Empirical Approach to Investigate Raynaud's Phenomenon : the Pearl Study : AB1085

Background: An early diagnosis of connective tissue disease (CTD) provides a window of opportunity for monitoring and treating patients. Objectives: We examined the role of history, capillaroscopy and autoantibodies to differentiate between patients with primary Raynaud's phenomenon (RP) and secondary RP due to a CTD at their first medical evaluation. Methods: One hundred fifteen consecutive adults with RP were studied. Patient profiles based on history, physical examination, capillaroscopy and laboratory investigations were examined. Logistic regression models were used in the statistical analysis. Results: 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). Fingers affected by RP with the cyanotic phase had a higher risk to have hemorrhages at capillaroscopy OR=4.46 (1.50-13.30) and giant capillaries OR=24.85 (1.48-41.74). None of the variables can discriminate between primary and secondary RP. Among these, thumb involvement and the presence of three colour phases have an OR of 1.48 and 1.85 respectively. Patients with SSc had a 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). Conclusions: Markers of a potential development of a CTD in patients with RP include: severe RP symptoms (high VAS pain), positive autoantibodies and capillary abnormalities. The presence of three colour changes and the involvement of thumb may also be a warning for secondary forms.