The validity of Raynaud's phenomenon symptoms in HAVS cases.
BACKGROUND
Raynaud's phenomenon, a common manifestation of the hand-arm vibration syndrome (HAVS), is typically diagnosed by a subjective history provided by employees.


OBJECTIVE
This study evaluates the validity of the subjective history of Raynaud's phenomenon provided by individuals applying for compensation for HAVS.


METHODS
Thirty-six workers with a history of occupational hand-arm vibration exposure who were labelled as having Raynaud's phenomenon were asked to photographically document their finger symptoms before undergoing a detailed clinical assessment. Each individual was provided with a disposable camera and instructions. Returned photographs were reviewed for signs of Raynaud's phenomenon. The reliability of photograph interpretation was tested with three physicians and a non-physician.


RESULTS
Inter and intra-rater reliability was very good, Kappa coefficient >0.80. Six individuals (17%) did not return cameras. Thirty individuals provided photographs and underwent a clinical evaluation. The photographs of 13 individuals (43%) did not show Raynaud's phenomenon and for four of these the diagnosis was not supported by careful symptom history. Seventeen individuals (57%) had photographic evidence of Raynaud's phenomenon.


CONCLUSIONS
A presenting history of Raynaud's phenomenon in workers seeking compensation for HAVS may not be accurate since approximately half the cases are unable to provide objective photographic evidence of Raynaud's phenomenon.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. syouakim@telusplanet.net
Sami
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Youakim
D001955:British Columbia; D053421:Hand-Arm Vibration Syndrome / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects; D010781:Photography / Q000379:methods; D011928:Raynaud Disease / Q000175:diagnosis* / Q000209:etiology; D014942:Workers' Compensation