by Carlo Selmi
The disorder mainly affects young women: it can be isolated or imply an illness. Here’s how to diagnose and find out
I am 22 years old and for several months I have been suffering from the so-called Raynaud’s phenomenon, with a capillaroscopy showing megacapillaries and a scleroderma pattern / dermatopolymyositis pattern, although with negative ANA and anti ENA. I am now taking a vasodilator, what should I expect?
Carlo Selmi, head of Rheumatology and Clinical Immunology, Humanitas Institute, Milan responds (GO TO THE FORUM)
Raynaud’s phenomenon represents a peripheral circulation disorder whereby, at the level of the extremities (hands, feet, but also nose and ears), some stimuli, especially cold and intense emotions, first cause a phase of pallor with white skin, then a cyanotic phase with bluish skin, finally a reperfusion with a bright red color. The entire disorder lasts on average 20-30 minutes and can be very annoying and even painful. In most cases, primary Raynaud’s phenomenon is a symptom that does not imply a systemic disease and often affects young women whose mothers or sisters suffer from the same phenomenon. However, when the disorder is associated with a disease, especially systemic sclerosis or another connective tissue disease, it is called a secondary form.
Exams
To distinguish between the two, capillaroscopy (a non-invasive test that investigates the shape of the capillaries of the cuticles of the fingers) and laboratory tests (especially anti-nuclear autoantibodies – ANA – or their subtypes, especially anti-nuclear antibodies) are useful. -ENA). Capillaroscopy mainly investigates the presence of very large capillaries, called megacapillaries, or the presence of areas without capillaries, defined as avascular, often associated with very early forms of systemic sclerosis (early scleroderma pattern). The negativity of both investigations suggests a primitive form, but in some cases there is a discrepancy between capillaroscopy and laboratory tests: in these cases it may be useful to repeat antibody tests, including rare antibodies for myositis and scleroderma, in a reference center .
The therapy
If the tests are confirmed as negative, it is suggested to observe the trend over time while using a vasodilatory therapy with calcium channel blockers which allows the severity of the symptom to be reduced, although it may be poorly tolerated due to the effect of reducing blood pressure. When this therapy is not sufficient and, for example, small ulcers form on the fingers which take a long time to heal, intravenous vasodilators such as prostanoids can be used, which are administered in a hospital setting.
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January 13, 2024 (modified January 13, 2024 | 07:31)
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