously a keen runner but found she was short of breath after 2 miles, particularly on an incline or flight of stairs. There was no history of weight loss, loss of appetite or night sweats. Examination revealed skin changes consistent with resolving chilblains on the feet, with some nail dystrophy. There were a couple of splinter haemorrhages on one of the fingernails and no features of active Raynaud’s. There was no lymphadenopathy or hepatosplenomegaly and both cardiovascular and respiratory examination were normal. Blood tests showed a normal full blood count and renal function. Further investigations went on to reveal a cryoglobulinaemia with IgM kappa paraprotein. She was then referred to the haematology team who arranged for a bone marrow biopsy. This showed a 10—15% infiltration of low-grade B-cell lymphoma. A CT chest, abdomen, pelvis reported no lymphadenopathy, a normal spleen and a thyroid goitre. Treatment was initiated in the form of a triple therapy, dexamethasone, rituximab and cyclophosphamide. She underwent one cycle with good response and her original symptoms have now resolved. She is awaiting her second cycle of treatment. Case report - Discussion Lymphoplasmacytic lymphoma (LPL) is a mature B-cell neoplasm composed of small B lymphocytes showing plasmacytoid or plasma-cell differentiation. WM is a form of LPL in which there is evidence of bone marrow involvement and a monoclonal IgM paraprotein in the serum. WM accounts for over 95% of cases of LPL. Patients with WM can have symptoms caused by tumour infiltration (fever, night sweats, weight loss, fatigue) and/or by monoclonal IgM (hyperviscosity, cyoglobinaemia, cold agglutinin). Cryoglobulins are immunoglobulins or immune complexes (which contain rheumatoid factor) that precipitate below 37 °C and re-dissolve on warming. Typically, cryoglobulin measurements are done on serum samples using tubes without gel separators. Temperature control of the specimen during collection, transportation and centrifugation is vital and if not done correctly, can affect diagnosis. The term cyroglobulinaemia refers to the presence of one or more of these immunoglobulins in the serum. Cryoglobulinaemia in association with WM usually involve type I cryoglobulins or mixed immunoglobulin complexes, where monoclonal IgM behaves as an antibody against polyclonal IgG. Patients with symptomatic cryoglobulinaemia can present in a variety of ways including rapidly progressive glomerulonephritis, polyarthralgia, cutaneous ulcers and Raynaud’s phenomenon. In WM patients with symptomatic cryoglobulinaemia, exposure to cold leads to intravascular gelling of cryoglobulins with subsequent intravascular agglutination of red cells. This impairs the circulation to the cold exposed organs and vasoconstriction of the vessels can occur. The stagnant blood causes ischaemia and with pallor and consequently cyanosis develops. In our patient this pathway led to Raynaud’s and facial cyanosis symptoms. Case report - Key learning points Although the presence of cryoglobulins is frequent in WM, fewer than 5% are symptomatic. This case illustrates the importance of thorough history and investigation in patients that are referred to the Rheumatology outpatient clinic with presumed primary Raynaud’s phenomenon. Our patient had probable primary Raynaud’s phenomenon for many years, however she then had a change in symptoms, i.e., facial cyanosis, and this is what prompted further investigation for potential malignancy. The symptoms can be present for many months before the insidious nature of the underlying WM manifests and thus a high index of suspicion is necessary. Another important learning point is, if a patient presents with Raynaud’s symptoms and they do not meet the typical demographic for primary Raynaud’s disease (young onset, relatively mild disease with female preponderance) it is crucial to investigate for secondary causes. Skin manifestations related to symptomatic cryoglobulinaemia are common, with the most frequent being purpura and ulcers. Our patient presented with intermittent cyanosis of the face that could have progressed to necrotic ulceration if a diagnostic delay had occurred. Treatment directed at the underlying cause of the symptomatic cryoglobulinaemia results in improvement or stabilisation of symptoms in the majority of patients, with disappearance of cryoglobulins in over 50% of cases. Finally, clinicians often rely on constitutional symptoms of lethargy, weight loss and night sweats being present as triggers to investigate for a malignancy. Our patient displayed none of these red flag symptoms and even had a normal haemogloblobin level. This emphasises that awareness of this relatively rare disease entity is essential when faced with similar clinical scenarios as our patient and that cryoglobulinaemia should be on our differential list.

Primary Raynaud's phenomenon (PRP) manifests as episodes of transient spasms of peripheral blood vessels. To elucidate the clinical clues and laboratory characteristics will facilitate the identification of PRP.A retrospective data collection of clinical and laboratory characteristics of 58 children with PRP was performed between January 2007 and December 2016.A positive ANA test at lower titers1:100 was detected in 24.1% of the patients. There was a significant relationship between presence of ANA positivity and migraine in female patients with PRP (p=0.01; p=0.020 respectively). The most common accompanying disorder was migraine which was detected in 37.9% of all patients with PRP. Hemoglobin and serum ferritin levels were significantly lower in PRP patients with migraine (p=0.045; p0.05, respectively). Additionally, the mean platelet volume (MPV) measurements were significantly higher in patients with migraine compared to those without migraine (p=0.045; p0.05 respectively).There is limited data concerning childhood PRP. For the first time we showed a high frequency of migraine in childhood PRP. Anemia and high MPV could be the underlying triggering factors of these two episodic diseases.

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.

Objective: This study aims to evaluate blood perfusion (BP) in various cutaneous regions of the hands and face in patients with systemic lupus erythematosus (SLE) and primary Raynaud's phenomenon (PRP) and healthy subjects (HS). Methods: A total of 20 patients with SLE, 20 patients with PRP, and 20 HS were enrolled. BP was detected by laser speckle contrast analysis in different regions of the hand and at the facial level. The absolute nailfold capillary number (CN) was assessed by nailfold videocapillaroscopy. Results: Patients with SLE and PRP had significantly lower BP levels than those of HS in 3 hand areas (fingertip, palm, and periungual; p

Key Clinical Message 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.

Background Raynaud’s phenomenon (RP) is frequently associated with the presence of scleroderma or other connective tissue diseases (CTD). Identify the presence of secondary RP is important to perform an adequate therapeutic management and to achieve the early control of these patients. Nailfold capillaroscopy is safe, economic, easy to perform and has proven to be useful in identifying patients with secondary RP. Objectives To assess a long-term follow-up primary RP patient’s cohort. Methods Retrospective observational study of a wide and unselected series of patients diagnosed as primary RP from a single university hospital from January 2012 to December 2018. Patients were classified as primary RP after the presence of CTD at the onset was excluded. Results We studied 248 patients (210 women/38 men), with a mean age of 46.3±15.2 years (range 15-88). After a mean follow-up period of 57.2±21.6 months, 9 (3.6%) patients were diagnosed of a CTD. The remaining 239 (96.4%) patients continued classified as primary RP. The main pathologies observed after follow-up were: Scleroderma/Systemic sclerosis (n=3), Systemic Lupus Erythematosus (n=3), Rheumatoid arthritis (n=1), Sjogren’s syndrome (n=2). The main capillaroscopic patterns observed were: Normal (n=175), Unspecific (n=64), Scleroderma pattern (n=3) and suggestive of other rheumatic diseases pattern (n=6). All the patients who developed a CTD during follow-up showed changes at successive nailfold capillaroscopic examinations. 28 of 239 patients who remained primary RP showed minor changes at successive nailfold capillaroscopy. The main capillaroscopic changes detected on this group were: Presence of capillary tortuosity (n=6), presence of a decreased capillary density (2) and the presence of capillary bleeding (n=20). Antinuclear antibodies (ANA) were positive at he onset in 46 patients (16.9%) and after follow-up in 44 (17.7%) patients. Conclusion After a mean follow-up period next to 5 years, most of our primary RP patients remained free of CTD. A minority of our patients showed changes at nailfold capillaroscopy exam or positivity of ANA. Disclosure of Interests None declared

Background Raynaud’s phenomenon (RP) is a clinical expression of recurrent reversible vasospasm of small peripheral arteries and arterioles. It is a common pathology in clinical practice and is classified into two main categories – primary RP in the absence of an underlying disorder and secondary RP that is in the context of another disease. The differential diagnosis is of crucial importance for the practising rheumatologists because the patients with primary RP are with benign course while those with secondary RP require further differentiation and establishment of the precise diagnosis and treatment. Differentiation between primary and secondary RP is based on clinical features, laboratory including immunological investigations and capillaroscopic findings. Objectives The nailfold capillaroscopy is a key imaging tool for monitoring the RP patients because of the high predictive value of the abnormal capillaroscopic pattern for future development of connective tissue disease. Patients with primary RP have younger age at onset ( Methods Literature data on quantitative analysis of capillaroscopic parameters in primary RP are limited. Results In an own study that included 31 patients with primary RP patients, significantly wider arterial and venous capillary diameters as compared with healthy controls was found in 96.6% of cases. The mean arterial capillary diameter (0.018±0.004 mm) in primary RP patients was significantly larger in comparison healthy volunteers (0.012±0.001 mm, p Conclusions These capillaroscopic observations in primary RP patients suggest that the absence of an abnormal capillaroscopic pattern is diagnostic for primary RP but minor capillaroscopic dilation is a frequent microvascular feature in these patients. References [1] Lambova S, Muller-Ladner U. Capillaroscopic findings in primary fibromyalgia. Curr Rheumatol Rev2017. doi: 10.2174/1573397113666170607160854. [2] Bukhari M,Hollis S, Moore T, Jayson MI, Herrick AL. Quantitation of microcirculatory abnormalities in patients with primary Raynaud’s phenomenon and systemic sclerosis by videocapillaroscopy. Rheumatology (Oxford)2000;39(5):506–12. [3] Anderson ME, Allen PD, Moore T, Hillier V, Taylor CJ, Herrick AL. Computerized nailfold videocapillaroscopy – a new tool for assessment of Raynaud’s phenomenon. J Rheumatol2005;32:841–8. Disclosure of Interest None declared

Background Raynaud’s phenomenon (RP) is frequently associated with the presence of scleroderma or other connective tissue diseases (CTD). Identify the presence of secondary RP is important to perform an adequate therapeutic management and to achieve the early control of these patients. Nailfold capillaroscopy is safe, economic, and relatively easy to perform and has proven to be useful in identifying patients with secondary RP. Objectives To assess a long-term follow-up primary RP patient’s series. Methods Retrospective observational study of a wide and unselected series of patients diagnosed as primary RP from a single university hospital from January 2012 to August 2017. Patients were classified as primary RP after the presence of CTD at the onset was excluded. Results We studied 214 patients (85.98% were female), with a mean age of 47.6±16.7 years (range 15–88). After a mean follow-up period of 46.4±23.3 months, 8 patients were diagnosed of a CTD (2 Scleroderma/Systemic sclerosis, 3 Systemic Lupus Erythematosus, 1 Rheumatoid arthritis and 2 Sjogren’s syndrome). The remaining 206 patients continued classified as primary RP. The main capillaroscopic patterns observed were: Normal (n=157), unspecific (n=49), scleroderma pattern (n=2) and suggestive of other rheumatic diseases pattern (n=6). All patients who developed a CTD during the follow-up, showed changes in successive nailfold capillaroscopic examinations. 20 of 206 patients who remained primary RP showed minor changes at successive nailfold capillaroscopy. The main capillaroscopic changes detected on this group were: presence of capillary tortuosity (n=4), presence of a decreased capillary density2 and the presence of capillary bleeding (n=16). Antinuclear antibodies (ANA) were positive at the onset in 34 patients and after follow-up in 39 patients. Conclusions After a mean follow-up period next to four years, most of our primary RP patients remained free of CTD. A minority of our patients showed changes at nailfold capillaroscopy exam or positivity of ANA. Disclosure of Interest None declared

Background/aim: The pathogenesis of Raynaud's phenomenon (RP) has not yet been fully elucidated. RP is characterized by exaggerated cold-induced vasoconstriction. Urotensin II (UII) is a potent vasoconstrictor. The aim of the present study was to evaluate plasma UII levels in both primary RP and secondary RP associated with systemic sclerosis (SSc).Materials and methods: Fifteen patients with primary RP, 30 patients with RP secondary to SSc, and 30 healthy controls (HC) were included in the study. Raynaud condition scores (RCS) were determined in the primary RP and SSc groups. Modified Rodnan skin score (MRSS) was determined for the SSc patients. Plasma UII level was analyzed by the ELISA method. Results: When compared to the HC group, plasma UII level was lower in the secondary RP group, but not in the primary RP group. Plasma UII level was not directly related to RCS in either the primary or secondary RP group. Moreover, it was not correlated with MRSS in the secondary RP group.Conclusion: The results of the present study suggest that UII is not associated with primary RP. Its level was lower in the secondary RP (SSc) patients. Therefore, it can be concluded that decreased UII level is related to SSc instead of RP.

The aim of this study is to assess the prognostic value of major provisional criteria for the development of systemic sclerosis (SSc) in primary Raynaud’s phenomenon (RP) patients. We retrospectively studied the chart of 497 patients with primary RP in whom anticentromere (ACA) and antitopoisomerase I (ATA) antibodies tests and a capillary reading were available. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratios (LHR+), negative likelihood ratios (LHR−), odds ratio (OR), and area under the receiver operating characteristics curve (AUC) of those criteria were assessed to predict the development of SSc. During the average follow-up of 2.3 ± 1.9 years, 159 (32 %) patients evolved to SSc, 245 (49.3 %) evolved to other connective tissue diseases, and 93 (18.7 %) patients did not progress. The SSc pattern predicted SSc satisfactorily (LHR+ 4.12, LHR− 0.07, OR 63, AUC 0.819; P

The aim of this study was to measure the sensitivity and specificity of transcutaneous oxygen tension and postocclusive hyperemia testing using laser Doppler flowmetry in patients with primary Raynaud’s phenomenon. One hundred patients and one hundred controls were included in the study. Baseline microvascular blood flow and then time to peak flow following occlusion were measured using laser Doppler flowmetry. Afterwards, the transcutaneous oxygen tension was recorded. The sensitivities of baseline microvascular blood flow, postocclusive time to peak flow, and transcutaneous oxygen tension were 79%, 79%, and 77%, respectively. The postocclusive time peak flow had a superior specificity of 90% and area under the curve of 0.92 as compared to 66% and 0.80 for baseline microvascular flow and 64% and 0.76 for transcutaneous oxygen tension. Time to postocclusive peak blood flow measured by laser Doppler flowmetry is a highly accurate test for differentiating patients with primary Raynaud’s phenomenon from healthy controls.

Background : Following digital surgical procedures, the ensuing post-operative course may be complicated by the presence of underlying ischaemic or vasospastic process. In the presence of such conditions, post-operative ischaemic changes may be further exacerbated with the use of local anaesthetics in combination with epinephrine. Case Details : We report a 21 year-old female who presented with an amputated fifth digit due to a rapidly spreading gangrene which started immediately after the surgical repair of a traumatic laceration which was infiltrated with a pre-mixed solution of lignocaine and epinephrine 3 hours earlier. The patient’s final diagnosis was epinephrine-associated digital gangrene in the background of primary Raynaud’s Phenomenon (RP). Conclusion : The author reports this case in order to reiterate the importance of thorough clinical evaluation prior to the use of epinephrine in digital anaesthesia as well as to increase awareness on how primary RP can be complicated by gangrene. Keywords : Digital gangrene, trauma, epinephrine, Raynaud’s phenomenon

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 and55 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.

We hypothesized that mean platelet volume (MPV), a reliable marker of platelet activation, might be elevated in primary Raynaud's phenomenon (PRP) even if there was no thrombotic complication in our subjects. In this retrospective-cohort study, we examined the clinical value of MPV in 200 patients with PRP and 116 clinical controls, and measured MPV and platelet P-selectin (CD62P) in all study participants. We also evaluated the effect of age, gender, and disease duration on these platelet activation markers in PRP. MPV and CD62 positivities were significantly (p

Raynaud's phenomenon (RP) is defined as episodic ischemia of the extremities in response to cold. Although the structure of skin capillaries is normal in primary RP, some data suggest impairment of microvascular function. We aimed at testing whether digital skin blood flow was lower in RP than in controls while cooling locally. We further evaluated the contribution of sensory nerves in the response. We recruited 21 patients with primary RP and 20 healthy volunteers matched on age and gender. After a 10-min baseline at 33°C, skin temperature was cooled at 15 or 24°C during 30 min on the forearm and the finger while monitoring perfusion with a custom-design laser Doppler flowmetry probe. Perfusion was also assessed after topical anesthesia. Blood flow was expressed as cutaneous vascular conductance (CVC). Data were subsequently expressed as area above the curve (AAC0–30) of the percentage decrease from baseline CVC (%BL). CVC on the dorsum of the finger was lower in RP patients compared with controls at 15°C (AAC0–30 were 106,237.2 and 69,544.3%BL·s, respectively; P = 0.02) and at 24°C (AAC0–30 were 86,915 and 57,598%BL·s, respectively; P = 0.04) whereas we observed no significant difference on the finger pad and the forearm. Topical anesthesia increased CVC in patients with RP ( P = 0.05), whereas it did not affect reactivity in controls ( P = 0.86). Our study shows exaggerated skin microvascular vasoconstriction to local cooling on the dorsum of the finger in primary RP compared with controls. Part of this abnormal response in primary RP depends on sensitive nerves.

To investigate simultaneously skin perfusion and digital artery pulsatility of hands in patients with primary Raynaud's phenomenon (PRP) and systemic sclerosis (SSc).In 100 SSc patients, 92 PRP patients, and 80 healthy controls, perfusion and digital artery pulsatility of the hands were investigated by laser Doppler perfusion imaging (LDPI) and photoplethysmography (PPG), respectively.Both the mean value of mean perfusion and the mean value of sphygmic wave amplitude were lower (p0.0001) in the PRP group than in the SSc group, and also in the SSc group compared with the healthy controls. A positive correlation (r = 0.95) was found between the mean value of mean perfusion and the mean value of sphygmic wave amplitude. A homogeneous perfusion distribution pattern was present in 95% of the healthy controls, 93% of the PRP patients, and 4% of the SSc patients. PPG shows a homogeneous pattern in 95% of the healthy controls, 93% of the PRP patients, and 28% of the SSc patients. LDPI and PPG showed a positive concordance (p0.05) in homogeneous pattern evaluation. In the SSc patients, no correlation (r = 0.38) was observed between the mean value of sphygmic wave amplitude and the mean value of mean perfusion of each finger.LDPI and PPG can provide useful information in distinguishing patients with PRP and SSc, although nailfold videocapillaroscopy (NVC) is the best method for analysing microvascular damage in rheumatic diseases.

Pregnancy outcomes were assessed in 67 women who had well-defined primary Raynaud's phenomenon and in 30 controls, each of whom had been pregnant at least once. Twenty-seven patients had onset of Raynaud's phenomenon prior to any pregnancy, and 37 patients had onset of Raynaud's phenomenon after their last pregnancy. The frequency of miscarriage, stillbirth, and small full-term infants was similar in all 3 study groups. Among the 4 Raynaud's phenomenon patients who had second-trimester miscarriages, 2 of 3 who were tested had moderately positive levels of IgG or IgM anticardiolipin antibody. Premature births were significantly more common in pregnancies that occurred after the onset of Raynaud's phenomenon (24%) than in pregnancies that occurred prior to the onset of Raynaud's phenomenon or in pregnancies among control subjects (9% and 1%, respectively). In addition, the mean weight of the full-term babies of women in both Raynaud's phenomenon groups was significantly less than that of babies born to controls. There were no neonatal deaths or other serious adverse outcomes. These findings may represent yet another manifestation of systemic vasospasm in patients with primary Raynaud's phenomenon.

Ian Poxon, Jack Wilkinson, Tonia Moore, Joanne Manning, Mark Dickinson, Ariane Herrick and Andrea Murray Photon Science Institute, University of Manchester, Manchester, Research and Development, Directorate of Rheumatology, Salford Royal Hospital NHS Foundation Trust, Salford and Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

Resume Propos Des etudes recentes ont suggere que les patients porteurs d'une maladie de Raynaud etaient plus souvent porteurs d'une infection a Helicobacter pylori. Devant ces resultats nous avons effectue une etude prospective, comparative afin de tester la prevalence des infections a H. pylori au cours de la maladie de Raynaud. Methodes Quarante patients presentant une maladie de Raynaud ont ete inclus dans l'etude. Ils ont ete compares a 80 sujets sains apparies pour l'âge et le sexe. L'infection a H. pylori a ete recherchee en utilisant une serologie et un test respiratoire a l'uree. Resultats Chez les patients porteurs d'une maladie de Raynaud la prevalence de l'infection a H. pylori etait de 12,5 % en utilisant les deux methodes de recherche. Dans le groupe temoin la prevalence etait de 16,7 % par la methode serologique et de 18 % en utilisant le test a l'uree. Conclusion Les prevalences etant similaires dans le groupe maladie de Raynaud et le groupe temoin (p = 0,53 et 0,43 respectivement), il apparait que l'infection a H. pylori ne joue aucun role dans la genese de la maladie de Raynaud. Par ailleurs, les patients atteints de maladie de Raynaud souffraient significativement plus que les temoins de troubles digestifs (p