Z.R. BAGAUTDINOVA¹, I.R. GAYSIN¹, L.V. IVANOVA^1,2, A.A. TRUKHINA¹, N.I. MAKSIMOV², I.V. SABELNIKOVA¹, O.V. SURNINA^1,2, A.A. TUKMACHEVA¹

¹Clinical Diagnostic Centre of the Ministry of Healthcare of Udmurt Republic, 87 Lenin Str., Izhevsk, Russian Federation, 426009²Izhevsk State Medical Academy, 281 Kommunarov Str., Izhevsk, Russian Federation, 426034

 Bagautdinova Z.R. ― rheumatologist of the specialized polyclinic, e-mail: zukhra.bagautdinova@yandex.ru, ORCID ID: 0000-0003-1683-4512

Gaysin I.R. ― D. Sc. (medicine), Professor of the Department of Hospital Therapy with courses in Cardiology and Functional Diagnostics, tel. (3412) 68-04-56, e-mail: igaisin@mail.ru, ORCID ID: 0000-0002-3920-8234

Ivanova L.V. ― Head of the Rheumatology Department, tel. (3412) 68-39-05, e-mail: loraivanova7@rambler.ru, ORCID ID: 0-8138-2015

Trukhina A.A. ― rheumatologist of the Rheumatology Department, tel. (3412) 68-39-05, e-mail: trukhina.49@bk.ru, ORCID ID: 0000-0002-3439-7128

Maksimov N.I. ― D. Sc. (medicine), Professor, Head of the Department of Hospital Therapy with courses in Cardiology and Functional Diagnostics, tel. (3412) 68-53-65, e-mail: maxni@list.ru

Sabelnikova I.V. ― rheumatologist of the specialized polyclinic, tel. (3412) 68-28-96, e-mail: nicksno@rambler.ru, ORCID ID: 0000-0003-4268-356Х

Surnina O.V. ― PhD (medicine), Head of the Department of Ultrasound Diagnostics, tel. (3412) 68-38-36, e-mail: uzd-ur@mail.ru, ORCID ID: 0000-0002-9538-1808

Tukmacheva A.A. ― rheumatologist of the Rheumatology Department, tel. (3412) 68-39-05, e-mail: tukmacheva.aniuta@yandex.ru, ORCID ID: 0000-0002-9508-1936

Objective ― to evaluate the frequency of Raynaud’s phenomenon (RP) in rheumatic diseases (RD), to analyze the clinical picture of RS in patients with RP and evaluate the effectiveness of prostanoid therapy.

Material and methods. A survey of 100 RD patients (83 women) was conducted, using the following questions: 1. Does the unusual sensitivity of fingers to cold occur? 2. Do fingers change color under the influence of cold? 3. Do they turn white and/or cyanotic? The results allowed distinguishing two groups ― 58 RS patients with RP and 42 patients without RP. 35 RP patients were treated with prostanoids. This group of patients underwent examination of clinical-instrumental and biochemical parameters (LDH, creatine phosphokinase, CRP, biomarkers ― interleukins 1, 4, 6, 8, TNF-α, γ-IF, complement (C3, C4), interview HAQ-DI, capillaroscopy).

Results and discussion. Unusual sensitivity of fingers to cold was observed in 56 patients (96.5%) out of 58 with the RP. Two- and single-phase color changes were marked in 81% of patients with RP, three-phase changes were in 19%. RP was subjectively accompanied by pain and numbness in more than 50% of cases. More than two thirds of RP patients treated with prostanoids had systemic sclerodermia (SSc). On average, the debut of RP was 1.4 years later than the beginning of RD. Capillaroscopy identified nailfold changes typical for secondary RP in RD. The levels of proinflammatory cytokines (IL-8) and acute phase proteins (CRP) were associated with RD activity in the group which received iloprost therapy and in the combined therapy group. Alprostadil and iloprost were effective in the treatment of RP complicated by digital ulcers.

Conclusion. The incidence of secondary RP in autoimmune rheumatic diseases is varied. In 50% of cases RP is associated with systemic scleroderma, in 12% ― with systemic lupus erythematosus. More than 50% of the RD respondents suffer from RP, which is accompanied with changes in color in all cases, and subjective pain and numbness in the fingers. Therapy with prostanoids of RP patients with digital ulcers is effective and appears to be promising in preventing the formation of new ulcers.

Key words: Raynaud’s phenomenon, rheumatic diseases, clinical epidemiology, prostanoids.

(For citation: Bagautdinova Z.R., Gaysin I.R., Ivanova L.V., Trukhina A.A., Maksimov N.I., Sabelnikova I.V., Surnina O.V., Tukmacheva A.A. Practical Medicine. 2018)

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