RAYNAUD'S PRESENTATION

Q. A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, and difficulty swallowing solid food. What is the best diagnostic test?

a. Rheumatoid factor

b. Antinucleolar antibody

c. ECG

d. BUN and creatinine

e. Reproduction of symptoms and findings by immersion of hands in cold water

Ans:  b.

The symptoms of Raynaud phenomenon, arthralgia, and dysphagia point toward the diagnosis of scleroderma. Scleroderma, or systemic sclerosis, is characterized by a systemic vasculopathy of small and medium-sized vessels, excessive collagen deposition in tissues, and an abnormal immune system. It is an uncommon multisystem disease affecting women more often than men. There are two variants of scleroderma—a relatively benign type called the CREST syndrome and a more severe, diffuse disease. Antinucleolar antibody occurs in only 20 to 30% of patients with the disease, but a positive test is highly specific. Cardiac involvement may occur, and an ECG could show heart block but is not at all specific. Renal failure can develop insidiously, but BUN and creatinine levels would not be diagnostically specific. Rheumatoid factor is nonspecific

and present in 20% of patients with scleroderma. Reproduction of Raynaud phenomena is nonspecific and is not recommended as an office test.