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Rheumatology Advance Access originally published online on June 11, 2008
Rheumatology 2008 47(8):1260; doi:10.1093/rheumatology/ken221
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Comment on: Sparing of the thumb in Raynaud's phenomenon: reply

B. Chikura1, T. Moore2, J. Manning2, A. Vail3 and A. L. Herrick2

1The Royal Liverpool University Hospital, Liverpool, 2Rheumatic Diseases Centre, University of Manchester, Hope Hospital, Salford and 3Biostatistics Group, University of Manchester, Manchester, UK

Correspondence to: B. Chikura, The Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. E-mail: docbatsi{at}aol.com

We thank Dr Binymin for his interest in our article [1]. We fully agree that although useful in the assessment of patients with RP, thermography has its limitations and we too have reported that there are concerns about reproducibility [2]. However, we believe that Dr Binymin's concern [3] about not including healthy controls in our cross-sectional study examining thumb involvement in patients with RP is unfounded: the reason for not including a control group was because the comparison was ‘within-subject’. Including healthy controls, who do not experience RP and who do not demonstrate temperature gradients along their fingers, would not have been meaningful.

Digit length or width may well be the explanation for the apparent thumb sparing as discussed, and adjustment for this would be inappropriate. We used both objective (thermography) and subjective (symptom reporting by patients) measures to assess thumb sparing in patients with RP. Thumb sparing found using thermography was confirmed by symptoms reported by patients.

Disclosure statement: The authors have declared no conflicts of interest.


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  1. Chikura B, Moore TL, Manning JB, Vail A, Herrick AL. Sparing of the thumb in Raynaud's phenomenon. Rheumatology (2008) 47:219–21.[Abstract/Free Full Text]
  2. Clark S, Hollis S, Campbell F, Moore T, Jayson M, Herrick A. The "distal-dorsal difference" as a possible predictor of secondary Raynaud's phenomenon. J Rheumatol (1999) 26:1125–8.[Web of Science][Medline]
  3. Binymin K. Comment on: Sparing of the thumb in Raynaud's phenomenon. Rheumatology. (2008) 47. doi:10.1093\rheumatology\ken228.
Accepted 14 May 2008


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This Article
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