{
  "abstract": "Introduction Raynaud’s phenomenon (RP) is caused due to transient vasospasm of blood vessels (mainly peripheral arteries of fingers and toes) in response to stimuli like cold temperature which causes typical triphasic colour changes. There is a dearth of studies in literature about paediatric Raynaud’s phenomenon and its treatment modalities that are both effective and safe in children, although effectiveness of calcium channel blockers and glyceryl trinitrate patches has been well established in adults.Through our case report, we wanted to highlight this atypical presentation of this rare entity as it posed a diagnostic challenge and her remarkable symptomatic relief with a calcium channel blocker.Case History A 14-year-old girl presented to us with complaints of intermittent pain in her interphalangeal joints since last six months. She mentioned that she previously had swelling on the proximal interphalangeal joint (PIP) of the left little finger and the PIP joint of her right ring and middle finger which resolved but the pain persisted. There was no history of trauma or morning stiffness and this pain worsened with activity. Her pain worsened over the next 6–8 months and gradually her handwriting and hand grip also deteriorated. No other joints were involved and there were no symptoms like fever, loss of appetite, weight loss, rash, mouth ulcers, myalgia or other systemic symptoms. There was no family history of SLE, JIA, RA, IBD or Psoriasis. On examination, she had pain in proximal interphalangeal joints of the the little finger, ring finger and thumb, more in the right hand than left but there was no obvious joint swelling, redness or deformity. Both her hands were erythematous with a slightly delayed capillary refill time. Systemic examination was unremarkable. She had strong central and peripheral pulses and both hands were warm to touch. There was full range of movement in all joints and there were no findings suggestive of arthritis.Discussion Initially suspecting an element of chilblains, lifestyle modification was offered but there was no improvement in symptoms. She was started on physiotherapy and occupational therapy, and extensively investigated for any connective tissue disorders like juvenile idiopathic arthritis but all routine blood investigations, inflammatory markers and autoimmune panel of antibodies was normal. Radiological investigations like xray of hands, ultrasound of hands followed by MRI was also done which were not suggestive of any active pathology. Orthopaedic opinion was also taken and after around 18 months of symptom onset after ruling out multiple causes, an atypical presentation of Raynaud’s phenomenon was suspected as she first started complaining of these symptoms in the winter months (although she refused any worsening of symptoms in a cold environment) and because she occasionally complained of change of colour of her fingers to pale which returned back to normal when warmed (but she never had the typical triphasic changes in colour of the fingers that is seen in Raynaud’s phenomenon). She was initially tried on topical application of glyceryl trinitrate patches which wasn’t helpful and hence a trial of oral nifedipine was given.She responded extremely well to it and still continues to be in remission needing nifedipine only during winter months occasionally. This case highlights the fact that although medications are rarely used in paediatric Raynaud’s disease, however in children with intractable symptoms this can be beneficial.",
  "authors": [
    {
      "affiliations": [
        "Bedford Hospital NHS Trust"
      ],
      "name": "Pramod Nair"
    },
    {
      "affiliations": [
        "Bedford Hospital NHS Trust"
      ],
      "name": "Nitika Gautam"
    },
    {
      "affiliations": [
        "Bedford Hospital NHS Trust"
      ],
      "name": "Elizabeth Philip"
    }
  ],
  "title": "8283 Calcium channel blockers for Raynaud’s phenomenon presenting with intractable dactylitis",
  "uid": "0fb1e47f-b944-56d5-9154-5444be22a4aa"
}