LETTER
The Raynaud Phenomenon and Interferon Therapy
Andreas Creutzig, MD;
Ludwig Caspary, MD; and
Mathias Freund, MD
1 September 1996 | Volume 125 Issue 5 | Page 423
TO THE EDITOR:
Interferon-
has been shown to prolong survival in patients with chronic myelogenous leukemia [1]. Long-term use of interferon- has been linked to side effects related to autoimmune disease [2].
We evaluated 9 women and 16 men (median age, 48 years; range, 24 to 74 years) with chronic-phase Ph1-positive myelogenous leukemia for episodes of the Raynaud phenomenon. Recombinant interferon- 2b was administered for a median of 39 months (range, 10 to 73 months) at a median dosage of 30 million U/wk (range, 7 to 56 million U/wk).
During interferon therapy, 13 patients (52%) reported symptoms typical of the Raynaud phenomenon that started a median of 18 months (range, 1 to 60 months) after initiation of therapy. In 8 patients, both hands were involved; in 5 patients, both hands and feet were involved. Trophic acral lesions were found in 2 patients. Nailfold capillary microscopy showed abnormal findings (tortuous capillaries with a bushy appearance, giant capillaries, and microhemorrhages) in 8 patients (32%). A standardized cold exposure [3] resulted in blood cell stasis in all visible capillaries in 14 of 19 patients (74%), a feature that is only rarely observed in healthy persons. Flow stop duration was 65.6 seconds, a value within the range seen in patients with the Raynaud phenomenon caused by scleroderma. Antinuclear antibodies were found in 14 patients (range, 1:40 to 1:160). In two cases, anti-ENA-CENP-B antibodies were present. No patients had cryoglobulin or antineutrophil cytoplasmic antibodies. Rheumatoid factor was found in four patients and cardiolipine antibodies, in five.
Transient blurred vision, severe headache, and worsening of the Raynaud phenomenon occurring shortly after interferon administration suggested the induction of vasospasm [4]. Retinal vasospasms leading to occlusion of the retinal capillaries have been observed in patients receiving interferon- [5]. Vasculopathic complications related to interferon- deserve further evaluation and definition.
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Author and Article Information
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Medizinische Hochschule, 30623 Hannover, Germany
1. Allan NC, Richards SM, Shepherd PC. UK Medical Research Council randomised, multicentre trial of interferon- for chronic myeloid leukemia: improved survival irrespective of cytogenetic response. Lancet. 1995; 345:1392-7.
2. Wandl UB, Nagel-Hiemke M, Kreuzfelder E, Kloke O, Kranzhoff M, Seeber S, et al. Lupus-like autoimmune disease induced by interferon therapy for myeloproliferative disorders. Clin Immunol Immunopathol. 1992; 65:70-4.
3. Mahler F, Saner H, Boss C, Annaheim M. Local cold exposure test for capillaroscopic examination of patients with Raynaud's syndrome. Microvasc Res. 1987; 33:422-7.
4. Ene L, Gehenot M, Horsmans Y, Detry-Morel M, Geubel AP. Transient blurred vision after interferon for chronic hepatitis C. Lancet. 1994; 344:827-8.
5. Guyer DR, Tiedeman J, Yannuzzi L, Slakter JS, Parke D, Kelley J, et al. Interferon-associated retinopathy. Arch Ophthalmol. 1993; 111:350-6.
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