DIAGNOSTIC INTEREST OF DIGITAL TOPOGRAPHI C ASSESSMENT OF RAYNAUDS-PHENOMENON - A PROSPECTIVE-STUDY OF 552 PATIENTS

From a prospective study of 552 Raynaud's phenomena, the authors have analyzed the relationships between digital topography of the attacks, etiologic diagnosis and type of hand vascularization. Five topographic subsets were differentiated: median (one of the three median fingers) , ulnar (the 2 or 3 last fingers), radial (the 2 or 3 first fingers), all fingers excluding thumb, all fingers including thumb. The respecti ve role of radial and ulnar arteries in hand vascularization was asses sed by Allen's test. It has been found 33 % Raynaud's phenomena with i nvolvement of all fingers excluding thumb, 31 % with median topography , 29 % with involvement of all fingers including thumb and 7 % with ul nar or radial topography. Unilaterality (9 % Raynaud's phenomena) pref erentially points out a syndrome with neurological origin essentially (ulnar or carpal tunnels and thoracic outlet syndromes). Factorial Ana lysis of Correspondences has been used to study the topographic repart ition of the attacks according to etiology: homogeneous involvement of an fingers including severe involvement of thumb has to evoke the dia gnosis of scleroderma, whereas involvement of the median fingers, of a ll fingers excluding thumb or with a mild involvement of thumb is stil l consistent with primary Raynaud's disease. Strictly lateral topograp hy (ulnar, radial) suggests the diagnosis of Raynaud's syndrome of neu rological cause essentially. It has not been found any correlation bet ween digital topography of Raynaud's phenomenon and type of hand vascu larization; this can probably be explained by the clear preponderance of neurological etiologies as compared to vascular ones. In conclusion , this study confirms the interest of clinical analysis of the digital topography of Raynaud's phenomenon; it permits to significantly guide etiologic diagnosis and minimizes the role of hand vascularization ch anges in the expression of this acrosyndrome.