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. 2000 Nov;59(11):870–874. doi: 10.1136/ard.59.11.870

Digital vascular responses and serum endothelin-1 concentrations in primary and secondary Raynaud's phenomenon

A Smyth 1, A Bell 1, I Bruce 1, S McGrann 1, J Allen 1
PMCID: PMC1753024  PMID: 11053063

Abstract

OBJECTIVE—To determine circulating endothelin-1 levels (ET-1) in patients with primary or secondary associated Raynaud's phenomenon (RP) under resting conditions and in response to cold provocation.
METHODS—Patients were categorised as primary RP (18) or scleroderma associated RP (14). Finger blood flow was measured by venous occlusion plethysmography at finger temperatures of 32°C and 24°C. Vasospasm was detected as a finger systolic pressure of 0 mm Hg after standardised provocative cooling. Severity of vasospasm was assessed by the level of cooling required to provoke spasm. Plasma ET-1 levels were measured in antecubital blood withdrawn under baseline conditions (finger 32°C) and at the point of vasospasm. Measurements were also made in 19 matched control subjects.
RESULTS—Finger blood flow was lower in patients with RP than in controls, with no difference between the two RP groups. Vasospasm occurred in all patients with RP but not in any control subjects and a grading system of severity was established. Baseline plasma ET-1 levels were similar in patients with RP and controls. Increases in ET-1 levels at the point of vasospasm in patients or corresponding timepoint in controls were also similar. There was no significant difference between the ET-1 levels in the two RP subgroups when the fingers were warm or when vasospasm was present.
CONCLUSIONS—These results do not support the hypothesis that ET-1 plays a part in the pathogenesis of RP. Objective testing is a useful adjunct to the clinical diagnosis of RP and allows assignment of a severity grade.



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Figure 1  .

Figure 1  

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Measurement of finger systolic pressure after digital cooling in a control subject. The upper trace shows flux in fingertip skin. The middle trace shows temperature around the middle phalanx of the finger. The bottom trace shows pressure in the cuff surrounding the proximal phalanx. A = proximal cuff inflation to 200 mm Hg with simultaneous middle phalangeal cooling to 15°C abolishes flux; B = after five minutes' cooling, gradual cuff deflation; C = return of flux at cuff pressure of 120 mm Hg. Part of the recording during cooling and occlusion between A and B has been omitted.

Figure 2  .

Figure 2  

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Measurement of finger systolic pressure after digital cooling in a patient with Raynaud's phenomenon. The upper trace shows flux in fingertip skin. The middle trace shows temperature around the middle phalanx of the finger. The bottom trace shows pressure in the cuff surrounding the proximal phalanx. A = proximal cuff inflation to 200 mm Hg with simultaneous middle phalangeal cooling to 15°C abolishes flux; B = after five minutes' cooling, gradual cuff deflation; C = no return of flux when cuff pressure is 0 mm Hg, rewarming started; D = return of flux after digital rewarming. Part of the recording during cooling and occlusion between A and B has been omitted.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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