Vasodilators underused for Raynaud's phenomenon, early systemic sclerosis in veterans
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Vasodilator therapy may be underused for Raynaud’s phenomenon and very early systemic sclerosis in U.S. veterans deployed in post-9/11 military operations, according to data published in BMC Rheumatology.
The researchers also noted that, among the veteran study population, those in craftworks, engineering, maintenance and health care demonstrated a greater likelihood of having Raynaud’s phenomenon.
“This study looks at Raynaud’s phenomenon and systemic sclerosis in the veteran population, which is predominately male,” Tracy M. Frech, MD, MS, of the University of Utah and Salt Lake Veterans Affairs Medical Center, told Healio Rheumatology. “Raynaud’s phenomenon is most commonly the first presenting symptom of SSc and highlights the value of veteran-based research.”
To analyze the prevalence of Raynaud’s phenomenon, SSc and potential very early SSc among U.S. veterans previously deployed in post-9/11, operations, Frech and colleagues analyzed the medical records of 607,665 individuals who entered VA care between Oct. 1, 2001, and Sept. 30, 2011. Other eligibility criteria included receiving 3 or more years of VA care — either inpatient, outpatient or pharmacy — prior to Sept. 30, 2014, and at least 1 year of care after 2007.
Cases of Raynaud’s phenomenon, very early SSc with swelling of the hands and SSc were determining via the codes ICD-9443.0, ICD-9729.81 and ICD-9710.1, respectively. The researchers used chi-squared tests and Fisher’s exact to compare frequency of these conditions, as well as logistic regression to assess likelihood.
According to the researchers, 857 included veterans demonstrated Raynaud’s phenomenon, while 45 met the possible very early diagnosis of SSc criteria, and 71 had SSc. The majority of these cases — including 70% of those with Raynaud’s phenomenon, 78% of those with possible very early SSc and 47% of the SSc group — were white. They were also predominately male, at 61% of the Raynaud’s phenomenon group, 60% of those with potential very early SSc and 58% of those with SSc.
In all, 48% of patients with Raynaud’s phenomenon, and 47% of those with very early SSc, received vasodilator medication, compared with 63% of patients with SSc. Meanwhile, patients working in craftworks (1.3; 95% CI 1-1.8), engineering or maintenance (1.8; 95% CI, 1.1-2.9) and health care (1.5; 95% CI, 1.2-3) demonstrated a greater likelihood of Raynaud’s phenomenon, compared with those with no conditions. The most common comorbidity among the included population was pain — which was highest in those with potential very early SSc, at 81.6% — followed by depression in all groups.
“This article highlights that that craftworkers, engineering and maintenance, and health care workers were more likely to have Raynaud’s phenomenon,” Frech said. “There was a potential underutilization of vasodilators to treat Raynaud’s phenomenon. Lastly, a comorbidity of pain and depression was present in these patients. This study emphasizes the value of studying Veterans with Raynaud’s phenomenon to improve outcomes.”
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