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Raynaud's phenomenon Best Practice & Research Clinical Rheumatology

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1 Raynaud's phenomenon Best Practice & Research Clinical Rheumatology
Michael Hughes, Ariane L. Herrick  Best Practice & Research Clinical Rheumatology  Volume 30, Issue 1, Pages (February 2016) DOI: /j.berh Copyright © Terms and Conditions

2 Fig. 1 Photographs of an RP attack taken by a patient with SSc using a smartphone camera. A: Whiteness (pallor of all four fingertips) is observed. B: The fingers return to their normal colour. The time between the two photographs was approximately two and a half minutes. Photographs provided courtesy of Dr Graham Dinsdale, the University of Manchester. Best Practice & Research Clinical Rheumatology  , DOI: ( /j.berh ) Copyright © Terms and Conditions

3 Fig. 2 Nailfold capillaroscopy. A: Normal capillaroscopy. The capillaries are regular (‘hairpin’ like) in appearance, which is reassuring in patients with RP. B: Abnormal nailfold capillaroscopy in a patient with SSc. Several capillaries are enlarged, with areas of avascularity. Best Practice & Research Clinical Rheumatology  , DOI: ( /j.berh ) Copyright © Terms and Conditions

4 Fig. 3 Thermographic imaging of the hands during dynamic temperature challenge. Left column: thermal images at 23 °C; middle column: thermal images at 30 °C; and right column: rewarming curves after cold challenge. At 23 °C, the fingertips are cooler in patients with both PRP and SRP (B and C), unlike in healthy controls in whom the fingertips are warm (A). At 30 °C, unlike in PRP (D), persistent temperature gradients (fingers cooler than the dorsum of the hand) are noted in SRP (E). Rewarming curves demonstrate prompt rewarming in a healthy control subject (top), complete but delayed rewarming in a patient with PRP (middle) and no rewarming in a patient with SSc (bottom). PRP: Primary Raynaud's phenomenon. SRP: Secondary Raynaud's phenomenon. Best Practice & Research Clinical Rheumatology  , DOI: ( /j.berh ) Copyright © Terms and Conditions

5 Fig. 4 The management of RP in patients with SSc. From the UK Scleroderma Study Group consensus best practice pathway of the UK Systemic Sclerosis: Digital vasculopathy in SSc. ACE: angiotensin-converting enzyme. ARB: Angiotensin receptor blocker. CCB: calcium channel blocker. IV: intravenous. PDE-5: phosphodiesterase type 5. SSRI: Selective serotonin receptor inhibitor. Reproduced with permission of the copyright owner [74]. Best Practice & Research Clinical Rheumatology  , DOI: ( /j.berh ) Copyright © Terms and Conditions

6 Fig. 5 The management of critical digital ischaemia in patients with SSc. From the UK Scleroderma Study Group consensus best practice pathway of the UK Systemic Sclerosis: Digital vasculopathy in SSc. IV: intravenous. PDE-5: phosphodiesterase type 5. Reproduced with permission of the copyright owner [74]. Best Practice & Research Clinical Rheumatology  , DOI: ( /j.berh ) Copyright © Terms and Conditions

7 Fig. 6 Digital vascular disease in CTD-associated RP. Digital pitting (A), ulceration (B) and critical ischaemia (C) in patients with SSc. Best Practice & Research Clinical Rheumatology  , DOI: ( /j.berh ) Copyright © Terms and Conditions


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