engleski

Application of computerized color telethermography in 225 children and adolescents with Raynaud's phenomenon

Introduction: Computerized color telethermography (CCTT) is an established diagnostic procedure in clinical practice that is used for assessment and follow-up of patients with microcirculatory disorders in adult population, such as Raynaud's phenomenon (RP). However, CCTT is still not validated in pediatric patients with RP. Objectives: To analyze the CCTT findings in children and adolescents with clinically suspicious RP and its relationship with age, gender and season as well as with biochemical and immunological laboratory findings. Methods: Retrospective study included pediatric patients with suspected RP who underwented CCTT diagnostic procedure at the University Hospital Centre Zagreb from 2010 to 2019. Laboratory findings included inflammatory parameters, complete blood count, renal function tests and immunological tests (ANA, ENA screen, ANCA, RF, antiphospholipid antibodies, serum IgG and complement levels). Differences between categorical variables were examined using Chi- Square test and among numerical using t-test, followed by logistical regression analysis. Results: Out of 225 patients with suspected RP, 176 were females (78.2%) and 49 were males (21.7%) giving a female to male ratio bigger than 3:1. In 44 patients (19, 6%) CCTT was compatible with the diagnosis of primary RP, 68 patients (30, 2%) were classified as secondary RP, whereas 27 patients (12%) had CCTT results which where considered unspecific. In 86 patients (38, 2%) CCTT findings were normal. Among the patients classificated as secondary RP using CCTT, the most of them, 28 (41.2%), were diagnosed with juvenile idiopathic arthritis, while 26 (38.2%) had no evident other disease. The median (range) age at the time of performing CCTT was 15.16 (13.50-16.75) years. According to their age, patients were divided into 3 groups: childhood (3-10 years), early adolescence (11-14 years) and late adolescence (15-18 years). The most of them were in late adolescence group (53, 8%) and these patients were 2.4 times more likely to be diagnosed with primary RP (OR 0.41, CI 0.18-0.92, p=0.03 for early adolescence group). Seasonal influence was a statistically significant factor in CCTT confirmation of the primary RP, since the largest number of patients with primary RP were diagnosed during the winter. If CCTT was performed in the winter, there was 7.25 times higher chance to confirm the primary RP with CCTT compared to the spring time (OR 7.25, CI 2.25-23.25, p=0.03). However, such influence was not observed for secondary RP. Patients diagnosed as secondary RP on CCTT had statistically significantly lower leukocyte (p=0.03) and platelet count (p=0.04), as well as C3 levels (p=0.008), but higher creatinine levels (p=0.008) in comparison with patients with normal CCTT findings. Concerning the immunological findings, it was shown that females, regardless of age, with positive ENA screen had 4 times higher risk to be diagnosed with secondary RP (OR 0.25, CI 0.06-0.95, p=0.04 for females with negative ENA). Conclusion: Patients with secondary RP in whom the underlying systemic disease had not yet manifested had the greatest benefit from CCTT. In these patients, no other diagnostic method can replace CCTT. In patients with suspected primary RP, it is best to perform CCTT in the winter months. We observed that female adolescents were referred to CCTT more often and that regardless of age females with positive ENA screen were more likely to be diagnosed as secondary RP on CCTT.

Raynaud's phenomenon ; thermography ; children ; adolescents

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