Typically, Raynaud’s Disease is diagnosed as a result of seeking medical advice or care after several episodes or flare-ups of the disease. However, in a recent case highlighted in The Journal of Emergency Medicine a patient was diagnosed with secondary Raynaud’s phenomenon in conjunction with systemic lupus erythematosus after a visit to the emergency room. A 41-year-old Chinese woman came to the emergency room after a minor trauma complaining of discoloration and pain in her right index finger. She’d been experiencing the symptoms for approximately two months which started after inadvertently catching her hand in a metal cupboard at work. About a month after the injury, she sought treatment from a hand specialist who diagnosed her with transient nerve injury (neuropraxia) secondary to contusion. Despite seeking treatment and a diagnosis, her symptoms persisted.
She came to the emergency room a month after her initial treatment with the hand specialist due to persistent symptoms. The doctors there noted discoloration over several fingertips on both her hands, and hyperpigmented, scaly-plaques on her forehead, which are signs suggestive of an underlying systemic disease. After some testing, the patient was diagnosed with systemic lupus erythematosus – an autoimmune disease. The initial testing did not produce the appropriate result for her Raynaud’s case to be considered primary. Typically, patients with primary Raynaud’s undergo vascular studies, including capillaroscopy and photoplethysmography, which frequently show abnormal results in cases of occupational-related or primary Raynaud’s phenomenon. As this patient’s results were normal, she was diagnosed with secondary Raynaud’s as a result of an accompanying autoimmune disorder.
Although no one is exactly sure why Raynaud’s phenomenon accompanies autoimmune disorders, doctors do know that there are a few that typically result in it: rheumatoid arthritis, scleroderma, and also lupus.
The team that wrote the journal article noted, “This case illustrates a common presenting complaint to the ED [emergency department] with an unexpected final diagnosis. The symptoms could have been easily attributed to chronic pain from the initial trauma and repetitive stress and treated with analgesia. However, the presence of discoloration over the affected finger as well as the uninjured fingers should prompt the emergency physician to look for other causes.”
Getting the appropriate diagnosis and care for Raynaud’s is crucial to treatment. If left untreated or unmonitored, Raynaud’s can lead to ulcerations of the fingers and eventually necrosis and gangrene. Ensuring you’re visiting the right physicians and making them aware of your entire history is key.
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