Raynaud’s phenomenon: a mirror of autoimmune disease
Raynaud’s phenomenon is a discoloration of the hands and feet provoked by cold or emotional stress. In some patients it is the first symptom of an underlying autoimmune disease (secondary), however, in most patients it is without an underlying disease (primary). Because it is important to treat patients with an autoimmune disease in an early stage, it is important to differentiate between the primary and secondary Raynaud’s. Furthermore, Raynaud’s can give complaints such as pain, which can reduce the patients’ quality of life.
In this thesis the mechanisms which lead to this phenomenon are addressed, differentiators between primary and secondary Raynaud’s are assessed, and treatment options are studied. The most important conclusions are that there is a relation between damage to the nailfold capillaries and the degree of the attacks, and also with body mass index. Furthermore, changes in the capillaries seem to predict the presence of abnormal pulmonary function tests in patients with different autoimmune diseases. When the thumb is uninvolved and after a Raynaud’s attack there is a quick recovery, an underlying disease is unlikely. Regarding to treatment, bosentan seems to improve the stiffness of the forearm arteries. Lastly, the ‘SPTS’, a procedure to treat Raynaud’s, seems to be effective on short-term and has minimal burden.