Abstract
Raynaud's phenomenon is easily affected by environmental temperature and the patient's own physical and emotional stress. In order to study the peripheral circulatory dynamics of such patients, we applied the vasoconstrictive stimuli by means of ice immersion and vasodilatory stimuli by means of topical nitroglycerin (NG) or an intravenous administration of prostaglandine E1 in a lipid microsphere (LipoPGE1). The digital temperature was monitored for a total of 170 minutes by an autonomic temperature monitoring system. The subjects consisted of 25 patients with Sjögren's syndrome, 8 with progressive systemic sclerosis, 6 with systemic lupus erythematosus, and 6 with other various connective tissue diseases, in addition to 5 with Raynaud's disease and another one with vibration disease. There were 7 control subjects. The digital temperature was automatically recorded by a core temperature monitor (Core Temp Model CTM-205, Thermo Co Ltd, Tokyo). The core temperature and surface temperature probes were attached to the left middle finger and the temperature was recorded for 20 minutes. The probes were then detached and both hands were immersed into an ice bath for one minute. After drying the hands the probes were reattached and the temperature was recorded for 60 minutes. Then, a 2% ointment of NG was rubbed on the surface of the fingers and hands or, alternatively, 5μg of LipoPGE1 was injected intravenously. After recording the temperature for 30 minutes by the same method the hands were immersed in an ice bath and the temperature was monitored for another 60 minutes. Digital temperature patterns were categorized into 4 types based on the resting, cooling, and rewarming temperatures and recovery time patterns before and after treatment: normal (N), moderately improved (I), markedly improved (II), and exacerbation (III). In the patients treated with NG ointment, 37 (62.7%) out of 59 patients came under category I or II. In those treated with intravenous LipoPGE1, 11 (57.9%) out of 19 patients came under categories I or II, while 9 patients (17.3%) out of the NG group and 5 patients (15.3%) out of the LipoPGE1 group came under category III. These results suggest that continuous monitoring of the digital temperature to demonstrate the effects of vasoconstrictive and vasodilatory stimuli is a useful test because it is highly sensitive to monitoring these changes and it has a high reproducibility to evaluate the Raynaud's phenomenon. Additionally, topical NG as well as intravenous LipoPGE1 treatment improved digital circulation in most patients. But for those patients who showed adverse effects, they should be treated cautiously by the oral administration of vasodilatory drugs.
