ART OF MEDICINE 2017

 

REYNAUD’S PREVALENCE OF SYNDROME IN YOUNG PEOPLE

 

R.V. Sabadosh, N.М. Rizuk, M.D. Rizuk

          Ivano-Frankivsk National Medical University, Ukraine, ORCID ID: 0000-0001-9770-5960 e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

  

Abstract

Abstract. The aim of the research was to increase the frequency of early revealed Raynaud’s phenomenon in young people via a survey of students using the special questionnaire and data analysis afterward.

Materials and methods. In January and February 2018, 1007 students of Ivano-Frankivsk National Medical University were asked for the detection of Raynaud’s syndrome. 737 of those interviewed were female and 270 - male. The age of those students ranged from 16 to 32. The median of the age range was 19 years (interquartile range: 18 – 21 years).

The questionnaire consists of 9 questions and 2 pictures. 8 of 9 questions were used in the Three-step approach to the diagnosis of Raynaud’s Phenomenon that was approved in 9th International Congress on Autoimmunity (2014). According to the approach, Raynaud’s phenomenon is confirmed if respondent gave a positive answer on both of Step 1 - 2 questions and pointed at least 3 items of Step 3. One item such as “patient provided photograph(s) strongly support a diagnosis of RP” wasn’t used because students couldn’t present photographs during asking the questions.

Database was formed by using “Microsoft Excel 2013” (Microsoft, USA). Statistical analysis was performed using STATISTICA 10 (Stat Soft, USA) and R (Revolution Analytics, USA) software. The frequency of qualitative indexes was presented by absolutely (n) and relative (%) values. The 95 % confident interval of those indexes was determined. We used Shapiro-Wilk’s test to estimate the pattern of age distribution. Results were present as “median (25th and 75th percentile)”. We used Fisher’s exact test to compare two independent groups of nominal variables. Such statistical measures as sensitivity, specificity and odds ratio were calculated to assess the significance of various symptoms that meet most often during Raynaud’s phenomenon. The significance level (p-value) was 0,05.

Results. Raynaud’s phenomenon was confirmed by 40 of 1007 students (4,0%; 95% CI 2,9 – 5,4%).The majority of students without Raynaud’s phenomenon had at least one the same symptom that meets in case of the phenomenon. Moreover, all of the above-mentioned symptoms occurred more often in case of the phenomenon than without it. The most prevalent symptoms in respondents with Raynaud’s phenomenon were numbness and/or paresthesia of thumbs and fingers (75%; 95% CI 58,8 – 87,3%). However, these symptoms also were detected in students without the phenomenon (28,6 %). Therefore, we calculated sensitivity and specificity of symptoms to estimate precisely significance of them for diagnostic of Raynaud’s phenomenon. The highest value of sensitivity were such symptoms as numbness and/or paresthesia during vasospasm episodes, an occurrence of episodes on both hands and triphasic colour changes. However, the highest value of specificity was a well-demarcated border of discolored skin, triggering of episodes by things other than cold and triphasic colour changes.

It was also calculated odds ratio for each symptom. The symptom of a well-demarcated border of discolored skin shown the highest odds ratio (5,33; 95% CI 2,62 – 11,66). Besides, the symptom of triphasic color changes also has the high odds ratio.

One of the key issues is what cause Raynaud’s phenomenon. We have used Diagnostic Criteria for Primary Raynaud’s Phenomenon to assess whether the disease is primary or secondary. According to criteria, the phenomenon is primary if all of the following conditions are present:

  • • Normal capillaroscopy;
  • • Physical examination is negative for findings suggestive of secondary causes (e.g. ulceration, tissue necrosis or gangrene, sclerodactyly, calcinosis, or skin fibrosis);
  • • No history of existing connective tissue disease;
  • • Negative OR low titer of antinuclear antibodies (ANA).

By using the questionnaire, we have verified only one condition: the history of existing connective tissue disease. As it turned out, 2,5% of respondents with Raynaud’s phenomenon had confirmed connective tissue disease before. That means at least 2,5% of students have had secondary Raynaud’s phenomenon. This percentage can be higher if we could assess other criteria.

Conclusions.

        1.           Raynaud’s phenomenon is present in 4,0% of IFNMU students (95% CI 2,9 – 5,4%). At least 2,5% of them have secondary Raynaud’s phenomenon.

  1. Such symptoms as a well-demarcated border of discolored skin during episodes of vasospasm and triphasic colour changes can be considered as the most important symptoms to diagnose Raynaud’s phenomenon.
  2. The early revealing of Raynaud’s phenomenon in young people can be performed via a survey of students using the special questionnaire.

 

Keywords: Raynaud's phenomenon, diagnostics.

 

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References

1. Maverakis, Emanual et al. “International Consensus Criteria for the Diagnosis of Raynaud’s Phenomenon.” Journal of autoimmunity 0 (2014): 60–65.

2. Herrick, Ariane L. “Evidence-Based Management of Raynaud’s Phenomenon.” Therapeutic Advances in Musculoskeletal Disease 9.12 (2017): 317–329.

3. Synycyka V. O. et al. “Osoblyvosti syndromu Reyno u ditey”. Actualni pytannya pediatrii, akusherstva ta ginekologii. № 2, 2011: 114-116.

4. Leontyeva S. R. “Clinichni ta patogenetychni osoblyvosti vtorynnogo syndromu Reyno ta yih medykamentozna corectia”. Lvivskiy klinichniy visnyk. № 4 (12), 2015: 22-27.

5. Holovach I. Y. et al. “Mechanizmy razvitia i vedeniya pacyentov s fenomenom Reyno i digitalnymi izyazvleniyami pri sistemnoy sklerodermii”, Practycuyuchiy likar, Tom 6, № 2, 2017: 11-18.

6. Román Ivorra JA et al. “Prevalence of Raynaud's phenomenon in general practice in the east of Spain.” Clinical Rheumatology. 2001; 20(2):88-90.

7. Czirják L et al. “Survey of Raynaud’s phenomenon and systemic sclerosis based on a representative study of 10,000 south-Transdanubian Hungarian inhabitants”. Clin Exp Rheumatol. 2005;23(6):801–8.

8. Voulgari PV et al. “Prevalence of Raynaud’s phenomenon in a healthy Greek population”. Ann Rheum Dis. 2000; 59(3):206–10.

9. Necati Çakır et al. Prevalence of Raynaud’s phenomenon in healthy Turkish medical students and hospital personnel. Rheumatology International. December 2008, Volume 29, Issue 2, pp 185–188.

10. Harada N., Ueda A., Takegata S. Prevalence of Raynaud's phenomenon in Japanese males and females. J Clin Epidemiol. 1991; 44(7): 649–655.

11. Garner R. et al. “Prevalence, risk factors and associations of primary Raynaud’s phenomenon: systematic review and meta-analysis of observational studies. British Medical Journal. 2015. 5(3).