Although Raynaud’s phenomenon affects almost one in every 20 adolescent girls, many
pediatricians will never actually see the pathology. This rheumatic-associated disorder is
hallmarked by dramatic digit color changes that, unfortunately, don’t appear on command in
examining rooms.
Numbness and Tri-phased Color Change in Fingers
Most frequently triggered by cold conditions, Raynaud’s
phenomenon causes blood vessels to constrict. Digits
undergo a three-staged color change “that starts with
white fingers that next turn blue, then red on rewarming,”
says Norman Ilowite, MD, chief, Pediatric
Rheumatology, The Children’s Hospital at Montefiore
(CHAM). Patients’ feet, ears, nose and lips may also
chill and become painful and numb.
Identifying At-risk Patients
The disorder is strongly associated with several
rheumatologic diseases – 95 percent of all scleroderma
patients experience Raynaud’s phenomenon, as do
85 percent of all patients with mixed connective tissue
disease.
“The question,” says Dr. Ilowite, “is how to pick the
patients who are going to have secondary Raynaud’s
phenomenon,” with underlying disease, “from the
patients who have primary Raynaud’s.”
Patients who persistently complain of cold, blanched
or blue hands should be carefully evaluated. “Most
important,” says Dr. Ilowite, “is examination of the
nail bed capillaries.” Red striations in this area suggest
nail bed capillary abnormalities – a strong indicator of
secondary disease. Morning stiffness in joints, shortness
of breath and serological presence of ANA also warrant
further investigation.
Nail bed capillaries in a patient with secondary Raynaud’s phenomenon
Pediatric Rheumatologists Provide
Best Diagnostic Reassurance
When secondary Raynaud’s phenomenon is suggested,
patients should be seen by a pediatric rheumatologic
specialist when possible. CHAM is fortunate to have
two pediatric rheumatologists – only 229 of these
sub-specialized experts practice in the U.S. today –
Dr. Ilowite and his colleague, Patricia Irigoyen, MD,
at the helm of its pediatric rheumatologic clinical and
research programs.
Supported by pediatric specialists in all related
disciplines, Drs. Ilowite and Irigoyen expertly manage
the most complex Raynaud’s-related rheumatologic
conditions or – to parents’ enormous relief – rule them
out. Because happily, at the end of the diagnostic day,
“95 percent of kids with primary Raynaud’s disease will
not have secondary Raynaud’s,” says Dr. Ilowite.
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