Relevance of low titers of cryoglobulins and cold-agglutinins in patients with isolated Raynaud phenomenon

Introduction: A Raynaud phenomenon can be associated with cold agglutinins or cryoglobulins. Although cold agglutinins or cryoglobulins may lead to se vere acral gangrene the finding of relevant titers is rare. Low titers of c old agglutinins or cryoglobulins are detected more frequently but are assum ed to be without any importance. Objectives: To prove a possible diagnostic or prognostic role of low titers of cold agglutinins or cryoglobulins in patients presenting an isolated Ra ynaud phenomenon we did a retrospective analysis. Settings and subjects: In 306 patients (40 +/- 16 years, range: 15-83 years ) with a mean duration of the history of an isolated Raynaud phenomenon of 48 +/- 73 months we did a clinical examination, an analysis of antinuclear antibodies, extractable antibodies, cold agglutinins, cryoglobulins, plasma and blood viscosity, erythrocyte aggregation and a nail fold capillaroscop y. Results: Low titers of cold agglutinins were found in 49 patients and of cr yoglobulins in 7 patients. The finding of such low titers was not associate d with extensive clinical symptoms, duration of clinical symptoms, megacapi llaries or haemorrhagies in capillaroscopy, pathologic plasma and blood vis cosity and erythrocyte aggregation. The follow-up investigations (mean: 3.1 +/-1.2 years, range: 3-7 years) revealed no development of a haematologica l, vasculitic or connective tissue disease in the subgroup of patients who only had low titers of cold agglutinins. Conclusion: The detection of low titers of cold agglutinins in patients wit h isolated Raynaud phenomenon is of no diagnostic or prognostic relevance.