RESEARCH - Thumb involvement in Raynaud's phenomenon as an indicator of underlying connective tissue disease

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Thumb Involvement in Raynaud's Phenomenon as an Indicator of

Underlying Connective Tissue Disease

BATSI CHIKURA, TONIA MOORE, JOANNE MANNING, ANDY VAIL and ARIANE L. HERRICK

+ Author Affiliations

From the Department of Rheumatology, Lincoln County Hospital, Lincoln;

Department of Rheumatic Diseases, Salford Royal NHS Foundation Trust,

Salford; and the Health Methodology Research Group, University of

Manchester, Manchester Academic Health Sciences Centre, Salford Royal

Hospital, Salford, UK.

B. Chikura, MRCP UK, Consultant Rheumatologist; T. , BSc, Senior

Vascular Technician; J. Manning, HNC, Senior Vascular Technician; A.

Vail, MSc, Senior Lecturer, Biostatistics; A.L. Herrick, MD, FRCP,

Consultant Rheumatologist, Reader in Rheumatology.

Abstract

Objective. To conduct a retrospective study to assess whether the

degree of thumb involvement differs between primary Raynaud's

phenomenon (PRP) and secondary Raynaud's phenomenon (SRP).

Methods. Thermography images from all patients attending Salford Royal

Hospital and referred for thermography for assessment of RP between

2004 and 2006 were retrospectively reviewed. A distal dorsal

difference (DDD) of -1°C or less between the fingertips and dorsum of

the hand (fingers cooler) at 23°C was considered clinically relevant.

The worse score (the lower score, i.e., the more negative value) from

each pair of digits was considered for analysis.

Results. One hundred seventy patients fulfilled the study criteria.

DDD at 23°C for the thumbs were significantly higher (digital tips

warmer) compared with other digits (p < 0.001) in both PRP and SRP.

All digits were significantly warmer in PRP compared to SRP with the

exception of the thumbs. The proportion of patients with clinically

relevant involvement of thumbs was significantly higher in SRP

compared to PRP (p = 0.003) and this difference was more pronounced in

the thumbs compared with other digits.

Conclusion. Although the median temperature gradient along the thumb

was not significantly different between SRP and PRP, the thumb is more

likely to be involved in SRP than in PRP. Thumb involvement is one of

a number of clinical indicators that should alert the clinician to the

possibility of an underlying connective tissue disease/disorder.

http://jrheum.org/content/37/4/783.abstract

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