Connective tissue disease in patients presenting with Raynaud's phenomenon alone

Article Abstract:

Raynaud's phenomenon is characterized by whitening of the skin due to constriction of small arteries during exposure to cold or emotional stress. The color of the skin progresses from white to a blue tinge. This second phase, which is due to stagnated blood flow in the small vessels, is followed by reactive hyperemia (increased blood flow), which causes skin reddening. Raynaud's phenomenon may be primary, occurring without any other disorder, or it may be a secondary condition and develop as a sign of a connective tissue disease, such as scleroderma (systemic sclerosis) or systemic lupus erythematosus. The phenomenon may precede the development of scleroderma or other diseases by many years, and it is important for rheumatologists and others to discriminate between the latter condition and primary Raynaud's phenomenon, which is usually benign. In one study of patients with primary Raynaud's and others with the secondary phenomenon and signs of an indeterminate connective tissue disease, about twice as many patients with the signs of disease progressed toward a full-blown illness, especially systemic sclerosis limited to skin involvement. Research suggests that the development of Raynaud's phenomenon in patients over 20 years who have severe symptoms, antinuclear antibodies (antibodies inappropriately produced against structures in the cell nucleus), and changes in capillaries (observed by nailfold capillary microscopy) is strongly associated with the presence of an underlying connective tissue disease. Tests to detect hidden organ involvement in the lungs and esophagus, for example, should be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Connective tissue diseases, Raynaud's disease

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Transient arthritis with positive tests for rheumatoid factor as presenting sign of shunt nephritis

Article Abstract:

Patients may receive shunts to allow drainage of accumulated fluid from the brain into the circulation. Infection of such ventriculoatrial shunts may occur in almost one-third of patients, but 'shunt nephritis,' kidney inflammation associated with chronic infection of the shunt, rarely occurs. When it does occur, it is thought to be related to reaction of the immune system to bacterial molecules, with deposition of antibodies and bacterial molecules within kidney structures. Similar immune system aberrations are often associated with the rheumatoid diseases, many of which are characterized by arthritis. This report describes the case of a 17-year-old boy who developed shunt nephritis. He received a shunt to alleviate hydrocephalus (fluid accumulation in brain) in June 1985, and this became infected two months later. Eight months after the infection, the patient developed arthritis in both ankles and purpura (purplish skin area due to underlying hemorrhage) on the legs. Blood tests indicated the presence of an inflammatory process. Evaluation in the following months showed a positive rheumatoid factor test (measurable levels of antibodies associated with several rheumatoid diseases). Bacteria similar to those from the shunt infection were isolated from blood. The patient recovered completely following removal of the infected shunt and treatment with antibiotics. The report suggests that deposition of immune factors, rather than bacteria, were responsible for the arthritis. As in rare cases of subacute bacterial endocarditis, symptoms of arthritis may precede symptoms of shunt nephritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Glomerulonephritis, Cerebrospinal fluid shunts

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Quantitative nailfold capillaroscopy findings in a population with connective tissue disease and in normal healthy controls

Article Abstract:

The small vessels found in the skin fold at the fingernail base appear to have some distinctive characteristics in patients with systemic sclerosis (SSc). Researchers used a microscope attached to a video camera and computer to visualize and measure the nailfold vessels of 23 patients with SSc, 21 patients with other connective tissue diseases, 22 patients with systemic lupus erythematosus, and 38 healthy volunteers. Patients with SSc had fewer vessels per millimeter, more areas with no vessels, more enlarged vessels, and more bleeding vessels than other diseased patients or the volunteers.

Abnormalities, Diagnosis, Systemic scleroderma, Scleroderma (Disease), Capillaries, Fingernails

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