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Clinical Science ( 1992) 82, 529-534 (Printed in Great Britain)
An objective test for the diagnosis and grading of vasospasm in patients with Raynaud's syndrome
Judith A. Allen, Mark A. Devlin, Sean McGrann and Ciaran C. Doherty
- Reliable objective tests for the diagnosis and grading of vasospasm would be helpful in the assessment of patients with Raynaud's syndrome.
- Measurements of finger blood flow at local ringer temperatures from 32°C down to 20°C did not reliably distinguish between patients with Raynaud's syndrome and matched control subjects.
- Using laser Doppler flowmetry to detect blood cell flux in fingertip skin, there was no significant difference (Wilcoxon's signed rank test) in the ringer systolic blood pressure of 28 patients with Raynaud's syndrome and their matched controls when the fingers were warm at 32°C.
- Absence of flux was considered to indicate complete vasospasm and the degree of cooling required to abolish flux indicated the severity of the vasospastic condition in an individual patient.
- Finger cooling for 5 min did not significantly alter finger systolic blood pressure in the control subjects, but abolished blood cell flux in the fingertip skin of 27 of the 28 patients with Raynaud's syndrome.
- A grading scale was derived from the flux measurements. There was a significant correlation (r=0.75, P<0.001) between the grading of disease severity as judged by the flux test and the clinical grade as assessed before the laboratory visit.
- There was one false-negative result in the 28 patients with Raynaud's syndrome tested and no false-positive results in 28 matched control subjects.
- This type of testing may prove helpful in the diagnosis and grading of vasospastic disorders.
INTRODUCTION
The dignosis of Raynaud's syndrome is usually based ()it the patient's typical episodic history of cold-induced blanching of the fingers, and physical signs of the disorder are seldom elicited unless the condition is severe. However, since vibration white finger became a prescribed industrial disease in 1985 [1], the need for more objective testing has become apparent. Stich testing
would also enable vascular responses to therapeutic procedures to be assessed.
This study describes and evaluates an objective procedure for the diagnosis and grading of vasospastic disease in patients with an established clinical diagnosis of Raynaud's syndrome of non-occupational origin.
METHODS
Patients and control subjects
Measurements were made on the fingers of 28 patients referred with an established clinical diagnosis of vasospastic disease of non-occupational origin and of' 28 healthy control subjects carefully matched for age and sex. All the patients with Raynaud's syndrome _,ave a clear-cut history of the typical triphasic colour change induced by cold exposure. The project had the approval of the local ethical committee and all patients and subjects gave their informed consent.
Patients were aged 16-68 years ( mean ± SEM 4 1 ± 2 years). Only six were men, 25 had primary Raynaud's disease, five had associated connective tissue disorder,, and in one the vasospasm may have been secondary to earlier traumatic injuries. Twenty-seven patient, had bilateral involvement of multiple digits and the disease duration varied from 6 months to 40 years.
Clinical grading, was carried out before the laboratory .studies using the modified form of tile
scale [2] shown in Table 1. Where possible. any involving drug,, with cardiovascular effects was stopped 1
Table 1. Clinical grading of vasospasm
Grade Symptoms
0 No tingling, numbness or blanching of digits
I Blanching of one or more finger-tips with or without tingling and numbness
II Blanching of one or more fingers beyond aps, usually confined to winter
III Extensive blanching of digits. Frequent episodes summer and winter
IV Extensive blanching of most fingers with frequent episodes summer and winter. Trophic skin changes in fingers.
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