title: Digital ischaemia during cooling is independently related to nailfold capillaroscopic pattern in patients with Raynaud's phenomenon.
abstract: OBJECTIVE
  The aim of the study was to assess the association between plethysmographically measured vasospasms during stepwise cooling and recovery, as an index for digital ischaemia, and nailfold capillaroscopic pattern (NCP) severity in patients with primary or secondary RP, including SSc.
  
  
  METHODS
  In 381 consecutive patients with suspected RP without a history of digital ulcers, NCP (assessed by widefield videocapillaroscopy), fingertip photoelectric plethysmography during cooling and recovery and clinical characteristics were analysed. NCPs were graded as follows: normal, non-specific, early and active. The mean ischaemic time was defined as the mean time of perfusion loss during cooling and recovery of five fingers.
  
  
  RESULTS
  In the patients with loss of perfusion during cooling and recovery, the NCP was normal in 152, non-specific in 96, early in 61 and active in 39 patients. The mean ischaemic time was positively associated with the severity of NCP, with P < 0.05 for each two- or three-grade increase and independent of underlying SSc. The difference was most pronounced during recovery.
  
  
  CONCLUSIONS
  We demonstrate that the degree of vasospasm and ischaemia provoked by stepwise cooling and recovery are positively associated with NCP in patients with RP of different aetiologies and without a history of digital ulcers.
authors.affiliation: Department of Internal Medicine, Division of Vascular Medicine a.m.van.roon01@umcg.nl.
authors.forename: Anniek M
authors.initials: AM
authors.lastname: van Roon
authors.affiliation: Department of Internal Medicine, Division of Vascular Medicine.
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Smit
authors.affiliation: Department of Internal Medicine, Division of Vascular Medicine.
authors.forename: Arie M
authors.initials: AM
authors.lastname: van Roon
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: Department of Internal Medicine, Division of Vascular Medicine Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Douwe J
authors.initials: DJ
authors.lastname: Mulder
mesh_terms: D000328:Adult; D003080:Cold Temperature / Q000009:adverse effects; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D011928:Raynaud Disease / Q000209:etiology / Q000503:physiopathology*; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology
keywords: Raynaud’s phenomenon; digital ischaemia; nailfold capillaroscopy; systemic sclerosis