title: 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.
abstract: In patients with Raynaud's phenomenon (RP), the role of medical history, capillaroscopy, and autoantibodies in order to provide an early diagnosis of connective tissue disease (CTD) were examined. 115 consecutive adults with uni-, bi-, or triphasic colour changes of the fingers were studied. RP was bilateral in 92.7% of patients. The middle finger was significantly more affected. A lack of association between fingers affected by RP and fingers with capillary abnormalities was observed OR = 0.75 (0.34-1.66). RP with the cyanotic phase had a higher risk at capillaroscopy to have hemorrhages OR = 4.46 (1.50-13.30) and giant capillaries OR = 24.85 (1.48-417.44). The thumb and triphasic involvement have an OR of 1.477 and 1.845, respectively. RP secondary to systemic sclerosis (SSc) had greater value of VAS pain (p = 0.011). The presence of anti-centromere antibodies was significantly associated with a higher risk of SSc (p < 0.001). 44.3% of subjects had uniphasic blanching of the fingers, and among these, 27% was diagnosed as having an overt or suspected CTD. Markers of a potential development of CTDs include severe RP symptoms, positive autoantibodies, and capillary abnormalities. These data support the proposal to not discharge patients with uniphasic blanching of the fingers to avoid missing the opportunity of an early diagnosis.
authors.affiliation: Department of Clinical Science & Community Health, University of Milano, 20122 Milan, Italy ; Division of Rheumatology, Istituto Gaetano Pini, 20122 Milan, Italy.
authors.forename: Francesca
authors.identifier: 0000-0002-6727-1273
authors.initials: F
authors.lastname: Ingegnoli
authors.affiliation: Department of Clinical Science & Community Health, University of Milano, 20122 Milan, Italy ; Division of Rheumatology, Istituto Gaetano Pini, 20122 Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Gualtierotti
authors.affiliation: Department of Clinical Science & Community Health, University of Milano, 20122 Milan, Italy ; Medical Statistics and Biometry, 20122 Milan, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Orenti
authors.affiliation: Division of Rheumatology, Istituto Gaetano Pini, 20122 Milan, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Schioppo
authors.affiliation: Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, 20122 Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marfia
authors.affiliation: Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, 20122 Milan, Italy.
authors.forename: Rolando
authors.initials: R
authors.lastname: Campanella
authors.affiliation: Rheumatology Unit, Ospedale Moriggia-Pelascini, 22015 Gravedona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mastaglio
authors.affiliation: Department of Clinical Science & Community Health, University of Milano, 20122 Milan, Italy ; Division of Rheumatology, Istituto Gaetano Pini, 20122 Milan, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Meroni
authors.affiliation: Department of Clinical Science & Community Health, University of Milano, 20122 Milan, Italy ; Medical Statistics and Biometry, 20122 Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Boracchi
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D003240:Connective Tissue Diseases / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology*; D042241:Early Diagnosis; D005260:Female; D005385:Fingers / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011928:Raynaud Disease / Q000175:diagnosis / Q000276:immunology / Q000473:pathology*; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000276:immunology / Q000473:pathology
chemical_list: D001323:Autoantibodies