The erythema was quite dramatic. I should have taken my associate's hand next to the patient's hand for comparison.
Lab: ANA 1:2560 Centromere, RF 25, C4 low 94, C3, nl. Low titer antibeta 2GP Igm. Negative ACA and LAC, negative ENA, dsDNA, CCP
Xray: resorption of distal L small finger
Raynaud's occurs in two main types:
- Primary Raynaud's is the most common form of the disorder and is not connected to an underlying disease or related medical problem. It is also called Raynaud’s phenomenon.
- Secondary Raynaud's is also called Raynaud's phenomenon. This form is caused by an underlying, or related, problem. Secondary Raynaud's is less common than the primary form, but it tends to be a more serious disorder. Symptoms of secondary Raynaud's often first appear at later ages — around 40 — while people with the primary form often see symptoms earlier.
The digital ulceration of the left fifth finger has progressed to distal reabsorption with bone protrusion. X-rays and orthopedic consultation is pending.
Comments of Richard Sontheimer, M.D.
These are extended and useful remarks that begin with: "This patient’s digital ulceration and the puffiness of her fingers together argue strongly in favor of systemic sclerosis. The fingertip ulceration in your patient would be highly atypical for isolated benign Raynaud's disease. And, Buerger's disease would not typically produce the sausage-like digital swelling," Please read the entire link as it is very helpful.
Also see Reference # 3 below.
[Minimal work-up for Raynaud syndrome: a consensus report. Microcirculation working group of the Société française de médecine vasculaire]. [in French]
Muroi E, et. al. Rheumatol Int. 2011 Dec;31(12):1601-6. doi: 10.1007/s00296-010-1532-0. Epub 2010 May 27.
McBride JD, Sontheimer RD. Dermatol Online J. 2016 Feb 17;22 Free Full Text Online