Raynaud's phenomenon in limited cutaneous systemic sclerosis.

To cite: Bonnecaze AK. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2015-212911 DESCRIPTION A 41-year-old African American woman with no significant medical history presented to clinic reporting of episodic finger numbness and colour changes. She described feeling as if her fingers were frostbitten and noted her second, third and fourth digits appeared white distally. She additionally reported of occasionally feeling food stuck in her throat after consuming solids. Physical examination revealed no joint abnormalities or evidence of skin tightening. Laboratories revealed a creatinine level of 0.95 mg/dL and trace proteinuria. An antinuclear antibody test was positive at 1:1200 and anticentromere antibody was also positive. The diagnosis of limited cutaneous systemic sclerosis (lcSSc) was performed on the basis of the patient’s symptoms and aforementioned serology. Her dysphagia was concerning for oesophageal dysmotility and required gastroenterology follow-up. The above images highlight one of the patient’s episodes of Raynaud’s phenomenon (RP) (figures 1 and 2). The patient reported this as having occurred several times per week over the past 18 months and was unable to associate it with any precipitating or alleviating factors. The patient was scheduled to follow-up further with rheumatology for management and monitoring of lcSSc. In RP, cold and pale fingertips result from episodic peripheral vasospasm. Nailfold capillaroscopy is often used to differentiate primary versus secondary RP, with decreased or distorted capillary loops being highly specific for secondary RP. While a wide variety of treatment modalities exist, current evidence supports the use of calcium channel blockers such as amlodipine or nifedipine, PDE-5 inhibitors, and prostanoids such as iloprost and beraprost sodium. Learning points