My wife has Raynaud's with pale violet and gangrene fingers. Please help.

Question

Hello doctor,

My wife has arthritis and has become very weak over the last few months. Now she has a condition that is more or less like Raynaud's phenomenon. Her fingers are turning pale violet and one of the fingers had gangrene-like occurrences. Not only the hands but even the toes are experiencing the same. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

You are right in saying that she has the symptoms of Raynaud's with digital gangrene which is on going. Arthritis, there are 50 variants of it and it is very important to distinguish which one she has as the management will differ for every arthritis. I would like to ask a few more queries: Is there any history of oral ulcers? Hairfall? Any history of fever? Which joints are affected? Is there swelling in the joints? Is there any deformity? Are there any changes in skin color or skin becoming tightened? Is there any history of dry eyes or dry mouth? Is there any muscle weakness that you have observed? With the start of Raynaud's, it seems like a systemic involvement more, something like lupus, but we need to rule it out. Kindly let me know these queries and I am advising a few tests. If they have been done, please attach the reports as well.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I suggest we get these tests done and sort out which type of arthritis she has. Meanwhile, you can start her on tablet Nifedipine 10 mg twice daily for the Raynauds as it will help the healing of the tissue as well.

Answer 3

Hello,

Welcome back to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity). The only report I found was ANA (antinuclear antibody) which is positive at 1: 80 and rheumatoid factor too. But since you mentioned there are no visible swelling in the joints and there is more of Raynauds, the diagnosis would be more in favor of undifferentiated connective tissue disease. Although, limitations remain to give a complete diagnosis without clinical examination, but we are fine to start her with milder medications to prevent the disease from progressing.

Diagnosis: Undifferentiated connective tissue disease.

Medications:

1. Tablet Hydroxychloroquine 200 mg twice daily.

2. Tablet Nicardia R (Nifidipine) 10 mg twice daily (for Raynauds).

3. Capsule Uprise D3 60 K once a week for eight weeks and then once a month to continue.