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How Can Raynaud's Phenomenon Be Treated In 13 Year Old ?

Posted on Mon, 7 May 2012

Question: My son is 13yrs, 46kg, 1.62cm and for the past year has presented with Raynauds phenomenon in his hands.It started last year in XXXXXXX with swollen fingers, dry skin , poor circulation in hands. Took him to many GP's last year, all said chill XXXXXXX keep warm, dont touch cold things etc. Got worse this winter, fingers going purple, white to red - classic Reynauds. Small broken skin at fingertips,skin on hands tight.Sometimes better- we are now in winter so worse. Not painful, just uncomfortable at times, has not affected daily life at all. He presents with no other symptoms, health otherwise is at best, excelling in athletics and academics. He has been on 36mg concerta since last year March-no other significant med hx. Feet not swollen, no rashes, no skin darkening. ECG - normal, lung function- normal, bloods - normal, CXR- normal, hand xray-normal. Rheumatologist concerned it's scleroderma, specific bloods done , all 15 negative eg Scl 70 neg, rheum factor neg, lupus neg, esr -neg, ANA-neg
Paed thinks its echo virus as he has felt glands in neck and says there is a fine rash on body.
As a mum, and being a health care worker [radiographer ]at my wits end and scared for my son, esp re scler. diagnosis, ?systemic in organs etc.Rheum has put him on tetroxin 2x a day, says side effect is loosen connect tissue, will help with swelling and circ in hands, till then dr's still not sure what to do. Whom should i listen to and what should i do.Also do not want to med my son unecessarily as there is talk from rheum re methotrexate etc. I have stopped concerta - vasoconstrictor- would make reynauds worse??
Please help.I am desperate, thank you.

Answered by Dr. Radhika (16 hours later)

Hi,
Thanks for the query.

I would like some more time to research and answer you question.Kindly give us some time.

Thank you for your patience.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Radhika (6 hours later)

Answered by Dr. Radhika (3 minutes later)

Hi,

Thanks for the patience.

I am sorry to know that your son is being diagnosed with Raynaud's Phenomenon.

You must understand that Raynaud's phenomenon can be due to either Raynaud's Disease (No systemic Symptoms) or due to secondary causes.

Although Raynaud's phenomenon has been described with various autoimmune diseases, the most common association is with progressive systemic sclerosis (90% in individuals with scleroderma) and mixed connective-tissue disease (85% prevalence).

Raynaud's phenomenon has also been described with such diverse diseases as Frost bite, Vibration injury, Polyvinyl Chloride Exposure, and Cryoglobulinemia.

Now, as your son is negative for autoimmune workup including scleroderma. Its quite unlikely that your son will be having a systemic disease.

Also, since his illness has started a few months ago, sometimes, it takes about a year or two for the underlying illness to manifest.

So as of now, be reassured.

You do not need to undergo any systemic treatment with toxic medications unless a systemic cause is ascertained.

A course of Vasodilators such as Calcium channel blockers is recommended to counteract Vasospasm.

So, in my opinion, do not go for systemic immunosuppressive medications unless there are any systemic symptoms.

Hope this answers my query. In case of any doubts, I am available for the follow ups.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Radhika (4 hours later)

Should i continue with tertoroxin 20mcg 2x a day as per rheum. He prescibed on 20/7 on his first consult and said take for 2 wks and come back on 3rd Aug to review bloods, so he has prescribed tertroxin [throid prep tabs]. His T3, T4 and TSH normal. Do you think he is being over cautious with scler diagnosis? Can he still have scler. and it is not showing in biochemistry as mentioned in your response , it might take a year for any disease to manifest. Should i stop concerta, could it be making reynauds worse
thanks

Answered by Dr. Radhika (19 hours later)

Hi,

Thanks for the follow up.

I feel that there is no indication for Tertoroxin (T3) in your child as it will not have any major impact. Also, its also not a strong recommendation.

In your child, its more likely to be due to Primary Raynaud's Phenomenon. In my opinion, Scleroderma is quite unlikely at his age. He however, needs a close follow up.

Avoid any further immunosuppressive medications till the clinical picture is clear.

If your child is academically doing well, you can consider stopping Concerta but after discussing with your treating doctor.

Also, Occasional Numbness, Prickling or Tingling of Fingers and Toes - Raynaud's Phenomenon is a side effect of Concerta. So, please discuss about this with your treating doctor.

Hope this answers your query.

Thanks and Regards.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari