Raynaud’s Syndrome: comparison of late and early onset forms using hand perfusion scintigraphy

Abstract

Primary Raynaud's disease is generally a disease of younger females; however, there are cases where symptoms present over the age of 40. These cases are described as late onset. In our current prospective study we compared the characteristics of early and late onset types of primary Raynaud's in 127 patients. In addition to the collection of medical records, we performed capillary-microscopy and hand perfusion scintigraphy using Tc-99 m DTPA to evaluate the microcirculation of each patient's fingers. Regarding the spectrum of the capillary-microscopic findings, we did not find any significant difference between the early and late onset forms. However, in hand perfusion examinations done using Tc-99 m DTPA, we measured a significantly lower finger/palm ratio (FPR) in the early onset group of patients. We also observed a correlation between the duration of the disease and the FPR, as well as between the age and FPR. Longer disease duration resulted in a significantly lower FPR. On the basis of our results, we believe that late onset Raynaud's should be treated as a separate entity. Due to its different characteristics found on examination and follow-up of our patients, functional hand perfusion examination should be recommended independently of the age-related characteristics of the disease.

Uniphasic Blanching of the Fingers, Abnormal Capillaroscopy in Nonsymptomatic Digits, and Autoantibodies: Expanding Options to Increase the Level of Suspicion of Connective Tissue Diseases beyond the Classification of Raynaud’s Phenomenon

“…In agreement with previous studies [ 2 , 23 , 25 , 27 – 30 ], in our cohort RP was more prevalent among women than men. By contrast, the median age of patients classified as pRP (44.2 years) was older than other studies, in which the “late-onset” RP (over 40 years old) was reported in a percentage of cases ranging from 22 to 40% [ 28 , 31 , 32 ]. This could be due to the fact that the patients' recruitment was done in tertiary referral hospitals.…”

Perfusion Scintigraphy for the Evaluation of Patients with Raynaud’s Phenomenon

“…Csiki et al also reported that longer disease duration was negatively correlated with FPR. They also reported in patients with early-onset RP that the FPR was significantly lower [26].…”

“…RP can be evaluated using perfusion scintigraphy, and there have been several studies of perfusion scintigraphy [3,[20][21][22][23][24][25]. Various radiopharmaceuticals are used, including technetium-99m (Tc-99m), diethylenetriamine pentaacetate (DTPA) [26][27][28], Tc-99m red blood cell (RBC) [20,23], Tc-99m pertechnetate [24,29], Tc-99m met hylene diphosphonate (MDP) [3], and Tc-99m hydroxymethylene diphosphonate (HDP) [22]. When the affected areas are the hands, intravenous injection of radiopharmaceuticals is done via the dorsal vein.…”

“…Perfusion scintigraphy for RP can be done with or without cold stimulation. The one-hand chilling method is widely used for cold stimulation [3,20,21,23,[25][26][27][28]. It is done by immersion of one hand (the non-dominant hand or the hand with more severe symptoms) in cold water (4°C) [22].…”