Prevalence of Raynaud's Phenomenon Among Rheumatology Patients in Khartoum State, Sudan: A Study from January to April 2023"

Malaz Alamin¹, Mohammad Osman², Ziryab Taha³, Marwa Alamin⁴, Marwa Osman⁵, Sharif Ahmed⁶

Abstract

 Introduction: Raynaud's phenomenon is   characterized by episodic digital vasospasm, often triggered by cold or stress, causing pallor, cyanosis, and/or erythema in extremities. It may present as a primary condition or secondary to disorders such as connective tissue diseases or medication effects.

Purpose: This study aimed to determine the frequency of Raynaud's phenomenon among patients attending rheumatology clinics in Khartoum State, Sudan, from January to April 2023.

Methods A descriptive cross-sectional study was conducted in three rheumatology clinics, including 182 patients who met the inclusion criteria. Data were collected through a structured questionnaire and analyzed using SPSS version 23.

Results The frequency of Raynaud's phenomenon was 25.8%. Most participants were aged 42–60 years (52%). Only 4.3% of patients received treatment, primarily calcium channel blockers and sildenafil, and 7.7% were aware of the condition. Male gender (AOR: 9.167, 95% CI: 2.109–39.838, p=0.003) and awareness (AOR: 4.158, 95% CI: 1.284–13.46, p=0.017) were significant predictors.

Conclusion The study reveals a high frequency of Raynaud's phenomenon among rheumatology patients in Khartoum State, with low awareness and treatment rates. Increased awareness and improved management strategies are urgently needed.

Keywords:  Raynaud's phenomenon, rheumatology, frequency, Khartoum, Sudan



Report 

Introduction: Raynaud’s phenomenon (RP) is a vasospastic disorder affecting peripheral circulation, particularly in response to cold or emotional stress, leading to color changes (pallor, cyanosis, erythema) in extremities. It can be classified as primary or secondary, often associated with connective tissue disorders. Objective: This study aimed to determine the prevalence, awareness, and management patterns of RP among patients attending rheumatology clinics in Khartoum State, Sudan. Methods: A descriptive cross-sectional study was conducted in three rheumatology clinics between January and April 2023, including 182 patients. Data were collected via structured questionnaires and analyzed using SPSS version 23. Results: The prevalence of RP was 25.8%. Most affected individuals were aged 42–60 years (52%), with a predominant female population (95%). Awareness of RP was low (7.7%), and only 4.3% received treatment. Male gender (AOR = 9.167, p=0.003) and awareness (AOR = 4.158, p=0.017) were significant predictors. Conclusion: The study highlights a substantial burden of RP among rheumatology patients in Sudan, compounded by poor awareness and low treatment rates. Improved health education and early diagnostic approaches are essential.

Keywords: Raynaud’s phenomenon, rheumatology, prevalence, Sudan, awareness, treatment

1. Introduction Raynaud’s phenomenon is a peripheral vascular disorder characterized by episodic vasospasm in the digits, typically triggered by cold or emotional stress. Symptoms progress from pallor to cyanosis and then erythema. RP may occur independently (primary) or secondary to autoimmune or connective tissue diseases. Global prevalence varies between 3–20%, but rises to 90% in patients with systemic sclerosis. In Africa, access to rheumatologic care remains limited, making timely diagnosis and management challenging. This study investigates the prevalence and characteristics of RP in rheumatology patients in Khartoum State, Sudan.

2. Literature Review Studies from different regions report varying prevalence rates of RP. A study in Saudi Arabia estimated a 15.1% prevalence in the general population. Similar findings were noted in Japan (14.1%) and Europe (12.6%). Up to 90% of systemic sclerosis patients reportedly experience RP, while prevalence is also high among patients with SLE and other autoimmune disorders. African studies underscore the barriers in accessing rheumatologic services due to cost, distance, and lack of awareness, all of which adversely affect disease management.

3. Methodology A descriptive cross-sectional design was employed. The study included 182 patients attending three rheumatology clinics in Khartoum State from January to April 2023. Participants were selected based on inclusion criteria and provided informed consent. Data were collected using structured questionnaires and analyzed via SPSS version 23. Logistic regression was used to identify predictors of RP.

4. Results Demographics:

• Age: 52% aged 42–60 years, 31% aged 26–40 years.

• Gender: 95% female, 5% male.

• Occupation: 73% housewives, 18.1% employed.

Clinical Characteristics:

• Most common rheumatologic disorder: SLE (22%), followed by Sjögren’s syndrome (4.4%) and scleroderma (3.3%).

• RP awareness: 7.7% of participants.

• Family history of RP: 1.1%.

• Long-term medications: Beta-blockers (3.8%), chemotherapy (0.5%), hormonal therapy (0.5%).

Prevalence and Symptoms of RP:

• RP prevalence: 25.8%.

• Common symptoms: Triphasic color change (white-blue-red) in fingers/toes, both hands involved.

• Duration of symptoms: 87.2% ≤ 5 years, 12.8% > 5 years.

• Complications: 21.3% had ulcers or gangrene.

Healthcare Interaction:

• Physician consultation: Only 14.9% sought medical care.

• Treatment rate: 4.3% treated with either calcium channel blockers or sildenafil.

• Treatment outcome: 100% of treated participants reported improvement.

Statistical Predictors:

• Male gender (AOR = 9.167, p = 0.003)

• RP awareness (AOR = 4.158, p = 0.017)

• Other factors (age, family history, medication use) were not significant.

5. Discussion The prevalence of RP in this study (25.8%) aligns with trends in patients with autoimmune rheumatic diseases. Low treatment rates and awareness reflect broader systemic challenges. The male gender emerged as a significant predictor, diverging from global findings where RP is more common among females. Treatment using calcium channel blockers and sildenafil was effective, supporting current therapeutic guidelines. However, the overall low engagement in healthcare for RP underlines the urgent need for community awareness campaigns and improved rheumatology services in Sudan.

6. Conclusion Raynaud’s phenomenon is prevalent among rheumatology patients in Khartoum State but is underdiagnosed and undertreated. Efforts must focus on enhancing awareness, improving diagnostic capabilities, and increasing access to appropriate treatment to reduce complications such as ulcers and gangrene.

7. Recommendations

• Launch public health education programs on RP.

• Train rheumatologists and general practitioners to recognize early symptoms.

• Expand access to medications like calcium channel blockers and sildenafil.

• Conduct longitudinal and multi-regional studies for broader epidemiological insight.

8. References [References formatted in Vancouver style - already listed in detail previously in the source document.]