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Fardoun M, Kobeissy F, Eid AH. Estrogen Receptor and the Gender Bias in Raynaud's Phenomenon. Curr Med Chem 2024; 31:133-137. [PMID: 36803760 DOI: 10.2174/0929867330666230220123237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Manal Fardoun
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Neurobiology and Neuroscience, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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Gérard AO, Merino D, Van Obberghen EK, Rocher F, Destere A, Lantéri-Minet M, Drici MD. Calcitonin gene-related peptide-targeting drugs and Raynaud's phenomenon: a real-world potential safety signal from the WHO pharmacovigilance database. J Headache Pain 2022; 23:53. [PMID: 35505285 PMCID: PMC9066820 DOI: 10.1186/s10194-022-01424-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Migraine is responsible for significant disability and societal burden. Recently, drugs targeting the calcitonin gene-related peptide (CGRP) pathway raised new hopes. CGRP, a potent vasodilator, plays a key role in the pathogenesis of migraine attacks. The deficiency of CGRP is involved in Raynaud’s phenomenon, which consists of abnormal vasoconstriction of the digits. We aimed to assess the potential association of Raynaud’s phenomenon with CGRP-targeting drugs, analyzing real-world data from the World Health Organization (VigiBase®). Methods We queried all reports of Raynaud’s phenomenon involving a CGRP-targeting drug. We sought disproportionate reporting of Raynaud’s phenomenon with these drugs. For this purpose, we relied on the calculation of the Information Component (IC). A positive lower end of the 95% confidence interval (CI) of the IC defines a statistically significant association. As migraine patients are prone to Raynaud’s phenomenon, we also calculated the IC of Raynaud’s phenomenon with CGRP-targeting drugs compared to 5HT1B/D agonists (triptans), and beta-blockers used in the treatment of migraine. Results Overall, 99 reports of Raynaud’s phenomenon involving CGRP-targeting drugs have been yielded in VigiBase®. The most reported CGRP-targeting drug was erenumab, with 56 reports (56.6%). The median time to onset was 84 days. No fatality was notified, but one patient suffered from gangrene and extremity necrosis. As a whole, CGRP-targeting drugs were significantly associated with Raynaud’s phenomenon, with an IC of 3.3 (95%CI: 3.0–3.5). There was a disproportionate reporting of Raynaud’s phenomenon with CGRP-targeting drugs compared to triptans (IC 0.4; 95%CI: 0.1–0.6) and to beta-blockers (IC 0.5; 95%CI: 0.2–0.7) as well. Conclusions There is a significant disproportionality signal of Raynaud’s phenomenon with CGRP-targeting. This signal stands out when CGRP-targeting drugs are compared to other drugs used in patients with migraine. This study is limited by missing data in pharmacovigilance reports. CGRP-targeting drugs may be subject to Weber effect and reporting bias. Nonetheless, CGRP blockade might be the last straw that disrupts the physiological balance of vascular response in patients at-risk of Raynaud’s phenomenon. Pending further data regarding vascular safety of CGRP-targeting drugs, caution is warranted in these patients.
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Affiliation(s)
- Alexandre O Gérard
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France.,Department of Nephrology-Dialysis-Transplantation, University Hospital Center of Nice, Nice, France.,Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d'Azur, Nice, France
| | - Diane Merino
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Elise K Van Obberghen
- Pain Department and FHU InovPain, University Hospital Center of Nice and Côte d'Azur University, Nice, France
| | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Alexandre Destere
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Michel Lantéri-Minet
- Pain Department and FHU InovPain, University Hospital Center of Nice and Côte d'Azur University, Nice, France.,Migraine and Trigeminal Pain, UMR 1107, INSERM, Auvergne University, Clermont-Ferrand, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France.
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3
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Mustafa M, Alsulaimani H, Alhaddad A, Almujil S, Albar Z, Bawazir Y, Alsolaimani R, Omair MA. Prevalence of Raynaud's Phenomenon in Saudi Arabia. Open Access Rheumatol 2022; 14:17-24. [PMID: 35299881 PMCID: PMC8922445 DOI: 10.2147/oarrr.s352655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Raynaud’s phenomenon (RP) is defined as frequent ischaemic attacks in the fingers and toes due to vascular vasospasm. Studies have been conducted in many countries worldwide to determine the prevalence of RP. The aim of the current study was to assess the prevalence of RP in the Saudi Arabian population. Patients and Methods An online survey based on international consensus criteria used to diagnose RP was conducted to collect data from individuals from the Saudi population. Participants were considered positive if they had triphasic or biphasic colours of the extremities with cold-related sensitivity. Awareness of RP was also assessed. Results A total of 1025 responses were collected and included in the final analysis. The prevalence of RP was 4.29%, including 22% men and 77% women. The most common age group among women was 26–40 years (36.3%). Familiarity with RP was low, with 56.82% of participants lacking adequate awareness regarding RP. Only 32% of patients with RP reported attending doctor visits regarding symptoms of the disease. Conclusion The RP prevalence in Saudi Arabia is comparable to that reported in the international literature. Public awareness activities should be conducted to increase knowledge about RP. Trial Registration Not applicable.
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Affiliation(s)
- Mohammad Mustafa
- Department of Medicine, Rheumatology Unit, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Abdulrahman Alhaddad
- Faculty of Medicine, King Saud Bin Abdulaziz University for Health and Science, Jeddah, Saudi Arabia
| | - Sara Almujil
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zainab Albar
- School of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Yasser Bawazir
- Rheumatology Unit, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Roaa Alsolaimani
- Rheumatology Unit, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A Omair
- Division of Rheumatology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
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Clemow DB, Baygani SK, Hauck PM, Hultman CB. Lasmiditan in patients with common migraine comorbidities: a post hoc efficacy and safety analysis of two phase 3 randomized clinical trials. Curr Med Res Opin 2020; 36:1791-1806. [PMID: 32783644 DOI: 10.1080/03007995.2020.1808780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Determine whether common migraine comorbidities affect the efficacy and safety of lasmiditan, a 5-HT1F receptor agonist approved in the United States for the acute treatment of migraine. METHODS In SPARTAN and SAMURAI (double-blind Phase 3 clinical trials), patients with migraine were randomized to oral lasmiditan 50 mg (SPARTAN only), 100mg, 200 mg, or placebo. Lasmiditan increased the proportion of pain-free and most bothersome symptom (MBS)-free patients at 2 h after dose compared with placebo. Most common treatment-emergent adverse events (TEAEs) were dizziness, paraesthesia, somnolence, fatigue, nausea, muscular weakness, and hypoesthesia. Based upon literature review of common migraine comorbidities, Anxiety, Allergy, Bronchial, Cardiac, Depression, Fatigue, Gastrointestinal, Hormonal, Musculoskeletal/Pain, Neurological, Obesity, Sleep, and Vascular Comorbidity Groups were created. Using pooled results, efficacy and TEAEs were assessed to compare patients with or without a given common migraine comorbidity. To compare treatment groups, p-values were calculated for treatment-by-subgroup interaction, based on logistic regression with treatment-by-comorbidity condition status (Yes/No) as the interaction term; study, treatment group, and comorbidity condition status (Yes/No) were covariates. Differential treatment effect based upon comorbidity status was also examined. Trial registration at clinicaltrials.gov: SAMURAI (NCT02439320) and SPARTAN (NCT02605174). RESULTS Across all the Comorbidity Groups, with the potential exception of fatigue, treatment-by-subgroup interaction analyses did not provide evidence of a lasmiditan-driven lasmiditan versus placebo differential treatment effect dependent on Yes versus No comorbidity subgroup for either efficacy or TEAE assessments. CONCLUSIONS The efficacy and safety of lasmiditan for treatment of individual migraine attacks appear to be independent of comorbid conditions.
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Affiliation(s)
- David B Clemow
- Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
| | - Simin K Baygani
- Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
| | - Paula M Hauck
- Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
| | - Cory B Hultman
- Corporate Center, Eli Lilly and Company, Indianapolis, IN, USA
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Shah FY, Hassan I, Zeerak S, Bashir S, Jabeen Y, Parveen S, Mubashir S, Sultan J, Jeelani S. Prevalence of Cold Dermatoses in Kashmir Valley: A Cross-Sectional Study from North India. Indian Dermatol Online J 2020; 11:731-737. [PMID: 33235838 PMCID: PMC7678543 DOI: 10.4103/idoj.idoj_543_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Often quoted as "heaven on earth," Kashmir forms one of the two divisions of the Union territory of Jammu and Kashmir. A high-altitude region with abundant precipitation and snowfall, the people of Kashmir experience peculiar dermatoses not commonly seen in the majorly tropical subcontinent of India. In this study, we focussed on cold dermatoses as a comprehensive cluster and attempted to study them as a group. AIMS To determine the prevalence of cold dermatoses in Kashmir valley and study their epidemiological characteristics. METHODS This observational, cross-sectional community-based study was conducted on native Kashmiri population in three districts of the valley, exclusively during the winter season of the year 2016-17 and 2017-18. The data were tabulated and analyzed with Chi-square test for discrete variables and t-test for continuous variables, using OpenEpi. A P value of less than 0.05 was taken as significant. RESULTS The study included a total of 1200 cases with 602 males and 598 females. Perniosis was most commonly encountered dermatoses in our study with a prevalence of 12.2%. Frostbite had a prevalence of 0.83%. Raynaud's phenomenon and asteatotic eczema were seen in 1.5% and 1.67% of the population, respectively. Cold panniculitis, cold urticaria, and livedo reticularis were each seen in 0.08% of the population. CONCLUSIONS Cold dermatoses form an important source of morbidity among the native population of Kashmir. These can be easily prevented by ensuring adequate protection against cold. Creating awareness regarding these disorders and probable association with connective tissue disorders is also imperative.
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Affiliation(s)
- Faizan Y. Shah
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Iffat Hassan
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Sumaya Zeerak
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shahnawaz Bashir
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Yasmeen Jabeen
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shagufta Parveen
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Syed Mubashir
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Javeed Sultan
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shazia Jeelani
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
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Prete M, Favoino E, Giacomelli R, Afeltra A, Cantatore FP, Bruno C, Corrado A, Emmi L, Emmi G, Grembiale RD, Navarini L, Marcoccia A, Liakouli V, Riccardi A, Valentini G, Perosa F. Evaluation of the influence of social, demographic, environmental, work-related factors and/or lifestyle habits on Raynaud's phenomenon: a case-control study. Clin Exp Med 2020; 20:31-37. [PMID: 31679095 DOI: 10.1007/s10238-019-00589-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
Raynaud's phenomenon (RP) is a clinical disorder characterized by recurrent, reversible episodes of digital vasospasm. RP can be classified as primary (pRP) or secondary, depending on whether it occurs as a benign condition (not disease-associated) or is associated with other diseases, mainly of the connective tissues. In both cases, it can be triggered by environmental factors, as indicated by the increased incidence of pRP episodes following exposure to cold, vibration injury or chemicals. The purpose of this prospective case-control study was to assess, in an Italian cohort of 132 pRP patients, the association of the phenomenon with demographic, lifestyle habits, environmental and work-related factors. Compared to healthy controls, pRP was found to be inversely associated with the use of contact lenses (OR = 0.4; p = 0.004) and of chlorous-based disinfectants (OR = 0.3; p < 0.001) and directly associated with the presence of prosthesis implants (OR = 5.3; p = 0.001) and the use of hydrogen peroxide-based compounds (OR = 2.6; p = 0.002), suggesting that the latter should be avoided in RP affected patients. Multivariate and multivariable analysis confirmed the associations. Further investigations are needed to understand the mechanism(s) underlying these findings.
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Affiliation(s)
- M Prete
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy
| | - E Favoino
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy
| | - R Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico, University of Roma, Roma, Italy
| | - F P Cantatore
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy
| | - C Bruno
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Corrado
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy
| | - L Emmi
- Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - G Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - R D Grembiale
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - L Navarini
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico, University of Roma, Roma, Italy
| | - A Marcoccia
- UOSD of Ischemic Microangiopathy and Sclerodermic Ulcers, Sandro Pertini Hospital, Roma, Italy
| | - V Liakouli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Riccardi
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - G Valentini
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - F Perosa
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy.
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Turan E, Kilic SS. Retrospective view of primary Raynaud's phenomenon in childhood. REUMATOLOGIA CLINICA 2019; 15:e92-e95. [PMID: 29426682 DOI: 10.1016/j.reuma.2017.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 12/09/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Primary Raynaud's phenomenon (PRP) manifests as episodes of transient spasms of peripheral blood vessels. To elucidate the clinical clues and laboratory characteristics will facilitate the identification of PRP. METHODS A retrospective data collection of clinical and laboratory characteristics of 58 children with PRP was performed between January 2007 and December 2016. RESULTS A positive ANA test at lower titers <1:100 was detected in 24.1% of the patients. There was a significant relationship between presence of ANA positivity and migraine in female patients with PRP (p=0.01; p=0.020 respectively). The most common accompanying disorder was migraine which was detected in 37.9% of all patients with PRP. Hemoglobin and serum ferritin levels were significantly lower in PRP patients with migraine (p=0.045; p<0.05, respectively). Additionally, the mean platelet volume (MPV) measurements were significantly higher in patients with migraine compared to those without migraine (p=0.045; p<0.05 respectively). DISCUSSION There is limited data concerning childhood PRP. For the first time we showed a high frequency of migraine in childhood PRP. Anemia and high MPV could be the underlying triggering factors of these two episodic diseases.
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Affiliation(s)
- Enes Turan
- Uludag University Medical Faculty, Department of Pediatrics, Gorukle, 16059 Bursa, Turkey
| | - Sara Sebnem Kilic
- Uludag University Medical Faculty, Department of Pediatric Immunology-Rheumatology, Gorukle, 16059 Bursa, Turkey.
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Evans RW. Raynaud's Phenomenon Associated With Calcitonin Gene‐Related Peptide Monoclonal Antibody Antagonists. Headache 2019; 59:1360-1364. [DOI: 10.1111/head.13596] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2019] [Indexed: 11/30/2022]
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Fábián B, Fábián AK, Bugán A, Csiki Z. Comparison of mental and physical health between patients with primary and secondary Raynaud's phenomenon Category: Article. J Psychosom Res 2019; 116:6-9. [PMID: 30654995 DOI: 10.1016/j.jpsychores.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/03/2018] [Accepted: 11/04/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare anxiety, depression, physical health and quality of life in patients with primary Raynaud's phenomenon (PRP) and patients with secondary Raynaud's phenomenon (SRP). METHOD Adult patients with Raynaud's phenomenon (RP) were assessed for the severity of anxiety and depressive symptoms, physical health and quality of life by using the General Anxiety Disorder Scale (GAD-7), the Beck Depression Inventory (BDI), the 12-item Short Form Health Survey: Physical Component Scale (PCS-12), and the Raynaud Specific Quality of Life Questionnaire (RQLQ), respectively. Patients with PRP and SRP were recruited for comparison at a single clinical center in Debrecen, Hungary from September to December 2017. RESULTS In total, 60 primary and 41 secondary patients with RP were studied. Gender distribution, family status, employment status and smoking were similar in the two groups. Significantly more patients with SRP had anxiety and depressive symptoms than patients with PRP. Patients with SRP had significantly higher GAD-7 and BDI; and lower overall PCS-12 and RQLQ scores than patients with PRP. CONCLUSION Anxiety and depression is more common in patients with SRP than in patients with PRP. Patients with SRP have a lower physical health condition and RP specific quality of life than patients with PRP. Anxiety, depression and quality of life impairments should be taken into account when managing all patients with RP. Further study is needed to assess whether appropriately designed interventions have the potential to reduce the mental and physical health burdens of RP on quality of life (QOL), especially in patients with SRP.
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Affiliation(s)
- Balázs Fábián
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| | - Anna Klaudia Fábián
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Antal Bugán
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csiki
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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10
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Pauling JD, Domsic RT, Saketkoo LA, Almeida C, Withey J, Jay H, Frech TM, Ingegnoli F, Dures E, Robson J, McHugh NJ, Herrick AL, Matucci-Cerinic M, Khanna D, Hewlett S. Multinational Qualitative Research Study Exploring the Patient Experience of Raynaud's Phenomenon in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2018; 70:1373-1384. [PMID: 29473715 DOI: 10.1002/acr.23475] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/14/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Raynaud's phenomenon (RP) is the most common manifestation of systemic sclerosis (SSc). RP is an episodic phenomenon, not easily assessed in the clinic, leading to reliance on self-report. A thorough understanding of the patient experience of SSc-RP is essential to ensuring that patient-reported outcome (PRO) instruments capture domains important to the target patient population. We report the findings of an international qualitative research study investigating the patient experience of SSc-RP. METHODS Focus groups of SSc patients were conducted across 3 scleroderma centers in the US and UK, using a topic guide and a priori purposive sampling framework devised by qualitative researchers, SSc patients, and SSc experts. Focus groups were audio recorded, transcribed, anonymized, and analyzed using inductive thematic analysis. Focus groups were conducted until thematic saturation was achieved. RESULTS Forty SSc patients participated in 6 focus groups conducted in Bath (UK), New Orleans (Louisiana), and Pittsburgh (Pennsylvania). Seven major themes were identified that encapsulate the patient experience of SSc-RP: physical symptoms, emotional impact, triggers and exacerbating factors, constant vigilance and self-management, impact on daily life, uncertainty, and adaptation. The interrelationship of the 7 constituent themes can be arranged within a conceptual map of SSc-RP. CONCLUSION We have explored the patient experience of SSc-RP in a diverse and representative SSc cohort and identified a complex interplay of experiences that result in significant impact. Work to develop a novel PRO instrument for assessing the severity and impact of SSc-RP, comprising domains/items grounded in the patient experiences of SSc-RP identified in this study, is underway.
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Affiliation(s)
- John D Pauling
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and University of Bath, Bath, UK
| | - Robyn T Domsic
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Jane Withey
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK
| | - Hilary Jay
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK
| | - Tracy M Frech
- University of Utah and Salt Lake Regional Veterans Affairs Medical Center, Salt Lake City
| | | | - Emma Dures
- University of the West of England, Bristol, UK
| | | | - Neil J McHugh
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and University of Bath, Bath, UK
| | - Ariane L Herrick
- University of Manchester, Salford Royal Hospital NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
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Ascherman DP, Zang Y, Fernandez I, Clark ES, Khan WN, Martinez L, Greidinger EL. An Autoimmune Basis for Raynaud's Phenomenon: Murine Model and Human Disease. Arthritis Rheumatol 2018; 70:1489-1499. [PMID: 29569858 DOI: 10.1002/art.40505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/15/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Raynaud's phenomenon (RP) is common in anti-RNP-positive patients with rheumatic diseases but is not itself known to be caused by autoimmunity. The aim of this study was to assess autoantibodies that could mediate this process. METHODS Antibodies derived from patient sera and from murine models of anti-RNP autoimmunity were screened for the ability to induce RP-like tissue ischemia and endothelial cell apoptosis in murine models and in vitro systems. RESULTS RNP-positive sera from RP patients and murine sera from RNP-positive B cell adoptive transfer recipients induced RP-like tissue ischemia and endothelial cell apoptosis. Proteomic analysis identified cytokeratin 10 (K10) as a candidate autoantigen in RP. Monoclonal anti-K10 antibodies reproduced patterns of ischemic tissue loss and endothelial cell apoptosis; K10 knockout or depletion of anti-K10 activity in serum was protective. Cold exposure enhanced K10 expression and in vivo tissue loss. CONCLUSION Anti-K10 antibodies are sufficient to mediate RP-like ischemia in murine models and are implicated in the pathogenesis of RP in patients with anti-RNP autoimmunity.
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Affiliation(s)
- D P Ascherman
- Miami VA Medical Center and University of Miami Miller School of Medicine, Miami, Florida
| | - Y Zang
- University of Miami Miller School of Medicine, Miami, Florida
| | - I Fernandez
- University of Miami Miller School of Medicine, Miami, Florida
| | - E S Clark
- University of Miami Miller School of Medicine, Miami, Florida
| | - W N Khan
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - E L Greidinger
- Miami VA Medical Center and University of Miami Miller School of Medicine, Miami, Florida
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12
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Munir S, Freidin MB, Brain S, Williams FMK. Association of Raynaud's phenomenon with a polymorphism in the NOS1 gene. PLoS One 2018; 13:e0196279. [PMID: 29698501 PMCID: PMC5919461 DOI: 10.1371/journal.pone.0196279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background Raynaud’s phenomenon (RP) describes the phenomenon of recurrent vasospasm of digital arteries, associated with skin colour changes: pallor, cyanosis and erythema. Twin studies have indicated a genetic predisposition for RP; however, the precise aetiology of RP remains unknown. It is thought that genetic variation in temperature-responsive or vasospastic genes might underlie RP so performed a candidate gene study in a large, population based sample. We assessed the association between RP and single nucleotide polymorphisms (SNPs) in the TRPA1, TRPM8, CALCA, CALCB and NOS1 genes. Methods Analysis included a total of 4276 individuals from the TwinsUK database. RP status had been determined using validated, self-administered questionnaires and was diagnosed in 640 individuals (17.6%). 66 tag SNPs across the candidate genes were tested for association with RP status using a linear regression model, accounting for covariates. Adjustment was made for multiple testing. RegulomeDB and GTEx databases were used to assess possible functional effects of the polymorphisms. Results Nominally significant associations between RP and four SNPs in NOS1 and one in CALCB were identified. After permutation testing, rs527590 SNP in NOS1 passed the significance threshold. RegulomeDB scores indicated an unlikely functional effect of this variant, while the survey of the GTEx database found the SNP and several variants in linkage disequilibrium to be cis-eQTLs in skin. Conclusion Results indicate that RP is associated with variation in gene NOS1. This finding may be related to the observation that the significant SNP in NOS1 is known to exhibit functional influence on the gene expression.
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Affiliation(s)
- Sabrina Munir
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Maxim B. Freidin
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Susan Brain
- Section of Vascular Biology & Inflammation, BHF Centre for Cardiovascular Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Frances M. K. Williams
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
- * E-mail:
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Ahmad AA, Randall MD, Roberts RE. Sex differences in the role of phospholipase A 2 -dependent arachidonic acid pathway in the perivascular adipose tissue function in pigs. J Physiol 2017; 595:6623-6634. [PMID: 28877347 DOI: 10.1113/jp274831] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/21/2017] [Indexed: 12/18/2022] Open
Abstract
KEY POINTS The fat surrounding blood vessels (perivascular adipose tissue or PVAT) releases vasoactive compounds that regulate vascular smooth muscle tone. There are sex differences in the regulation of vascular tone, but, to date, no study has investigated whether there are sex differences in the regulation of blood vessel tone by PVAT. This study has identified that the cyclooxygenase products thromboxane and PGF2α are released from coronary artery PVAT from pigs. Thromboxane appears to mediate the PVAT-induced contraction in arteries from females, whereas PGF2α appears to mediate the contraction in arteries from males. These sex differences in the role of these prostanoids in the PVAT-induced contraction can be explained by a greater release of thromboxane from PVAT from female animals and greater sensitivity to PGF2α in the porcine coronary artery from males. ABSTRACT Previous studies have demonstrated that perivascular adipose tissue (PVAT) causes vasoconstriction. In this present study, we determined the role of cyclooxygenase-derived prostanoids in this contractile response and determined whether there were any sex differences in the regulation of vascular tone by PVAT. Contractions in isolated segments of coronary arteries were determined using isolated tissue baths and isometric tension recording. Segments were initially cleaned of PVAT, which was then re-added to the tissue bath and changes in tone measured over 1 h. Levels of PGF2α and thromboxane B2 (TXB2 ) were quantified by ELISA, and PGF2α (FP) and thromboxane A2 (TP) receptor expression determined by Western blotting. In arteries from both male and female pigs, re-addition of PVAT caused a contraction, which was partially inhibited by the cyclooxygenase inhibitors indomethacin and flurbiprofen. The FP receptor antagonist AL8810 attenuated the PVAT-induced contraction in arteries from males, whereas the TP receptor antagonist GR32191B inhibited the PVAT-induced contraction in arteries from females. Although there was no difference in PGF2α levels in PVAT between females and males, PGF2α produced a larger contraction in arteries from males, correlating with a higher FP receptor expression. In contrast, release of TXB2 from PVAT from females was greater than from males, but there was no difference in the contraction by the TXA2 agonist U46619, or TP receptor expression in arteries from different sexes. These findings demonstrate clear sex differences in PVAT function in which PGF2α and TXA2 antagonists can inhibit the PVAT-induced vasoconstriction in male and female PCAs, respectively.
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Affiliation(s)
- Abdulla A Ahmad
- Cell Signalling and Pharmacology Research Group, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Michael D Randall
- Cell Signalling and Pharmacology Research Group, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Richard E Roberts
- Cell Signalling and Pharmacology Research Group, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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14
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Moreau J, Dupond AS, Dan N, Untereiner T, Vidal C, Aubin F. [Comparative evaluation of dermoscopy and capillaroscopy in Raynaud's phenomenon]. Ann Dermatol Venereol 2017; 144:333-340. [PMID: 28343718 DOI: 10.1016/j.annder.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/15/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Raynaud's phenomenon (RP) is a common cause for consultation. Capillaroscopy is a well-established technique to detect capillary abnormalities suggestive of a connective tissue disease, but it is sometimes unavailable. The aim of this study was to compare dermoscopy and capillaroscopy in the assessment of RP. METHODS This was a prospective single-centre observational study in adult patients consulting for RP at the Hôpital Nord Franche-Comté between January 2014 and June 2015. Dermoscopy was performed at dermatological consultations and capillaroscopy was prescribed. For each capillaroscopy and dermoscopy, the following parameters were examined: normal appearance, giant capillaries, avascular areas, dystrophic capillaries or tortuosity and haemorrhages. Kappa coefficients were calculated. RESULTS Twenty-six patients participated in this study. The kappa coefficient was 0.76 for "normal" status, 0.78 for tortuosity, 0.70 for giant capillaries, 0.48 for haemorrhage and 0.62 for avascular areas. The global kappa coefficient was 0.33. Detection of these abnormalities with capillaroscopy was significantly associated with abnormal dermoscopic status (P<0.05). The sensitivity of dermoscopy for the detection of "abnormal" capillaroscopic status was 0.87. CONCLUSION The correlation coefficients were good. Despite poor global concordance, 80% of patients had the same status, normal or abnormal, for both capillaroscopy and dermoscopy, which resulted in the same clinical management. Dermoscopy is thus a valuable tool screening for periungual anomalies and provides support for clinical examination by the dermatologist, although the reference method continues to be capillaroscopy.
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Affiliation(s)
- J Moreau
- Service de dermatologie, CHU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
| | - A-S Dupond
- Service de dermatologie néphrologie, CH Montbéliard, 2, rue du Dr-Flamand, 25200 Montbéliard, France
| | - N Dan
- Service de dermatologie, hôpital de jour, CH Montbéliard, 2, rue du Dr-Flamand, 25200 Montbéliard, France
| | - T Untereiner
- Service de radiologie, CH Montbéliard, 2, rue du Dr-Flamand, 25200 Montbéliard, France
| | - C Vidal
- Centre d'investigation clinique, CHU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - F Aubin
- Service de dermatologie, CHU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
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15
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Putilina MV. [Chronic cerebral ischemia associated with Raynaud's syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:90-96. [PMID: 26356403 DOI: 10.17116/jnevro20151156190-96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Over the last years, a number of patients with chronic cerebral ischemia has been increased significantly. Compensatory possibilities of the brain and cerebral circulatory system are so great that even serious disturbances of blood circulation could not cause clinical signs of brain dysfunction for a long time. At the same time, long-term ischemia can lead to peripheral local disturbances of microcirculation that is appears to be a first signal of the problems with homeostasis. Therefore, Raynaud's syndrome may be one of the predictors of standard symptoms of chronic cerebral ischemia (CCI). This phenomenon is explicitly considered as a sign of blood circulation impairment while the pathogenetic mechanism of vascular arterial bed instability is completely ignored. Detailed study of clinical correlations of Raynaud's syndrome in CCI would help to develop a common pharmacotherapeutic approach to its treatment.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical University, Moscow
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16
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Garner R, Kumari R, Lanyon P, Doherty M, Zhang W. Prevalence, risk factors and associations of primary Raynaud's phenomenon: systematic review and meta-analysis of observational studies. BMJ Open 2015; 5:e006389. [PMID: 25776043 PMCID: PMC4368987 DOI: 10.1136/bmjopen-2014-006389] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To systematically review the literature with regard to the prevalence, incidence, risk factors and associations of primary Raynaud's phenomenon (PRP). METHOD A systematic review of the literature of observational studies for PRP was undertaken using five electronic databases. Any studies reporting prevalence, incidence and risk factors of PRP were collected. Relative risk or OR and 95% CI were extracted or calculated to present the association between risk factors and PRP. Random effects model was used to pool the results. RESULTS 33 articles assessing a total of 33,733 participants were included in this analysis (2 cohort, 17 cross-sectional and 14 case-control studies). The pooled prevalence of PRP was 4.85% (95% CI 2.08% to 8.71%) in the general population. The pooled annual incidence of PRP was 0.25% (95% CI 0.19% to 0.32%). Risk factors and associations for PRP included female gender (OR=1.65, 95% CI 1.42 to 1.91), family history (OR=16.6, 95% CI 7.44 to 36.8), smoking (OR=1.27, 95% CI 1.06 to 1.53), manual occupation (OR=2.66 95% CI 1.73 to 4.08), migraine (OR=4.02, 95% CI 2.62 to 6.17), cardiovascular disease (OR=1.69, 95% CI 1.22 to 2.34) and marital status (married, OR=0.60, 95% CI 0.43 to 0.83). The definition of PRP varied considerably between studies. CONCLUSIONS This is the first systematic review of the prevalence, incidence, risk factors and associations of PRP. Further study using uniform strict criteria for the condition is required to confirm these findings, particularly the possible association with cardiovascular disease.
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Affiliation(s)
- Rozeena Garner
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
| | - Rakesh Kumari
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
| | - Peter Lanyon
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
| | - Michael Doherty
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
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17
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Erb C, Göbel K. [Importance of perimetric differential diagnostics in patients with primary open-angle glaucoma]. Ophthalmologe 2013; 110:116-30. [PMID: 23392837 DOI: 10.1007/s00347-012-2691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Functional deficits in glaucomatous optic neuropathy are, apart from other disturbances in the visual field, typically detected with achromatic perimetry as a well accepted gold standard. With the development of new perimetric devices and strategies (e.g. short wave perimetry, frequency doubling perimetry and flicker perimetry) individually different patterns of scotomas in the different perimetric devices could be recognized. The reasons for this could be a different sensitivity reaction of the ganglion cell subpopulations to an increased intraocular pressure as well as an influence of the underlying systemic diseases. To obtain a differentiated detection of the functional loss in the visual field in glaucoma, the use of different perimetric methods seems to be reasonable and helpful.
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Affiliation(s)
- C Erb
- Augenklinik am Wittenbergplatz, Kleiststr. 23-26, 10787, Berlin, Deutschland.
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Yang SS, Park KM, Kim YW, Kim DI. Three-Grade Classification of Photoplethysmography for Evaluating the Effects of Treatment in Raynaud Phenomenon. Angiology 2012; 64:609-13. [DOI: 10.1177/0003319712461930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed the utility of a 3-grade classification of photoplethysmography (PPG) with cold water provocation test in Raynaud phenomenon (RP). A total of 35 patients with RP and 38 healthy volunteers were recruited. In healthy volunteers, PPG was measured twice at intervals of 30 minutes for evaluating reproducibility of test. Percentage variation of the PPG amplitude in post- versus precold provocation was expressed on a 3-grade scale at 1, 3, and 5 minutes (reflection index: RI) in patients with RP. The improvement pattern of the PPG (IPPPG) was evaluated by summing the score differences from RI1 min to RI3 min and RI5 min. After a therapeutic period of 8 weeks with nifedipine, the decreases in posttherapeutic RI3 min and RI5 min were statistically significant ( P < .05). Subgroup analysis of IPPPG showed statistical significance in patients with negative fluorescent antinuclear antibody ( P < .05). The analysis of cold-provoked PPG waves demonstrated and quantified improvements in peripheral arterial circulation in RP.
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Affiliation(s)
- Shin-Seok Yang
- Department of Surgery, Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun-Myoung Park
- Department of Surgery, Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Department of Surgery, Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Roquelaure Y, Ha C, Le Manac'h AP, Bodin J, Bodere A, Bosseau C, Descatha A, Leclerc A, Goldberg M, Imbernon E. Risk factors for Raynaud's phenomenon in the workforce. Arthritis Care Res (Hoboken) 2012; 64:898-904. [DOI: 10.1002/acr.21615] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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20
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Botzoris V, Drosos AA. Management of Raynaud's phenomenon and digital ulcers in systemic sclerosis. Joint Bone Spine 2011; 78:341-6. [DOI: 10.1016/j.jbspin.2010.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 11/05/2010] [Indexed: 11/30/2022]
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21
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The prevalences of some rheumatic diseases in western Turkey: Havsa study. Rheumatol Int 2011; 32:895-908. [DOI: 10.1007/s00296-010-1699-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 11/21/2010] [Indexed: 01/17/2023]
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22
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Tzilalis V, Panagiotopoulos N, Papatheodorou G, Rallis E, Kassimos D. Prevalence of Raynaud's phenomenon in young Greek males. Clin Rheumatol 2010; 30:57-9. [PMID: 21120563 DOI: 10.1007/s10067-010-1621-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/30/2010] [Accepted: 11/03/2010] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to study the prevalence of Raynaud's phenomenon in young males. Young males were examined prospectively in a district hospital, and laboratory tests were performed on the basis of the clinical history. Young males (3.912), age 18-28 years old, were examined. Raynaud's phenomenon was present in seven men (1,79 per 1.000, 95% CI 0.72-3.68). Three of them had at least one member in their family diagnosed with Raynaud's phenomenon. Three were smokers. All had negative immunological test. Five patients reported having severe attacks and two had only mild ischemic attacks. The treatment was conservative for all patients, two of them necessitated vasodilators. Very low prevalence of Raynaud's phenomenon was observed in this young male group compared with the previous studies.
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Affiliation(s)
- Vassilios Tzilalis
- Department of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece
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23
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Zhang X, Coté CJ. Raynaud's phenomenon in a child presenting as oxygen desaturation during transfusion with cold blood. Paediatr Anaesth 2008; 18:1208-10. [PMID: 19076576 DOI: 10.1111/j.1460-9592.2008.02782.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of Raynaud's phenomenon (RP) triggered by transfusion of cold blood to a pediatric burn patient under general anesthesia. The child was febrile so a decision was made to not use a blood warmer. When the blood was rapidly administered the child suddenly developed 'desaturation'. The child was placed on 100% oxygen, adequate ventilation assured, and the color of his oral mucosa assessed as 'pink'. Placement of the oximeter on the opposite hand revealed 100% saturation. To our knowledge, this is the first case of apparent RP reported in a pediatric patient triggered by transfusion of cold blood.
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Affiliation(s)
- Xiaopeng Zhang
- Division of Pediatric Anesthesia, Department of Anesthesia and Critical Care, Harvard Medical School, The MassGeneral Hospital for Children, Boston, MA 02114, USA
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KRÄUCHI KURT, GASIO PAOLAFONTANA, VOLLENWEIDER STEPHANIE, VON ARB MARIELLA, DUBLER BARBARA, ORGÜL SELIM, FLAMMER JOSEF, STUTZ ELISABETHZEMP. Cold extremities and difficulties initiating sleep: evidence of co-morbidity from a random sample of a Swiss urban population. J Sleep Res 2008; 17:420-6. [DOI: 10.1111/j.1365-2869.2008.00678.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Cakir N, Pamuk ON, Dönmez S, Barutçu A, Diril H, Odabaş E, Kiliçcigil V. Prevalence of Raynaud's phenomenon in healthy Turkish medical students and hospital personnel. Rheumatol Int 2008; 29:185-8. [PMID: 18682952 DOI: 10.1007/s00296-008-0666-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 07/28/2008] [Indexed: 11/30/2022]
Abstract
In this study, we investigated the frequency of Raynaud's phenomenon (RP) in medical students and hospital personnel and determined associated factors. Students and hospital personnel of our medical faculty (1,414 subjects; 838 females, 576 males, mean age, 27.2+/-6.6) were questioned for symptoms associated with RP, and the presence of smoking and headache. 530 subjects (37.5%) defined color changes on cold exposure. 51 subjects (3.6%) had biphasic or triphasic color changes (definite RP). The prevalence of definite RP in females (4.8%) was significantly higher than in males (1.9%) (P=0.005). The frequency of smoking subjects (45.1 vs. 28.8%) was significantly higher in patients with RP (P=0.009). There was numbness and/or paresthesia in 174 subjects (12.3%) who defined uniphasic color change on cold exposure (possible RP). Female sex and being a smoker were factors associated with RP in our study.
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Affiliation(s)
- Necati Cakir
- Department of Rheumatology, Trakya University Medical Faculty, 22030, Edirne, Turkey
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26
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Li M, Kuo L, Stallone JN. Estrogen potentiates constrictor prostanoid function in female rat aorta by upregulation of cyclooxygenase-2 and thromboxane pathway expression. Am J Physiol Heart Circ Physiol 2008; 294:H2444-55. [PMID: 18310519 DOI: 10.1152/ajpheart.01121.2007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Estrogen potentiates vascular reactivity to vasopressin (VP) by enhancing constrictor prostanoid function. To determine the cellular and molecular mechanisms, the effects of estrogen on arachidonic acid metabolism and on the expression of constrictor prostanoid pathway enzymes and endoperoxide/thromboxane receptor (TP) were determined in the female rat aorta. The release of thromboxane A2 (TxA2) and prostacyclin (PGI2) was measured in male (M), intact-female (Int-F), ovariectomized-female (OvX-F), and OvX + 17beta-estradiol-replaced female (OvX + ER-F) rats. The expression of mRNA for cyclooxygenase (COX)-1, COX-2, thromboxane synthase (TxS), and TP by aortic endothelium (Endo) and vascular smooth muscle (VSM) of these four experimental groups was measured by RT-PCR. The expression of COX-1, COX-2, and TxS proteins by Endo and VSM was also estimated by immunohistochemistry (IHC). Basal release of TxA2 and PGI2 was similar in M (18.8 +/- 1.9 and 1,723 +/- 153 pg/mg ring wt/45 min, respectively) and Int-F (20.2 +/- 4.2 and 1,488 +/- 123 pg, respectively) rat aortas. VP stimulated the dose-dependent release of TxA2 and PGI2 from both male and female rat aorta. OvX markedly attenuated and ER therapy restored VP-stimulated release of TxA2 and PGI2 in female rats. No differences in COX-1 mRNA levels were detected in either Endo or VSM of the four experimental groups (P > 0.1). The expression of both COX-2 and TxS mRNA were significantly higher (P < 0.05) in both Endo and VSM of Int-F and OvX + ER-F, compared with M or OvX-F. Expression of TP mRNA was significantly higher in VSM of Int-F and OvX + ER-F compared with M or OvX-F. IHC revealed the uniform staining of COX-1 in VSM of the four experimental groups, whereas staining of COX-2 and TxS was greater in Endo and VSM of Int-F and OvX + ER-F than in OvX-F or M rats. These data reveal that estrogen enhances constrictor prostanoid function in female rat aorta by upregulating the expression of COX-2 and TxS in both Endo and VSM and by upregulating the expression of TP in VSM.
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Affiliation(s)
- Min Li
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4466, USA
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Sellers MM, Stallone JN. Sympathy for the devil: the role of thromboxane in the regulation of vascular tone and blood pressure. Am J Physiol Heart Circ Physiol 2008; 294:H1978-86. [PMID: 18310512 DOI: 10.1152/ajpheart.01318.2007] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Historically, the vasodilatory prostanoids, especially prostacyclin and prostaglandin E(2), are believed to contribute significantly to the regulation of normal vascular tone and blood pressure (BP), primarily by counteracting the prevailing effects of the systemic vasoconstrictor systems, including angiotensin II, the catecholamines, and vasopressin. In contrast, the primary vasoconstrictor prostanoid thromboxane A(2) (TxA(2)) is produced in far smaller quantities in the normal state. While TxA(2) is believed to play a significant role in a variety of cardiovascular diseases, such as myocardial infarction, cerebral vasospasm, hypertension, preeclampsia, and various thrombotic disorders, its role in the regulation of vascular tone and BP in the normal physiological state is, at best, uncertain. Numerous studies have firmly established the dogma that TxA(2), while important in pathophysiological states in males, plays little or no role in the regulation of vascular tone or BP in females, except in the pulmonary vasculature. However, this concept is largely based on the predominant and preferential use of males in animal and human studies. Recent studies from our laboratory and others challenge this dogma and reveal that the TxA(2) pathway in the systemic vascular wall is an estrogen-dependent mechanism that appears to play an important role in the regulation of vascular tone and BP in females, in both normal and pathophysiological states. It is proposed that the potent vasoconstrictor action of TxA(2) is beneficial in the female in the normal state by acting as a local counterregulatory mechanism to increase vascular tone and BP and defend against hypotension that could result from the multiple estrogen-sensitive local vasodilator mechanisms present in the female vascular wall. Validation of this proposal must await further studies at the systemic, tissue, and molecular levels.
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Affiliation(s)
- Minga M Sellers
- Department of Veterinary Physiology & Pharmacology, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843-4466, USA
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Suter LG, Murabito JM, Felson DT, Fraenkel L. Smoking, alcohol consumption, and Raynaud's phenomenon in middle age. Am J Med 2007; 120:264-71. [PMID: 17349450 DOI: 10.1016/j.amjmed.2006.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Revised: 05/24/2006] [Accepted: 06/01/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Data suggest Raynaud's phenomenon shares risk factors with cardiovascular disease. Studies of smoking, alcohol consumption, and Raynaud's have produced conflicting results and were limited by small sample size and failure to adjust for confounders. Our objective was to determine whether smoking and alcohol are independently associated with Raynaud's in a large, community-based cohort. METHODS By using a validated survey to classify Raynaud's in the Framingham Heart Study Offspring Cohort, we performed sex-specific analyses of Raynaud's status by smoking and alcohol consumption in 1840 women and 1602 men. Multivariable logistic regression analyses were used to examine the relationship of Raynaud's to smoking and alcohol consumption. RESULTS Current smoking was not associated with Raynaud's in women but was associated with increased risk in men (adjusted odds ratio [OR] 2.59, 95% confidence interval [CI], 1.11-6.04). Heavy alcohol consumption in women was associated with increased risk of Raynaud's (adjusted OR 1.69, 95% CI, 1.02-2.82), whereas moderate alcohol consumption in men was associated with reduced risk (adjusted OR 0.51, 95% CI, 0.29-0.89). In both genders, red wine consumption was associated with a reduced risk of Raynaud's (adjusted OR 0.59, 95% CI, 0.36-0.96 in women and adjusted OR 0.30, 95% CI, 0.15-0.62 in men). CONCLUSIONS Our data suggest that middle-aged women and men may have distinct physiologic mechanisms underlying their Raynaud's, and thus sex-specific therapeutic approaches may be appropriate. Our data also support the possibility that moderate red wine consumption may protect against Raynaud's.
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Affiliation(s)
- Lisa G Suter
- VA Connecticut Healthcare System, West Haven, Conn, USA.
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Bernatsky S, Pineau CA, Lee JL, Clarke AE. Headache, Raynaud's syndrome and serotonin receptor agonists in systemic lupus erythematosus. Lupus 2007; 15:671-4. [PMID: 17120594 DOI: 10.1177/0961203306069997] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are potential concerns regarding serotonin receptor agonists in SLE patients with migraine, particularly patients with concomitant Raynaud's syndrome. We estimated the prevalence of lupus-related headache and Raynaud's syndrome in the Montreal General Hospital SLE clinic cohort and evaluated the relationship between these two variables in multivariable logistic regression models, controlling for age, sex, race, SLE duration and the presence of lupus anticoagulant and antibodies to cardiolipin and beta2 glycoprotein I. We also assessed, through chart review in those individuals with both Raynaud's syndrome and migraine, a history of serotonin receptor agonist use, and any associated worsening vasospasm. Based on Systemic Lupus Activity Measure (SLAM) scores, the cumulative incidence of lupus-related headache in our sample (n = 391) was 46.1%; the prevalence of Raynaud's syndrome was 49.4%. The adjusted odds ratio (OR) for lupus-related headache and Raynaud's syndrome was 1.7 (95% CI 1.1, 2.5). In addition, there was a strong independent relationship between headache and anti-beta2 glycoprotein I antibodies (adjusted OR 5.6 [95% CI 1.8, 17.0]). The data from our chart review suggest that careful use of serotonin receptor agonists in patients with both Raynaud's syndrome and migraines may be undertaken, although caution would necessitate that these agents not be used in individuals with very severe Raynaud's (eg, digital ulcerations, and so on).
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Affiliation(s)
- S Bernatsky
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, PQ, Canada
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Pistorius MA, Planchon B, Schott JJ, Lemarec H. Aspects héréditaires et génétiques de la maladie de Raynaud. ACTA ACUST UNITED AC 2006; 31:10-5. [PMID: 16609626 DOI: 10.1016/s0398-0499(06)76512-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The pathophysiology of primary Raynaud's phenomenon (Raynaud's disease) remains uncertain but the transmission of this primary microcirculatory dysregulation seems strongly influenced by genetic factors. For a long time, physicians have found that the hereditary factor plays an important role in the genesis of Raynaud's disease. Familial analysis and twin studies have confirmed the role of an hereditary factor. It seems heterogeneous but pedigree analysis indicates the possibility of an autosomal dominant transmission influenced by sex, in some families, allowing an approach called "reverse genetic" based on linkage analysis. Such an approach has focused on few loci but sequencing of candidate genes for genetic mutations remains negative. Given the supposed heterogeneity of the genetic transmission of Raynaud's disease, diversification of strategies in molecular genetics is suitable with reference to techniques applied to multifactorial heredity.
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Affiliation(s)
- M A Pistorius
- Service de Médecine Interne et Vasculaire, CHU Hôtel-Dieu, Place Alexis Ricordeau, 44000 Nantes
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De Angelis R, Salaffi F, Grassi W. Raynaud's phenomenon: prevalence in an Italian population sample. Clin Rheumatol 2005; 25:506-10. [PMID: 16292469 DOI: 10.1007/s10067-005-0077-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 07/01/2005] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
To estimate the prevalence of Raynaud's phenomenon (RP) in an Italian population aged 18 years and above, a validated questionnaire was mailed to a random sample of 3,664 subjects. Sociodemographic data and data regarding the prevalence of RP symptoms were collected. Trained rheumatologists carried out a subsequent standardized clinical examination to confirm diagnosis of RP and to detect associated diseases. The subjects (2,155) completed the questionnaire, with 45 reporting RP [prevalence rate 2.1%, 95% confidence intervals (CI) 1.8-2.4]. The mean age [standard deviation (SD)] was 57.5 (12.7), and 40 (88.8%) were women. Prevalence was found higher in women (3.4%, 95% CI 2.8-4.1) than in men (0.5%, 95% CI 0.2-0.9) (p<0.0001). A connective tissue disease was diagnosed in six (0.28%) subjects, three of the participants (0.14%) were identified as having RP associated to an idiopathic carpal tunnel syndrome, and 36 (1.67%) were diagnosed as having primary RP. Our study has found a lower prevalence of RP than others have reported. There is thought to be an association with climate and ethnic factors. No relationship was found regarding factors that are thought to be among the most relevant triggering factors for RP, e.g., occupational exposure. Differences with previous studies may be related to the current characteristics of the population surveyed.
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Affiliation(s)
- Rossella De Angelis
- Clinica Reumatologica, Ospedale "Augusto Murri", via dei Colli, 52, 60035, Jesi, (AN), Italy.
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Li M, Stallone JN. Estrogen potentiates vasopressin-induced contraction of female rat aorta by enhancing cyclooxygenase-2 and thromboxane function. Am J Physiol Heart Circ Physiol 2005; 289:H1542-50. [PMID: 15937092 DOI: 10.1152/ajpheart.01024.2004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To determine the roles of estrogen and constrictor prostanoids in vasopressin (VP)-induced contraction of female rat aorta, vascular reactivity to VP was determined in thoracic aortas of intact, ovariectomized, and ovariectomized + estrogen-replaced female rats in the presence of indomethacin (Indo), NS-398, SQ-29,548, or vehicle control. The effects of estrogen on vascular reactivity to the thromboxane A(2) analog U-46619 were also examined. Maximal contractile response to VP in intact female rats (5,567 +/- 276 mg/mg of aortic ring wt) was markedly attenuated by ovariectomy (2,485 +/- 394 mg; P < 0.001) and restored by estrogen replacement with 17beta-estradiol (5,059 +/- 194 mg; P > 0.1). Indo and NS-398 significantly attenuated maximal responses to VP in intact female rats to a similar extent [3,176 +/- 179 (P < 0.0001) and 3,258 +/- 152 mg (P < 0.0001), respectively]. Ovariectomy abolished and estrogen replacement restored the inhibitory effects of Indo, NS-398, and SQ-29,548. Contractile responses of rat aorta to U-46619 were significantly greater (P < 0.0001) in females (5,040 +/- 238 mg) than in males (3,679 +/- 96 mg). Ovariectomy markedly attenuated (3,923 +/- 84 mg; P < 0.01) and estrogen replacement restored (5,024 +/- 155 mg; P > 0.1) responses to U-46619 in female aortas. These data reveal that estrogen is an important regulator of the contractile responses of female rat aorta to VP, which appears to potentiate both cyclooxygenase-2 and constrictor prostanoid function in the vascular wall.
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Affiliation(s)
- Min Li
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine, Texas A and M University, College Station, Texas 77843, USA
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Onbaşi K, Sahin I, Onbaşi O, Ustün Y, Koca D. Raynaud's phenomenon in a healthy Turkish population. Clin Rheumatol 2005; 24:365-9. [PMID: 15906111 DOI: 10.1007/s10067-004-1045-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 10/12/2004] [Indexed: 10/25/2022]
Abstract
Raynaud's phenomenon (RP) is a vasospastic disease and is characterized by ischemia of the digits, nose, and ears. The vasospasm can be triggered by cold weather, cold water, or emotional stress and is followed by triphasic color changes. First white color (ischemia), then blue color (congestion and cyanosis), and finally red color change (reactive hyperemia) can be observed. The prevalence is reported to be between 0.5 and 20% in different studies and is dependent on genetic, occupational, and environmental factors. The purpose of our study was to determine the prevalence of RP in an eastern part of Turkey among healthy subjects. A total of 768 people were included in the study. This cross-sectional study was conducted between April 2003 and October 2003 at the University Hospital and at the State Hospital in Van, Turkey. The participants were interviewed and examined to diagnose RP and a questionnaire and color charts were used. Of these 768 patients, 25 women and 20 men were diagnosed to have RP. A female predominance (25/20) was observed. Their mean age was 24.78 +/- 5.71 years. The prevalence of RP was 5.9% in our study population.
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Affiliation(s)
- Kevser Onbaşi
- Department of Internal Medicine, Yüzüncü Yil University School of Medicine, Van, Turkey.
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Hummers LK, Wigley FM. Management of Raynaud's phenomenon and digital ischemic lesions in scleroderma. Rheum Dis Clin North Am 2003; 29:293-313. [PMID: 12841296 DOI: 10.1016/s0889-857x(03)00019-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Raynaud's phenomenon is a challenging problem in patients who have scleroderma. It causes a great deal of morbidity with recurrent painful attacks and frequent digital ischemic lesions. The strategy to treat the vascular disease must consider treatment for the vasospasm and the intrinsic vascular disease with intimal proliferation and vessel occlusion. Vasodilator therapy remains the main method to treat Raynaud's phenomenon, but new understanding of the pathobiology of scleroderma vascular disease is providing novel treatment options. We need more investigations into these vasoactive drugs before routine use can be recommended. Critical ischemia can cause deep tissue injury and digital loss. An aggressive approach to reversing an ischemic crisis is essential for preventing these severe events.
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Affiliation(s)
- Laura K Hummers
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD 21205, USA
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Nigrovic PA, Fuhlbrigge RC, Sundel RP. Raynaud's phenomenon in children: a retrospective review of 123 patients. Pediatrics 2003; 111:715-21. [PMID: 12671102 DOI: 10.1542/peds.111.4.715] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the clinical presentation and disease associations of Raynaud's phenomenon (RP) in children and adolescents. METHODS A systematic retrospective chart review was conducted of 123 cases drawn from 2 computerized databases at the Children's Hospital of Boston. Participants aged <19 years with episodic reversible color changes in the extremities were examined. Case records were analyzed for clinical presentation, disease associations, and physical examination and laboratory findings. RESULTS In contrast to the findings of smaller pediatric series reported to date, the large majority of our patients-approximately 70%-did not have a recognized underlying connective tissue disease. For both primary and secondary RP, approximately 80% of patients were female, and mean age of onset was similar in the 2 groups. Biphasic or triphasic color changes were less common than monophasic changes and were no more common in secondary than primary RP. Findings predictive of secondary RP were limited to the presence of antinuclear antibodies and abnormal nailfold capillaries. Antiphospholipid antibodies were found at some time in at least 21% of patients with both primary and secondary RP. CONCLUSIONS RP in children, as in adults, principally affects girls and is frequently free of association with connective tissue disease. Antinuclear antibody positivity and abnormal nailfold capillaries correlate with secondary disease. Antiphospholipid antibodies are surprisingly common, a new finding of uncertain implications.
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Affiliation(s)
- Peter A Nigrovic
- Division of Immunology, Program in Rheumatology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Abstract
Although originally described more than 100 years ago, the pathophysiology of Raynaud's phenomenon (RP) remains incompletely understood. Epidemiologic studies have the potential to improve our understanding of the pathogenesis of RP and to identify potential targets for therapeutic interventions. Such studies require standardized instruments to accurately identify subjects with RP. Dr. Maricq was the first to develop and validate a standardized instrument to classify patients with this disorder. Her work has facilitated many of the epidemiologic studies of RP that are discussed in this review.
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Affiliation(s)
- Liana Fraenkel
- Yale University, Department of Internal Medicine, Section of Rheumatology, PO Box 208031, 333 Cedar Street, New Haven, CT 06520-8031, USA.
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