Background/Purpose: The Raynaud’s condition score (RCS) diary is recommended for use in clinical trials of Raynaud’s phenomenon (RP) and systemic sclerosis (SSc). We report the findings of a cross-sectional study exploring determinants of the RCS diary in patients with primary RP and SSc. We report associations between the RCS diary and objective assessment of digital vascular function using infrared thermography (IRT) and laser speckle contrast imaging (LSCI).

Methods: Patients with primary RP and SSc were recruited between December 2010 and February 2012. All patients underwent a standardized local cold challenge (15°C for 60s) with simultaneous assessment of digital vascular perfusion using IRT and LSCI. Patients with SSc completed a Scleroderma Health Assessment Questionnaire (SHAQ) and had disease characteristics documented. Baseline demographics and medication usage were recorded for all subjects. Patients received training on the completion of a 2-week RCS diary enabling calculation of the mean daily frequency, duration and impact (10-point RCS score) of RP attacks.

Results: Twenty-five patients with SSc and 18 patients with primary RP took part. Four (9.3%) patients failed to adequately complete the RCS diary. A similar number of patients were recruited between October-March (n=21) compared with April-September and the distribution of primary RP vs. SSc was similar in each group. There was a high correlation between individual components of the RCS diary (Spearman’s Rho 0.62-0.78, p<0.001 for all comparisons). The RCS score was higher in patients taking vasodilator therapy (median 2.14 vs. 1.57, p=0.058). There was moderate correlation between the RCS and the HAQ-Disability Index (Rho 0.51, p=0.013). There was moderate to high correlation between components of the RCS diary and the SHAQ RP Visual Analogue Scale (VAS, Rho 0.54-0.83, p<0.05). There were no associations between RCS diary endpoints and a history of digital ulceration (DU) or the SHAQ DU VAS (Rho 0.26-0.46) in patients with SSc. The daily frequency of RP attacks was significantly higher in females (median 1.93 vs. 0.82, p=0.031). The RCS score was significantly higher in October-March compared with April-September (median 2.29 vs.1.57, p=0.024). There were moderate to high correlations between IRT and LSCI (Spearman’s Rho 0.577-0.837, p<0.01 for all comparisons). There was no correlation between individual components of the RCS diary and objective non-invasive microvascular imaging, using either IRT or LSCI. Perfusion of the digits was significantly lower in females for all IRT assessments and the majority of assessments using LSCI. Temperature of the palmer aspect of the digits was higher during April-September (p<0.05). LSCI and IRT assessment of perfusion at other regions of the fingers was not influenced by season.

Conclusion: Subjective and objective assessment tools provide differing information on digital vascular function and impact of disease in RP and SSc. This is the first study to demonstrate the influence of gender and seasonal variation on both patient self-report and objective non-invasive microvascular imaging assessment of RP. These findings must be considered when using such tools as outcome measures in clinical trials of RP and SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/investigating-determinants-of-subjective-and-objective-assessments-of-peripheral-vascular-function-in-primary-raynauds-phenomenon-and-systemic-sclerosis/