Cold hands associated with scleroderma: an early presentatio
The present case has been published in NEJM.

A 45-year-old woman presented with cold hands. These symptoms had developed over a period of 6 years. Raynaud's phenomenon was seen after her hands were exposed to cold.

The antinuclear antibody titer was greater than 1:1280, with an anticentromere antibody pattern. This pattern may be present in 40 to 80% of patients with limited scleroderma, and secondary Raynaud's phenomenon may be seen in 80 to 90% of such patients.

In 30% of patients with secondary Raynaud's phenomenon, it may be an early presentation of scleroderma. The patient's blood pressure was 135/95 mm Hg at presentation, and she had no other symptoms except skin thickening.

Treatment with a calcium-channel blocker was initiated. Laboratory testing during follow-up showed mild lymphopenia (1540 lymphocytes per cubic millimeter) and a creatinine level of 0.70 mg per deciliter (60 μmol per liter); the blood pressure was 120/70 mm Hg. The patient wears gloves to protect her hands in cold weather.

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