Impaired Thermoregulation in Raynaud's Phenomenon

Greenstein, D.; Gupta, Neeraj; Martín, Paul; Walker, Duncan R.; Kester, R. C.

doi:10.1177/000331979504600707

Cited by 39 publications

(23 citation statements)

References 13 publications

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“…24 Greenstein et al reported that subjects with Raynaud's phenomenon have an impaired thermoregulation, which they suggest to explain the cold sensitivity in this patient group. 38 In this study, we found abnormal rewarming in both healthy subjects and patients. Second, we found no relationship between rewarming patterns after cold stress testing in patients with cold intolerance recovering from a hand fracture and subjective cold intolerance.…”

Section: Discussionmentioning

confidence: 50%

Rewarming Patterns in Hand Fracture Patients With and Without Cold Intolerance

Smits

Nijhuis

Huygen

et al. 2011

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 50%

Rewarming Patterns in Hand Fracture Patients With and Without Cold Intolerance

Smits

Nijhuis

Huygen

et al. 2011

The Journal of Hand Surgery

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“…Unfortunately, CS was not investigated in that study. Other studies have shown that patients with RP show a decreased perfusion of fingers during cold exposure [35] and have an increased risk of contracting cold injuries [36]. As described above, ischemic effects on peripheral nerves might then serve as an explanation for CS in heavily cold-exposed subjects with RP.…”

Section: Interpretation and Comparisonmentioning

confidence: 89%

Raynaud’s phenomenon in Northern Sweden: a population-based nested case–control study

et al. 2018

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The aim of this study was to determine the association between individual and external exposure factors, and the reporting of Raynaud's phenomenon, with or without concomitant cold sensitivity. In a population-based nested case-control study, cases with Raynaud's phenomenon (N = 578), and matched controls (N = 1156), were asked to respond to a questionnaire focusing on different risk factors. Univariate and multiple conditional logistic regression were performed. Analyses were stratified according to whether the cases reported cold sensitivity or not. In total, 1400 out of 1734 study subjects answered the questionnaire (response rate 80.7%). In the final multiple model, the factor with the strongest association to Raynaud's phenomenon, with and without cold sensitivity, was previous frostbite affecting the hands (OR 12.44; 95% CI 5.84-26.52 and OR 4.01; 95% CI 1.78-9.01, respectively). Upper extremity nerve injury was associated to reporting Raynaud's phenomenon and cold sensitivity (OR 2.23; 95% CI 1.29-3.85), but not Raynaud's phenomenon alone. Reporting any exposure to handarm vibration or cumulative cold exposure was significant in univariate analyses for cases with both Raynaud's phenomenon and cold sensitivity, but not in the multiple model. Raynaud's phenomenon is strongly associated to previous cold injury, with a larger effect size among those who also report cold sensitivity. The fact that only upper extremity nerve injury differed significantly between case groups in our multiple model offers additional support to the neural basis for cold sensitivity.

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“…Indeed, patients with primary and secondary RP have lower baseline CVC compared with controls (4,14,28). As temperature plays a key role in baseline flux, standardizing baseline skin temperature when performing microvascular reactivity improves reproducibility, especially when expressing data as a function of baseline (26,27).…”

Section: Discussionmentioning

confidence: 99%

Impaired transient vasodilation and increased vasoconstriction to digital local cooling in primary Raynaud's phenomenon

Roustit

Blaise

Millet

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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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 ϭ 0.02) and at 24°C (AAC0 -30 were 86,915 and 57,598%BL·s, respectively; P ϭ 0.04) whereas we observed no significant difference on the finger pad and the forearm. Topical anesthesia increased CVC in patients with RP (P ϭ 0.05), whereas it did not affect reactivity in controls (P ϭ 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. microcirculation; skin blood flow FIRST DESCRIBED BY MAURICE RAYNAUD in 1862 (25), Raynaud's phenomenon (RP) is defined as episodic ischemia of the extremities in response to cold or emotional stimuli, often accompanied by pain. It presents clinically as pallor, cyanosis, and often rubor of the skin. Pallor indicates vasospasm and decreased blood flow, and cyanosis is a sign of deoxygenation of the static venous blood, while rubor implies reactive hyperemia (2). RP can be primary (i.e., idiopathic) or secondary to a connective tissue disease. The pathophysiology of primary RP is multifactorial and complex, with both vascular and neural abnormalities (7,15). Although available evidence suggests that microvascular function is impaired in primary RP, the exact mechanism of such dysfunction remains poorly understood.

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Impaired Thermoregulation in Raynaud's Phenomenon

Cited by 39 publications

References 13 publications

Rewarming Patterns in Hand Fracture Patients With and Without Cold Intolerance

Rewarming Patterns in Hand Fracture Patients With and Without Cold Intolerance

Raynaud’s phenomenon in Northern Sweden: a population-based nested case–control study

Impaired transient vasodilation and increased vasoconstriction to digital local cooling in primary Raynaud's phenomenon

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