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Analysis of rewarming curves in Raynaud’s phenomenon of various aetiologiesFrom the School of Graduate Entry Medicine & Health, Division of Vascular Medicine The University of Nottingham, Department of Hand Surgery, Research and Development Department and Rheumatology Department, Derby Hospitals NHS Foundation Trust, Derby Correspondence: Dr Gillian Manning, The University of Nottingham, School of Graduate Entry Medicine and Health, Derby City General Hospital, Derby, DE22 3DT, UK. Tel.: +44 (0)1332 724682; fax: +44 (0)1332 724690. E-mail:gillian.manning{at}nottingham.ac.uk.
This study investigated whether a modified Cold Provocation Test could distinguish between 86 normal subjects and 31 patients with Raynaud’s phenomenon or 59 with hand arm vibration syndrome (HAVS). Of the HAVS subjects, 56 were seen for medical reports as they were involved in litigation. Their assessments were done in a different location but the same protocol was used. A standardised cold stress was used to reduce the finger temperature to 15°C or less without inducing reflex hyperaemia. This test had acceptable repeatability for subjects without HAVS with an intra-class correlation of 0.7. Baseline temperature, temperature rise in the first 30 seconds and the time taken to rewarm by 5°C were measured. Patients with Raynaud’s phenomenon and HAVS had cooler hands than controls. HAVS patients rewarmed most in the first 30 seconds. Patients with Raynaud’s phenomenon take longer to rewarm by 5°C than controls or those with HAVS (P<0.001). A baseline difference of >7.5°C between the temperature of the digit and that of the room is unlikely to occur in patients with Raynaud’s phenomenon or HAVS. A temperature gain of
Key Words: Cold Provocation Test • Raynaud’s phenomenon • HAVS
This version was published on October
1, 2009 Journal of Hand Surgery (European Volume), Vol. 34, No. 5,
621-626 (2009) |
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2.2°C in the first 30 seconds on rewarming combined with a low baseline temperature strongly suggests HAVS. This modified cold provocation test may differentiate between patients with Raynaud’s phenomenon, HAVS and controls but this observation requires independent verification in subjects not involved in litigation and tested in the same facility.