title: Symptoms of Raynaud's phenomenon (RP) in fibromyalgia syndrome are similar to those reported in primary RP despite differences in objective assessment of digital microvascular function and morphology.
abstract: Symptoms of Raynaud's phenomenon (RP) are common in fibromyalgia syndrome (FMS). We compared symptom characteristics and objective assessment of digital microvascular function using infrared thermography (and nailfold capillaroscopy where available) in patients with FMS (reporting RP symptoms) and primary RP. We retrospectively reviewed the outcome of microvascular imaging studies and RP symptom characteristics (captured using patient-completed questionnaire at the time of assessment) for patients with FMS (reporting RP symptoms) and patients with primary RP referred for thermographic assessment of RP symptoms over a 2-year period. Of 257 patients referred for thermographic assessment of RP symptoms between 2010 and 2012, we identified 85 patients with primary RP and 43 patients with FMS. There were no differences in RP symptom characteristics between FMS and primary RP (p > 0.05 for all comparisons). In contrast, patients with FMS had higher baseline temperature of the digits (32.1 vs. 29.0 °C, p = 0.004), dorsum (31.9 vs. 30.2 °C, p = 0.005) and thermal gradient (temperature of digits minus temperature of dorsum; +0.0 vs. -0.9 °C, p = 0.03) compared with primary RP. Significant differences between groups persisted following local cold challenge. In primary RP, patient reporting "blue" digits, bi-phasic and tri-phasic RP was associated with lower digital perfusion. In contrast, no associations between skin temperature and RP digital colour changes/phases were identified in FMS. Our findings suggest that symptoms of RP in FMS may have a different aetiology to those seen in primary RP. These findings have potential implications for both the classification of RP symptoms and the management of RP symptoms in the context of FMS. Digital colour changes reported by patients might reflect the degree of digital microvascular compromise in primary RP.
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.|Sección Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: M
authors.initials: M
authors.lastname: Scolnik
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.
authors.forename: B
authors.initials: B
authors.lastname: Vasta
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Hart
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Shipley
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.|Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: McHugh
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK. johnpauling@nhs.net.|Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. johnpauling@nhs.net.
authors.forename: J D
authors.initials: JD
authors.lastname: Pauling
mesh_terms: D000328:Adult; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000503:physiopathology; D005385:Fingers / Q000098:blood supply; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D011928:Raynaud Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D063189:Symptom Assessment / Q000379:methods
keywords: Classification; Fibromyalgia syndrome; Objective; Raynaud’s phenomenon; Self-report; Thermography