Journal of Clinical Studies & Medical Case Reports Category: Medical Type: Case Report

The Secondary Raynaud's Phenomenon

Mancuso G1* and Salvade I1
1 Department of Internal Medicine, EOC, “La Carità” Hospital of Locarno, Switzerland

*Corresponding Author(s):
Mancuso G
Department Of Internal Medicine, EOC, “La Carità” Hospital Of Locarno, Switzerland
Email:mancuso.gaia@hsr.it

Received Date: Nov 10, 2024
Accepted Date: Jan 16, 2025
Published Date: Jan 22, 2025

Abstract

The Secondary Raynaud Phenomenon (RP) accounts for 10% to 20% of all cases of secondary Raynaud’s and could be the first sign of connective tissue diseases. The nail capillaroscopy warrants an earlier diagnosis of Systemic Sclerosis (SSc), which is still associated with a high burden of morbidity and mortality. We present the history of 73 year-old man who complain the recent appearance of RP. On the examination he show a prolonged RP that last for all the visit time and on  capillaroscopy shows an “active scleroderma pattern”, he underwent to detailed examination and a diagnosis of SSc was made.  We believe that sharing these images, among the others, could contribute to provide a significant advantage for correct diagnosis and management of RP and early diagnosis of the associated clinical entities.

Keywords

Capillaroscopy; Connective tissue diseases; Raynaud phenomenon; Vedoss criteria

List of Abbreviations

RP: Raynaud’s Phenomenon

mRSS - modified Rodnann Skin Score

VEDOSS criteria - Very Early Diagnosis of Systemic Sclerosis

Background

Raynaud Phenomenon (RP) is one of the earliest clinical signs of SSc-related digital vasculopathy, improving recognition and study of this vasospastic phenomenon could improve and promote an early diagnosis of the associated connective tissue disease and improve the clinical management, significantly preventing the tissue loss associated with a long-standing RP [1].

Case Presentation

A 73-year-old man presented to the immunology clinic with a one-year history of Raynaud's phenomenon and concomitant onset of dry mouth and eyes, dyspepsia, and paraesthesia in the lower extremities. On physical examination there were puffy fingers, digital skin sclerosis with mRSS 4 (modified Rodnann Skin Score) and Raynaud's phenomenon which persisted for the entire duration of the visit.  Capillaroscopy of the nail fold performed at 200x magnification shows an “active” scleroderma pattern with reduced capillary density, frequent giants (diameter ≥ 5 µm), and some apical micro-hemorrhages. Serological evaluation reveals positivity for anti-centromere antibodies and positivity for anti-RO/SSA antibodies [2-4]. These findings were suggestive of “very early” systemic sclerosis according to the VEDOSS (Very Early Diagnosis of Systemic Sclerosis criteria) [5,6], and the patient underwent a comprehensive evaluation of end-organ damage (Figure 1).

Figure 1: N1 and N2 Prolonged Raynaud’s Phenomenon of the patient’s hands. It last for more than one hour. Teleangiectasis are appreciable.

N3 and N4 Nail fold capillaroscopy showing a normal density with few giant capillarie and defining a “scleroderma active pattern”.

Conclusions

Early recognition and prompt evaluation of Raynaud's phenomenon are essential in the early diagnosis of sitemic sclerosis and in preventing complications resulting from tissue loss related to connective tissue diseases

References

  1. Herrick AL, Wigley FM (2020) Raynaud's phenomenon. Best Pract Res Clin Rheumatol 34: 101474.
  2. Wigley FM, Flavahan NA (2016) Raynaud's Phenomenon. N Engl J Med 375: 556-565.
  3. Pauling JD, Hughes M, Pope JE (2019) Raynaud's phenomenon-an update on diagnosis, classification and management. Clin Rheumatol 38: 3317-3330.
  4. Smith V, Ickinger C, Hysa E, Snow M, Frech T, Sulli A, Cutolo M. Nailfold capillaroscopy. Best Pract Res Clin Rheumatol 37: 101849.
  5. Smith V, Herrick AL, Ingegnoli F, Damjanov N, De Angelis R, et al. (2020) EULAR Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium Group on Capillaroscopy. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev 19: 102458.
  6. Bellando-Randone S, Matucci-Cerinic M (2013) From Raynaud's Phenomenon to Very Early Diagnosis of Systemic Sclerosis- The VEDOSS approach. Curr Rheumatol Rev 9: 245-248.

Citation: Mancuso G, Salvade I (2025) The Secondary Raynaud's Phenomenon. J Clin Stud Med Case Rep 10: 0256.

Copyright: © 2025  Mancuso G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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