instruction: hello doctor my wife has arthritis and has become very weak over the last few months now she has a condition that is more or less like raynaud phenomenon her fingers are turning pale violet and one of the fingers had gangrene like occurrence not only hands but even the toes are experiencing the same please help
output: hello you are right in saying that she has the symptoms of raynaud with digital gangrene which is on going with arthritis there are 50 variants of it and it is very important to distinguish which one she has it as the management will differ for every arthritis I would like to ask a few more queries any history of oral ulcers hairfall any history of fever which joints are affected swelling in the joints any deformity any changes in skin color or skin becoming tightened any history of dry eyes or dry mouth any muscle weakness which you have observed with the start of raynaud it seems like a systemic involvement more something like lupus but we need to rule it out kindly let me know these queries and I am advising a few tests if they have been done please attach the reports as well abc complete blood count ear erythrocyte sedimentation rate cop reactive protein rheumatoid factor anti cop antibody a na by immunofloroscence serum creatinine urine routine connective tissue disease