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The Raynaud Phenomenon and Interferon Therapy
- Andreas Creutzig, MD;
- Ludwig Caspary, MD; and
- Mathias Freund, MD
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TO THE EDITOR:
Interferon-α has been shown to prolong survival in patients with chronic myelogenous leukemia [1]. Long-term use of interferon-α 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-α 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-α [5]. Vasculopathic complications related to interferon-α deserve further evaluation and definition.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
