Rheumatology Advance Access originally published online on October 2, 2006
Rheumatology 2007 46(3):533-538; doi:10.1093/rheumatology/kel330
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The ‘distal–dorsal difference’: a thermographic parameter by which to differentiate between primary and secondary Raynaud's phenomenon
University of Liverpool Academic Rheumatology Unit, University Hospital Aintree, Liverpool L9 7AL, 1University of Manchester Rheumatic Diseases Centre, Hope Hospital, Salford, M6 8HD and 2Arthritis Research Campaign Epidemiology Unit, University of Manchester, Manchester, Ml3 9PT, UK.
Correspondence to: Ariane Herrick, University of Manchester Rheumatic Diseases Centre, Hope Hospital, Salford M6 8HD, UK. E-mail: ariane.herrick{at}manchester.ac.uk
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Abstract |
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Objective. To test the hypothesis that in a patient with Raynaud's phenomenon (RP), a difference of >1°C between the fingertips and the dorsum of the hand [‘distal–dorsal difference’ (DDD), fingers cooler] is specific for underlying structural vascular disease as occurs in systemic sclerosis (SSc), and to evaluate other thermographic parameters in the separation of secondary from primary RP.
Methods. A retrospective analysis of the case notes and thermography results of patients attending thermography, primarily over a 2-yr period. Multinomial logistic regression was used to ascertain whether thermography variables differed between groups with primary RP (56 patients), undifferentiated connective tissue disease (21 patients) and SSc (45 patients), with adjustment for age, sex and smoking.
Results. A DDD >1°C in any finger at 30°C had a positive predictive value of 70%, and a negative predictive value of 82%, in identifying the patient with RP secondary to SSc. From the results of the multinomial logistic regression, a score was derived incorporating age, number of fingers with DDD >1°C at 30°C and maximum rewarming gradient. This score (with a suitable cut-off) was 82% sensitive and 82% specific in identifying RP secondary to SSc, with a positive predictive value of 73% and a negative predictive value of 89%.
Conclusion. Parameters derived from thermography (incorporating both a heat and cold challenge) aid in the prediction of SSc in patients with RP.
KEY WORDS: Thermography, Raynaud's phenomenon, Systemic sclerosis
Submitted 3 August 2006;
revised version accepted 15 August 2006.
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