Primary versus systemic-sclerosis-associated Raynaud's phenomenon: relationship with clinical and environmental factors

Objectives: Raynaud's phenomenon (RP) can be induced by stress and environmental factors, occurring as a primary disease (pRP) or associated with connective tissue disease. RP is seen in more than 95% of patients with systemic sclerosis (SSc) and may precede its diagnosis by several years. Accordingly, there is a clear need to identify those patients with RP who will eventually develop connective tissue disease, including SSc. The aim of this case-control study was to assess the association of SSc-RP versus pRP with respect to environmental factors, lifestyle habits, and clinical setting. Methods: A questionnaire was used to collect current data from 180 patients with SSc-RP and 103 with pRP. Statistical analyses were performed to identify possible risk factors for SSc-RP. Results: SSc-RP was found to be inversely associated with living in urban area (OR=0.37; p<0.001), computer use (OR=0.38, p<0.001), contraceptive use (OR=0.32; p=0.017), habitual alcohol use (OR=0.35; p=0.029), and hepatitis B virus vaccine (OR=0.09; p=0.011),while it was directly associated to cold sensitivity (OR=3.48; p=0.001), lower quality of life (OR=2.69; p<0.001), finger pain (OR=3.03; p<0.001) and autoimmune hypothyroidism (OR=3.62; p=0.007). All associations were supported by either multivariate and/or multivariable analyses. Conclusions: This study revealed differences in lifestyle and preventive health behaviours between SSc-RP and pRP, and also suggests that patients with pRP and autoimmune hypothyroidism should be strictly monitored for any clinical changes that may indicate SSc onset. Further investigations are needed to prospectively evaluate autoimmune hypothyroidism as a predisposing condition for SSc-RP.