Royal National Hospital for Rheumatic Diseases in Bath
Transcription
Royal National Hospital for Rheumatic Diseases in Bath
Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 2 hot news Issue No. 107 Royal National Hospital for Rheumatic Diseases in Bath Volume 1 2009 In this issue... The Lungs and Scleroderma Page 5 Pictured above back row standing from left to right: Dr Zoe Betteridge, Post Doctoral Research Fellow, Dr John Pauling, Specialist Registrar in Rheumatology, Sister Sue Brown, Clinical Nurse Specialist in Connective Tissue Diseases and Professor Neil McHugh, Consultant Rheumatologist. Front row seated from left to right: Dr Harsha Writing Competition Winner Gunawardena, Honorary Consultant Rheumatologist, Dr Jay Sunrathalingham, Consultant Pulmonary Physician Page 8 RUH and Dr Chris Lovell, Consultant Dermatologist RUH. The Royal National Hospital for Rheumatic Diseases in Bath (RNHRD) has been supporting patients with Raynaud's and scleroderma in the Connective Tissue Disease (CTD) service for many years. Led by Professor Neil McHugh, Dr Ellie Korendowych and Sister Sue Brown, we provide not only a clinical and educational service, but also a comprehensive research programme that includes acting as a European centre for autoantibody testing, undertaking collaborative genetic studies in scleroderma and participating in multicentre trials of new forms of treatment. Sister Sue Brown has been a leading figure in support for patients, and works closely with national colleagues and the RSA. Sue has been very generously financially supported by the RSA over the last 9 years. Continued on page 4 My hands turned white Page 9 BBC Breakfast TV Raises Awareness On 5th January, Dr Rosemary Leonard showed some of the heating aids and garments available from the RSA and helped to raise awareness of Raynaud’s on BBC Breakfast TV programme. This publicity resulted in the Association receiving literally hundreds of enquiries from interested viewers, many of whom have since become members. Fundraising Page 10 Raynaud’s Awareness Month - February 2009 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 3 Welcome Dear Readers, Welcome to the 1st edition of Hot News 2009. What a cold start to the New Year. I am sure all our members were affected by the severe cold weather. It is probably the only time of year when other people can understand what we go through on a regular basis. Make sure you stock up on heating aids as there is still a long way to go before we put away our winter woolies and look forward to some warmer weather! Anne H Mawdsley MBE Another milestone reached RSA Meeting I am delighted to tell you that by the end of December, the total raised by the RSA in 26 years had reached over 10 million pounds. The majority of this money has been used to fund research into Raynaud’s and scleroderma in addition to welfare projects. Well done and thank you to everyone who has been instrumental in supporting us over this time. It shows that every little helps and no matter how large or small a donation, it all adds up. A meeting chaired by Professor Dame Carol Black was held in London in December. The aim of the meeting was to bring together all the expert clinicians and scientists who the RSA have been funding over the years and to discuss where we are today and what the priorities are for the future. This meeting was well attended and gave the trustees information which will be most helpful when considering grant applications in the future. Credit crunch Thanks to everyone who has been collecting loose change in their Percy boxes. This has amounted to the grand sum of £25,700. We have recently ordered a new batch of Percy boxes so if yours has worn out just let us know and we will send you a new one. Keep collecting! This is the most talked about topic at the moment. I think all charities are going to feel the effects of today’s economic climate. All we can do is find different ways of raising money. It is all too easy to sit back and say we are having a bad time but the only way forward is to think positive and and keep trying. We are very aware that many of our members will be having difficulty with high heating bills this winter and hope that some of our reasonably priced heating aids will be of help. Don’t forget the cheapest handwarmer - a jacket potato put in the microwave for a few minutes, then wrapped in tinfoil can stay warm for hours! Percy boxes Anne H Mawdsley MBE PRESIDENT Prof. Dame Carol Black DBE TRUSTEES Barry Hicks, Joanna Kaddish Kevin Lafferty, Jeremy Pearson Freezing cold! Sponsor for newsletter For the past 26 years many companies have generously supported the costs of producing our quarterly newsletters. We are now looking for new sponsors so if you work for or know of any company who could help, even by sponsoring just one issue, we would be most grateful. If you would like further information i.e. costings etc., please let us Bio-Biloba Pilot Study know by emailing info@raynauds.org.uk or Thank you to the members with Primary call 01270 872776. Raynaud’s who took part in the Bio-Biloba Publicity pilot study. The results showed that 71% of The Association had a busy time in the run those who took part, found that the ginkgo up to Christmas with renewals etc. A sincere biloba product helped their Raynaud’s. For thank you for all the Christmas cards and details of how to order the supplement see donations which we received. However, page 11. January wasn’t just busy - it was manic! It all started with a piece in the Daily Mail on New CHIEF EXECUTIVE & FOUNDER Year’s Day and a few days later Dr Rosemary Leonard gave us a plug on BBC Breakfast and then a piece in the Daily Express promoted our heating aids. This resulted in hundreds of letters, orders, e-mails and phone calls every day. It was probably the highest volume of enquiries and orders we have ever received. Thank you to everyone for your patience if your orders were slower than usual in getting to you. The staff were so busy there was hardly time to come up for breath! A special thanks to Jiffy Packaging who very kindly supplied us with Jiffy bags free of charge to help with all the parcels. This cartoon was spotted in the Express! With many thanks to everyone for their support - we are going to need you in the days to come and we are here if you need us! Anne PATRONS MEDICAL ADVISORS William Bromley-Davenport Prof. J Belch; Sister S Brown Sharron Davies MBE Prof. C Denton; Dr. A L Herrick Roger Jefcoate CBE Dr. C Lovell; Dr. R Macdonald Veronica, Lady Piercy Prof. P Maddison; Prof. R Moots Nick Ross Prof. D Scott; Prof. A Silman David Wilkie MBE Dr. D Veale HEAD OFFICE: 112 Crewe Road, Alsager, Cheshire ST7 2JA Tel: 01270 872776 Fax: 01270 883556 Email: info@raynauds.org.uk Website: www.raynauds.org.uk Charity Reg. No. 326306 DISCLAIMER: The Association does not accept responsibility for the information contained in the newsletter, either medical or the advertised products. Remember what suits one person does not necessarily suit another. If in doubt consult your doctor before trying any suggested remedies. 02 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 4 Doc Spot Your Questions Answered Professor Chris Denton FRCP Consultant Rheumatologist, Royal Free Hospital I was diagnosed with Raynaud’s a couple of years ago and have managed quite well. However, recently I have had to have my wedding ring cut off as my fingers have started to swell. Why is this? Swelling of the fingers can occur in Raynaud's due to an increase in fluid content of the skin that occurs when blood vessels become leaky. This can occur in the red phase of a Raynaud's attack and is common even in primary Raynaud's. However, if the fingers are persistently swollen this may suggest the development of scleroderma, arthritis or another form of connective tissue disease and you should discuss that with your doctor. I have been prescribed beta blockers for heart problems but they appear to have made the Raynaud’s in my hands worse. Could this be the reason and if so, why? Although beta blocker drugs can be very helpful for a number of common medical conditions including high blood pressure, heart disease and migraine by blocking nerves that stress the heart or blood vessels, they can worsen Raynaud's because they also affect some of the nerve fibres that actively dilate some blood vessels in the extremities. You should discuss this with your doctor as there may be alternative treatments. Not all beta blockers are the same, and there are newer more selective beta blockers that may not have such a marked effect. Does scleroderma cause muscle weakness for example, in the ankles? Scleroderma often causes some degree of muscle wasting although weakness is uncommon. Approximately one fifth of patients with scleroderma have some evidence of another rheumatic disease. This is termed an overlap syndrome and some of these have myositis which causes severe muscle weakness but may be treated with medication including steroids and immunosuppressive drugs such as azathioprine, methotrexate and others. Three years ago I was tested for scleroderma as a doctor felt sure I could be suffering from a mild form of the disease. Thankfully the blood test was negative. Now three years later I asked if it could now be present (I am 83 and have had Raynaud's for as long as I can remember). I have been told both by my consultant and GP that as the test done three years ago was negative, I will not get scleroderma ever - is this correct? The commonest age for onset of scleroderma is between 45 and 60 and new cases developing after the age of 65 are very rare. In addition, when Raynaud's does progress to scleroderma this occurs within 10 to 15 years. It is therefore very unlikely that scleroderma will ever develop. With regards to blood tests, it is possible for them to change from negative to positive, but unless there are other features of scleroderma or worsening Raynaud's then repeating the tests is not really necessary, as it would be of little significance. I have pulmonary hypertension. Do I need to alter my diet? There is no evidence that any particular diet influences pulmonary hypertension, which occurs when blood vessels become narrowed in the lungs and can affect patients with scleroderma. If this complication is diagnosed you should be seen and treated in a specialist centre as there are several new and effective treatments available. There has been interest in whether food rich in a substance called arginine may help pulmonary hypertension (by stimulating the body to produce a chemical called nitric oxide) but very large amounts would have to be consumed and formal trials have not been positive, so no specific diet is recommended. I have Raynaud’s in my hands and feet. Recently I have noticed that when I get really cold my right nipple goes white then blue/purple and painful. Could this be connected with Raynaud’s? You are describing Raynaud's of the nipple. Raynaud's phenomenon can affect any part of the skin in which the blood vessels respond to changes in temperature. This troublesome symptom may benefit from the general therapies for Raynaud's including antioxidant vitamin supplements, fish oils or ginkgo biloba, as well as prescription vasodilator drugs from your doctor. Sometimes local application of a nitrate ointment around the nipple can be helpful. I have Raynaud's and limited scleroderma and wonder if these are contributory to the rapid tooth deterioration which I experienced with the onset of scleroderma being diagnosed. Many patients with scleroderma develop dryness of the mouth due to involvement of the salivary glands and changes in the lining skin of the mouth and gums. This, together with problems for dental care related to the tissues around the jaw and mouth becoming tighter, can be a major problem. Maintaining good oral hygiene is particularly important in scleroderma but can be very challenging. I have had Raynaud’s since I was 10 years old. I am now 20 and have been trying to conceive with my partner but unfortunately have had 2 miscarriages 4 months apart, both before 8 weeks. I have been trying to research pregnancy and Raynaud’s to see if that may be causing me any problems. I would be grateful for any information you have on pregnancy and Raynaud’s. The main thing to establish if you have Raynaud’s is whether there is an associated medical condition that may be relevant to pregnancy. The most important association is with connective tissue disease (lupus, scleroderma and others – these are all rare) and this should be confirmed or excluded by blood tests and capillaroscopy. It is important to test for an antibody called anti-phospholipid (APS, or lupus anticoagulant) as this can cause miscarriages. Taking low dose aspirin is important if you have a connective tissue disease or APS. If you are concerned you should be seen by a specialist in obstetric medicine. Raynaud’s often improves during pregnancy but then frequently worsens temporarily 3 to 4 months after delivery. This is thought to be due to the hormonal adjustments that occur at this time. Many drugs used to treat Raynaud’s are not safe in pregnancy and this needs to be discussed with your doctor. Sometimes it is necessary to give infusions (drips) during delivery and these should be warmed if possible to avoid triggering Raynaud’s. If you have a question you would like Professor Chris Denton to answer, please send to Head Office 03 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 5 Research Research An Update from Bath Pictured above are Prof Neil McHugh and Dr Noeleen Foley Our clinical service We receive local and national referrals from GPs and other consultants, and also provide a shared care service with other rheumatologists in areas of the country where there is not a specialist CTD service. Patients are seen in a twice weekly dedicated CTD clinic which is led by Professor Neil McHugh, Dr Ellie Korendowych, Sister Sue Brown and supported by two registrars. Nurse led clinics provide all CTD patients with education, advice, information and counselling. This is particularly useful for newly diagnosed patients and Sue provides support according to individual need. Those embarking on complex treatment plans or struggling to come to terms with their diagnosis and symptoms, also benefit from Sue's specialist input. A nurse led rheumatology telephone advice line is also available to support patients between clinic appointments as needed (01225 428 823). As conditions like scleroderma can affect many different parts of the body, we have developed combined clinics with other physicians. This reduces the amount of clinics you may have to attend and also allows the clinicians to discuss your case together, enabling full discussion and assessment of your condition. This joint working also leads to further collaborations, not only clinically but also in the research field. Our combined clinics presently are: 1. Monthly pulmonary/rheumatology clinic with Dr Noeleen Foley, Respiratory Physician 2. Monthly dermatology/rheumatology clinic with Dr Chris Lovell, Dermatologist 3. Two monthly pulmonary hypertension clinics with Dr Gerry Coghlan, Cardiologist, Dr Jay Sunrathalingham, Respiratory Physician 4. Two monthly renal clinics with Dr Chris Dudley, Renal Physician Research service One of the main areas we concentrate on is the measurement of autoantibodies, how they can be used in the diagnosis of 04 scleroderma, and their relevance to the underlying cause of the disease. Currently the RSA supports the work of Dr Jean North, a postdoctoral scientist who is studying how autoantibodies may be formed in scleroderma and how they may have possible effects on cells. Over the past few years we have been able to discover new autoantibodies by using a rapidly advancing technology termed proteomics. Some of these new autoantibodies are associated with particular patterns of disease. We are also able to offer a central facility which is only one of very few world-wide that can undertake measurement of the full range of autoantibodies seen in scleroderma. We have also established a large biobank of 30,000 blood samples over the last 10 years from patients with connective tissue disease including scleroderma, who have consented to participate in research studies. The biobank is interlinked with a clinical database that collects anonymised data related to patient outcome. This allows us to investigate the behaviour of certain diseases over time and the impact they have on the individual. The database is managed by Charlotte Caville. Importantly the biobank allows us to collaborate with other centres and provide the numbers of samples in uncommon conditions such as scleroderma that are necessary to undertake genetics studies. The biobank allows us to collaborate with other centres One of our other main interests is measuring the blood flow in small vessels (microvasculature) in patients with Raynaud's and scleroderma. In our clinical measurement department led by Dr Nigel Harris, we have well established techniques such as thermography, nailfold capillaroscopy and laser Doppler imaging. For example, Dr Harris in collaboration with Dr Chris Lovell and Dr Lindsay Shaw is completing a project funded by the RSA investigating the way laser Doppler may be used to measure the activity of localised scleroderma in adults and children. Finally, we have long recognised the importance of collaborating with other major scleroderma centres in the UK in clinical studies. As part of the UK Scleroderma Study Group, there have been several important studies either completed or near completion (e.g. QUINs, FAST, Observational study in diffuse scleroderma), in which our patients have participated. Such studies provide the knowledge base for providing the most effective and safe treatment for patients with scleroderma. We hope to continue to actively undertake clinical studies including those evaluating newer therapies for Raynaud's and scleroderma. Education service We provide an active education service for our patients, and local and national colleagues. Patient newsletters are available in the CTD clinic addressing issues of importance to patients, giving information about conditions such as scleroderma, our current CTD service and details of how to access help and advice. Patient meetings are regularly held at the RNHRD, with the local Bath/Bristol RSA group meeting here in Bath twice a year. During these meetings Sister Sue Brown is available to answer questions and offer advice and support. Sue is chair of the United Kingdom and Ireland Scleroderma (UKIS) group for nurses and health professionals. This national group meets to discuss treatments, share good practice and formulate and consider health professional led research proposals. Sue is also convenor to the British Health Professionals in Rheumatology Special Interest Group and is running a session on scleroderma at the forthcoming national conference in Glasgow in April 2009. We meet with other clinicians with an interest in scleroderma at the twice yearly combined Bath/Bristol CTD meetings. This is an opportunity to meet many different CTD specialists (such as pulmonary, cardiology, renal, dermatology and ophthalmology consultants) and enables us to set aside a full post graduate session for CTD presentations. We also hold a monthly CTD interest meeting for clinicians at the RNHRD, where the full mutlidisciplinary team has the opportunity to engage in presentations and discuss important areas for practice. We have also collated a number of evidence based protocols to enable new clinicians to access our diagnosis, treatment and management plans. Finally, our scleroderma patient education and self management programmes have been evaluated and re-designed and will be available for any patients at the RNHRD to attend. Our 2009 programmes will be in March, June and September. Sister Sue Brown MSc RGN EN (G) Clinical Nurse Specialist in Connective Tissue Diseases , RNHRD, Bath Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 6 Research The Lungs and Scleroderma Early diagnosis, early treatment, longer life. In the 1970’s kidney disease was the most serious complication of scleroderma. It was the leading cause of death and renal dialysis was a common issue for people with the condition. However, Dr Sean Gaine scientific advances, the use of antihypertensive medication, have all but eliminated this as a problem in scleroderma. The main problem now affecting people with scleroderma is lung disease, which can be either scarring in the lungs or pulmonary hypertension. The prognosis of these conditions is quite poor and so early recognition to ensure treatment can be initiated and is now a cornerstone of our approach to scleroderma. The symptoms of possible lung disease include shortness of breath, chest pain with exertion, and cough. It is very important that if someone with scleroderma develops these symptoms that they be taken very seriously and consideration be given to doing further testing. These tests would include a physical examination by a physician, a chest x-ray, lung function tests and an echocardiogram. If there is evidence of lung scarring and it is caught early there are effective therapies now that can help reduce the inflammation and preserve lung function. This treatment would generally include steroids and other agents that strongly reduce inflammation. If there is evidence of pulmonary hypertension and disease of the blood vessels, then a number of new therapies have recently improved the outcome. These therapies are designed to help improve blood flow through the lung and include such agents as endothelin antagonists, prostanoids and indeed Viagra, a phosphodiesterase antagonist. These drugs have been shown to significantly improve the symptoms of patients with scleroderma. It is very important that anyone with scleroderma understands the importance of lung disease and the importance of an early diagnosis. These new treatments are believed to work better the earlier they are used. So treat your lungs well. It is important that anyone with scleroderma should not smoke cigarettes. They should exercise regularly - staying strong so that they will notice any problems with breathing earlier. You should encourage your doctor to send you for lung function tests every year and make sure that you have an echocardiogram at baseline to evaluate for pulmonary hypertension. Dr Sean Gaine National Pulmonary Hypertension Unit Mater Misericordiae Hospital MediQuest Update MediQuest Therapeutics is a specialty pharmaceutical company using its proprietary topical delivery system targeting infectious and inflammatory skin diseases and conditions. The company's major efforts are focused on projects targeting Raynaud's, nail psoriasis and actinic keratosis. Vascana Vascana is a topical therapy indicated for the treatment of symptoms associated with Raynaud's. Raynaud's patients, 90 percent of whom are women, can experience severe pain associated with chronic vasospasm episodes in their hands, feet and other extremities. Vascana is a locally acting, topical formulation that is designed to be applied to prevent or treat the symptoms associated with Raynaud's episodes, which would allow patients control over their disease. No drugs have been approved by the Food and Drug Administration (FDA) for the treatment of Raynaud's. FDA indicated that the New Drug Application (NDA) could not be approved in its present form. The FDA identified issues that must be addressed by MediQuest before final marketing approval will be granted for Vascana. MediQuest will discuss these issues with the FDA and will provide an update when appropriate. Different Types of Scleroderma Many patients are still not sure what type of scleroderma they have. Below is a brief outline of the different types of scleroderma, also called systemic sclerosis. Diffuse Cutaneous Patients with Diffuse Cutaneous Systemic Sclerosis present with skin changes (puffy or hidebound), have truncal skin involvement and ‘creaking’ tendons at joints for example wrists and elbows. Early lung disease, kidney, gastro-intestinal and heart involvement become evident in some patients. There are changes in the nailfold capillary and certain antibodies maybe present in the blood. Anyone with diffuse scleroderma needs to be checked frequently (at least every 6-12 months) in the first 5 years. Limited Cutaneous Morphoea Patients with Limited Cutaneous Systemic Sclerosis will have had Raynaud’s for years (occasionally decades) and there will be skin involvement to the hands, face, feet and forearms. These patients used to be diagnosed as having the CREST syndrome. Patients with limited disease need checking every 6-12 months, depending on the stability of the disease as it is now known that pulmonary hypertension may become a problem in some patients. This affects the skin, beginning with an inflammatory stage followed by the development of one or many slowly enlarging patches or plaques. These plaques are usually oval in shape but vary in size and colour and may enlarge or shrink, sometimes disappearing spontaneously. Localised scleroderma There are two types of localised scleroderma - morphoea, linear or a combination of the two. These types of scleroderma are more common in childhood-onset disease but can affect any age group. Linear scleroderma This usually develops in childhood and can affect the growth of a limb. It is a form of localised scleroderma which starts as a band-like thickening of skin, usually limited to one area such as an arm, leg or forehead (en coup de sabre). Unlike morphoea, linear scleroderma tends to involve layers of tissue below the skin and can sometimes affect the muscle and bones and finally the mobility of the underlying joints. 05 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 7 News 10 Blood-pumping Foods 1. Wheatgerm is a great source of vitamin E - an Australian study of patients with diabetes (who suffer from reduced circulation) revealed that this antioxidant vitamin improved their blood flow. 2. Mackerel is rich in omega-3 essential fatty acids, which aid healthy blood flow. 3. Onions contain a plant chemical called allicin - a US study found it breaks down to produce hydrogen sulphide, which relaxes blood vessels. 4. Museli is a tasty source of oats and other soluble-fibre-rich grains, which help lower your levels of artery-coating cholesterol. 5. Brussels sprouts are full of folic acid, a B vitamin that reduces blood levels of homocysteine, helping blood flow more freely. 6. Pomegranates appear to have circulation-boosting effects. In a small study, patients who drank the juice daily for 1-3 years had less thickening of the arteries, and therefore better circulation. 7. Chillies - A study of 27 healthy people found that eating chilli-rich diets improved circulation by reducing the potential for arteries to become clogged up with blood lipids (fats). 8. Kiwi fruits contain vitamin C, and American research found that 2g of vitamin C given to smokers improved the blood flow in their coronary arteries. 9. Peas are a source of vitamin B3. A study found that people with Raynaud’s who took them had fewer and less severe symptoms. 10. Grape juice is rich in phyto-chemicals called phenols. Research suggests that four glasses of red grape juice a day could help boost circulation. Why the name? The name Raynaud’s Disease was given to this condition by a French doctor, Maurice Raynaud in 1862 when he published a thesis on ‘Gangrene and Intermittent Asphyxia of the Extremities’. Since Maurice Raynaud’s time, many theories as to the cause of Raynaud’s have been explored but to date no one cause has been found. Researchers have however, discovered much more about the condition and it is now known to be very common, varying in severity from mild to severe. LOCAL CONTACTS Eastleigh, Kathy Allen 02380 610678 Cumbria, Ruth Randall 01229 835727 Taken from Healthy Magazine Sept/Oct 2008 Dorking, Sue Neve Best Buy Gadgets 01306 713382 Belfast, Heather Semple My son saw the Cullinare One Touch Automatic Jar and Can openers advertised on television and a member wrote in to tell us how good they were, so I decided to try them out. I can honestly say I have never found a gadget as brilliant as the Cullinare tin opener. You just place it on the tin and press a button and hey presto the lid is taken off!! The jar opener is also a great aid in the kitchen - it is a bit like a darlek! You place it on the jar, press the button and clamps come in to hold the jar, then a second set of grippers come in and hold the lid. The Jar Opener gadget stops once the lid is removed. I would certainly recommend these items if you have difficulty opening tins or jars. The only downside was that I couldn’t get either gadget out of the packaging without help! The company have had so many complaints about the packaging that they are looking into it. Cullinare don't sell direct to the public but the gadgets are available by ordering online from Lakeland and Amazon or they can be purchased from Argos. Anne Mawdsley 01942 877259 Co. Durham, Jessie Pickering 01388 527840 Fife, Rose Bevan 01382 552272 01386 553392 Burton on Trent, Helen Nutland 01283 566333 Ext. 5032 Bristol, Margaret Goff Can Opener These new stylish pens are printed with the Association's details. Retractable ballpen with translucent finish and chrome highlights. Its beautifully moulded design gives this high quality ballpen perfect balance, and a comfortable matching rubber grip completes the look. 06 Manchester, Gill Holden Pershore, Shirley Lynch New Printed Pens The pens cost £1.25p each including p & p. To order please send a cheque made payable to the 'RSA' to 112 Crewe Road, Alsager, Cheshire, ST7 2JA. 0289 0851210 01454 310225 Contacts Wanted Victoria Nash from Slough has erythromelalgia and Sue Taylor from Penzance has scleroderma. They would like to hear from others with the condition, preferably who live in their respective areas. Please write to Victoria or Sue via Head Office and we will forward your correspondence. Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 8 News Treatment of Ulcers What are ulcers? Ulcers are erosions or holes in the skin which can be tender and very sore. These can develop particularly on the fingertips and underneath the nails and can also appear on the feet, elbows and legs. They are extremely painful and can take a long time to heal due to the poor circulation. They may be associated with pieces of calcium which work their way to the surface and break through the skin, becoming infected and causing pain. What can I do to prevent ulcers? If you are prone to develop these on your fingers and toes, care should be taken to maintain good circulation by keeping your hands and feet warm. It is also essential to keep the trunk of the body warm. Make sure that your hands are kept as clean as possible and do not be too aggressive when manicuring your cuticles. How is an ulcer treated? If an ulcer develops it needs medical attention and an antibiotic is usually prescribed. In order to heal, dead tissue needs to be removed and infection needs to be cleared. Unwanted crusts and dried pus can be removed by soaking the ulcer in luke-warm water for approximately five minutes. The area should then be allowed to dry before applying a dressing. There are several good dressings available but they need to be used properly to get the best results. Treatments available from your doctor may include antiseptic or antibiotic ointments. Sometimes a dry dressing is best, such as gauze or a nonadherent dressing or one of the hydrocolloid adhesive preparations. Alternatively, you may be given a calcium alginate dressing derived from seaweed. The dressings have the great advantage that they can be removed from the ulcers by washing with saline solution. Skin Care & Digital Ulcers Leaflet To request a copy of this leaflet please send an SAE to RSA, 112 Crewe Road, Alsager, Cheshire, ST7 2JA Medical Records Access for England A summary of everyone’s medical records is to be put on a central NHS database in England during the next two years. Changes to the plans for the national medical records database will require NHS staff to ask a person if they can access their medical records, unless the person is unconscious or unable to give consent. This summary will be available to clinical staff throughout the country and be updated at each appointment. It will contain a treatment history, recent medical history, medication and allergies, although the full details have yet to be finalised. The summary record is designed to give paramedics and staff in casualty units and walk-in centres immediate access to a person’s records. The changes were made after an independent report recommended that health staff should have to ask for permission - a system used successfully in Scotland and Wales. While there are concerns about records being included automatically, there are no plans to change this. People not wanting to be part of the system will need to register to prevent their records going onto the national database. ‘The system uses the strongest national and international security measures available,’ said a spokesperson from the Government agency that is setting up the system. ‘NHS staff have to pass three tests to access your records.’ Taken from Arthritis News, December 2008/ January 2009. NURSE ADVICE LINES Clare Das & Sally Reddecliffe Royal Free 020 7472 6354 (For Pulmonary Hypertension Enquiries) Specialist Nurses Royal Free 020 7830 2326 Sue Brown Bath 01225 428 823 Liz Wragg Manchester 0161 206 0192 Specialist Nurse Leeds 0113 3923 035 Steve McSwiggan Dundee 01382 633 957 Jan Lamb Liverpool 0151 525 5980 Bleep 2231 Karen Walker Newcastle-u-Tyne 0191 223 1503 Sally Marsh Northampton 01604 523 849 Audrey Hamilton Belfast 02890 561 310 The nurse advice lines are for members to use whenever they have a problem or just want reassurance. They are not a replacement for care by your GP but very often it helps to talk to a nurse who can listen and offer advice. It should be emphasised that the nurses who run the advice lines also have very busy schedules within their hospital and it is inevitable that on many occasions you will get an answerphone asking you to leave your details for the nurse to get back to you as soon as they are available. Some of the nurses work part time and therefore if it is their day off or at a weekend, it may take longer. The above advice lines are not intended for use in an emergency. Manuka Honey Manuka honey is still being recommended for ulcers and abscesses. It absorbs the pus and doesn’t stick to the dressing. Ordinary honey is cheaper and also seems to work, but Manuka (from New Zealand) is sold for medical application. 07 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 9 News & Views Writing Competition Winner Melanie’s Story One morning in 1960, I awoke to find my feet covered in blisters - the pain woke me - I had been sitting in front of an open fire the night before in fur lined boots with freezing feet and blistered my feet through the boots. Time Eve Warr to visit the GP! She referred me urgently, by phone, to the hospital and I was diagnosed with Raynaud's. Within two weeks of visiting the surgery the neurologist said he would have to carry out sympathectomies for my hands and feet. There would be four operations, two on my back and two on my neck. I was a teenager and scared - I had never been ill since a child, although always cold. Nobody I knew had ever heard of Raynaud's and I duly went into hospital. The ward was long and daunting and I was the youngest person there. I took a while getting over the operations but ended up with two beautifully warm feet, which to this day remain warm. The hands were less successful. After one month, they returned to their painful state and I was told there was little more that could be done. I married and had two children. They grew up and my hands got worse. I was later referred to the Royal Free Hospital in Hampstead under the care of Professor Carol Black, who suggested iloprost infusions. My daughter Sally, who had been as warm as I had been cold, also developed Raynaud's. My heart sank. She too had to have a sympathectomy for her feet, as apart from the numbness and pain, she was unable to drive her car. Sally was unperturbed and insisted that, like me, she would learn to cope and live with the condition. The sympathectomy for her too was a great success, although she still suffers with her hands and has had bouts of treatment in hospital. We now have three beautiful granddaughters with another baby due, and I pray none of them will develop the same condition. How have I handled the illness over the years? It hasn't been easy but I have a determination not to let Raynaud's or the accompanying gut and digestive problems, along with the finger ulcers in the winter, ruin my life. Our state of mind is important how we handle the illness. Nobody said life would be easy, and if we look around, nearly every family has 08 something to cope with, be it family problems, money worries, problem teenage children and of course, illness. I try to not let minor things irritate me like they used to. It had become an office joke - me wrapped up in a thick jacket and scarf in our air-conditioned office. ‘Not planning on staying, Mel?’ colleagues teased. Thinking positively is a definite help, especially when harsher weather is here (although we all know that the condition is an all year round one). Yes, it is hard when the whole body temperature is low and you feel vague and sleepy. The ulcers seem unbearable, the joint aches and pain prevail and you do not want to venture out. At this stage I put on plenty of clothes, boots, socks, tights and woollen ski pants, trousers, several jumpers, plus all the outdoor gear, hat and men-sized gloves and hand warmers. What sartorial elegance that image produces! Even the dog looks at me in a strange manner. Looking like the Michelin man, we venture out. I see people, trees, the countryside in all seasons and meet and chat with people (if you want to meet people, get a dog!). My circulation is jerked back into life for a while. I was 38, loved my high-flying PA job in London. I was too busy at work to worry why I suddenly seemed so cold, why my fingers turned blue. It had been going on for weeks - ever since a chilly, damp cycling holiday in Slovenia. After that, my fingers had swelled and none of my rings would fit. It no longer bothers me what people say, such as “are you really cold?” and “you won't need that extra cardigan/jacket/coat in this weather” and “why do you keep dropping everything?” “why have you got gloves on today?” and “why are your hands that awful colour?” I now have my inpatient treatment locally and can hear my consultant's resounding voice and laughter as he approaches my bed - he immediately makes me smile, and he is always ready to listen and help with problems. We can change the way we think about illness I have a patient, kind, loving husband (who is used to clearing up broken glass or china!), children and grandchildren. My friends and family know the problem and are caring and thoughtful. My little grand-daughter looked at my purple hands recently and said “but they are kind hands grandma”. It made me think that you can be happy when unwell. I send my love and thoughts to all those reading this who are much worse off than I am. Eve Warr, Colchester The competition runner up was Annette Dawson. To read her piece go to www.raynauds.org.uk and click on ‘Patient Stories’. Thank you to everyone who sent in entries for the competition. Six months later, when my legs puffed up, I saw the company doctor. He referred me to a vascular specialist, who diagnosed me with Raynaud’s. The specialist said it could get worse over time. I didn’t want to think about it, and was too focused on work to take it in. I was given drugs for the Raynaud’s and patches for the tops of my hands to boost my circulation. Although the drugs helped, the patches didn’t and soon I was getting a stiff pain in my shoulders, knees and other joints arthritis. Then my legs and feet swelled so much that only flip-flops would fit. The skin on my face tightened too, so opening my jaw was difficult and my lips looked thin. Friends and colleagues were supportive and kind. But when my terrible tiredness came on - as if I’d walked miles and couldn’t take one more step - I became weepy and felt vulnerable. I’d been ill a year now and my doctor referred me to a specialist. She diagnosed aggressive diffuse scleroderma. Devastated and fearful, I was then admitted to hospital for treatment. Gradually my legs improved but a few months later, still very ill, I opted for early retirement. My whole life had turned upside down. I moved out of London, back with my parents, and sank into depression. I’d lost my confidence and didn’t want to talk to anyone. The next year was even more miserable. Ulcers on my ankles and fingertips caused indescribable pain. Acupuncture eventually helped me. It restored my confidence so I could talk to family and friends again. I’m calmer now and realise that you have to enjoy your life no matter what. Being ill has taught me not to think too deeply, and to smile, because it brings out the best in people. Melanie Bowen Taken from That’s Life, November 2008 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 10 News & Views My Hands Turned White Fiona Trotter When Fiona, 29, was first diagnosed with Raynaud's her attacks were so severe and frequent that at times, she was even unable to walk. But with exercise, alternative remedies and other lifestyle changes, she is now fighting fit. ‘For as long as I can remember I've been sensitive to the cold. But I assumed it was because I was slim with little body fat. It wasn't until I was 18 and at university that I first began to notice that something was wrong with my hands. An attack could happen at any time. I would be drying myself after a swim when my hands would suddenly turn white then blue and become unbearably painful. I couldn't do even the simplest things, such as hold a pen and the attacks could last for up to 45 minutes. Gradually they became more frequent - I was having up to four attacks a day. It was when they began in my feet that I started to worry. One night I went out wearing strappy shoes. I was waiting for a taxi when I had an attack. I couldn't stand, let alone walk and had to find a seat to wait it out. It was then I decided to see my GP. Daunting diagnosis The diagnosis was straightforward enough. After I explained my symptoms, the doctor told me I was probably suffering from Raynaud's, a condition that affects blood flow to the fingers and toes. I was referred to a rheumatologist, who explained how the condition restricts blood flow to the fingers and toes in extreme weather. People think it's a coldweather condition, but in some ways the summer can be worse. Sudden changes in temperature, swimming and air conditioning can all trigger attacks, and because you tend to wear lighter clothes and open shoes, you are less protected. I knew the condition wasn't serious, but it is debilitating and I was daunted at the thought that I was just going to have to live with it. Coping Over the next few months, I had so many attacks that it was becoming impossible to lead a normal life. I had to wear gloves if I wanted to get things out of the fridge and I just felt so helpless. Having such a supportive family and friends kept me going however, and gave me the confidence to try to get better. I went back to the doctor, who prescribed a vasodilatory medication to help improve the blood supply to my hands and feet. But all drugs come with side effects - one gave me such terrible headaches - so it took a while to find something that suited me. An alternative approach Two years ago, I decided I no longer wanted to be on long-term medication so I decided to try to wean myself off the tablets, and start managing my own condition. I started by taking a high-strength ginkgo biloba supplement. Ginkgo has been proven to help with circulation disorders, as has ginger, which I began including in my diet. I also dressed warmly and bought gloves containing silver to protect my hands from the cold. I now wear boots for most of the time and take exercise more seriously, to boost my circulation. Little steps, big differences These adjustments may seem small, but they have changed my life. I no longer take any medication, and suffer only one attack a week. When they do come, they’re generally shorter and milder. I now feel in control of my body and don't let my condition stop me from doing anything. It may never go away but it certainly isn't holding me back’. Fiona’s story appeared in Zest magazine Patient Opinion Inform others about your experiences of NHS healthcare by logging on to the Patient Opinion website. Patient Opinion is a free, confidential non-profit service. Visit www.patientopinion.org.uk or call 0845 113 0012. Shop Online & Raise Money Easyfundraising.org.uk is a free online shopping directory which enables charities to raise valuable funds simply by shopping online. Every time a purchase is made, the retailer will make a FREE donation of up to 15% to the cause, which the buyer chooses to nominate. It does not cost you a penny extra to shop and raise funds in this way, so please visit www.easyfundraising.org.uk and nominate the Raynaud’s & Scleroderma Association as your chosen charity. Beat the Freeze Home Simple measures to keep you cosy indoors include installing draught seals around your window frames and draught strips on the bottom of doors. Heavy curtains are good insulators and make sure you keep furniture away from radiators so the heat can circulate around the room. Clothing Wrap up! Several layers of thin clothing will keep you warmer than one thick layer because the layers trap body heat and warm air. Clothes containing wool, cotton, silver or fleecy synthetics are best. Put on a coat, scarf, gloves, hat and warm shoes when you go out. A waterproof outer layer is also a good idea because heat is lost 20 times faster through wet clothing. Stay cosy in bed by wearing bed socks and thermal night clothes. Exercise As the weather gets colder it can be tempting to hibernate but resist the urge to huddle up beneath duvets for hours on end. According to fitness expert, Jane Taylor, staying active is important in the winter. “This is especially true for older people who spend much of their lives being sedentary,” she says. “Many people are under the illusion that you lose energy if you’re up and about but you actually generate more energy and heat by moving around. If you don’t want to be outside, do the equivalent of a mini workout inside by marching on the spot or, if you have stairs, go up and down them a few times. Exercise also helps joints which tend to stiffen in winter. Circulation becomes sluggish when you’re cold, but getting the heart pumping means you get blood to the extremities so your toes and fingers warm up.” Taken from the Daily Express Mail Order Leaflet Our new mail order leaflet is now available on receipt of an SAE. 09 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 11 Fundraising Raynaud’s Awareness Month February 2009 Percy Penguin Following our Scleroderma Week in November we have been concentrating our efforts to highlight Raynaud’s during February with our Winter Blues Campaign. Up to 10 million people in the UK suffer from Raynaud’s in one way or another yet the condition gets very little publicity unless we really work at it. Press releases were sent to journalists throughout the UK and awareness packs distributed to hospitals and health centres nationwide. There is still time left if you would be happy to speak to a journalist on the phone about your Raynaud’s. Please call Fiona Trotter if you can help, on 01270 872776 or email: fiona@raynauds.org.uk. Often a paper will only print an article if they are able to interview a local sufferer. Any help which members can offer would be very much appreciated. How Can You Help the RSA? Gift Aid Gift Aid is one of the simplest and most effective ways of giving to charity. Using Gift Aid means that for every pound you give to our charity, the RSA will receive an extra 28 pence from the Inland Revenue. This means that a £10 Gift Aid donation, is worth £12.80 to the charity - and it doesn't cost you a thing. We will simply recover tax which you have already paid. It can apply to donations of any amount. A single Gift Aid declaration can apply to all past donations you have made (since April 2000) and to all future donations you make. Next time you give a donation or renew your membership please let us know if you are a taxpayer. Justgiving Justgiving is a major online sponsorship agency. You can use this site to make a donation to the RSA. You can also create your own fundraising page on their site and get sponsors to give online. Justgiving then send us payments direct. If you are a UK taxpayer, they also reclaim the tax on our behalf. See www.justgiving.com/raynauds Donations in Memory At a time when charities are going to find it difficult to raise funds, we are most grateful for the donations which have been sent in lieu of flowers, in legacies or donations in memory of loved ones. Leaving money to charity is tax-free so it is a good way to save inheritance tax and get 100% of your gift to the cause which you want to support. Legacies left to the RSA help to fund vital research. It acts as a heartfelt, long lasting gesture of support for people facing Raynaud’s and scleroderma in the future. Legacy Leaflet Legacies are something that we are often asked about and a leaflet is available, which explains how your Will could make a difference to the RSA. To request a copy please send an SAE with your request to Head Office. Musical Fun Lin Ford organised a music event at Fairkytes in Essex which raised £134.50 for the RSA. Pictured left, Lin is seen instructing the children on how to perform a puppet dance. 10 Donations & Fund Raising There have been an incredible number of donations since the last issue so we are unable to list all below. However, we do thank everyone who has made a donation or taken part in a fundraising event. Our thanks to: Aviceena PLC; Amicus Longton & Uttoxeter; Bearwood Lakes; Bauer Publishing; Encysive UK Ltd; Misses Barrie Charitable Trust; Multithon Trust; Glenwood Laboratories; MurphyNeumann Charity Company Limited; Oakley Charitable Trust; Rosetrees Trust; Sir Jules Thorn Charitable Trust; Thorpe Willoughby Primary School; Tayport Charity Shop; Woolf Charitable Trust and Yorkshire BS Charitable Foundation. Our special thanks also to the following individuals: B Arnold; M A Amess; M Abdallah; M Boulter; T S Bailey; D G Betteridge; L Burwitz; W J & I Beveridge; V Birch; C Buckledee; M Bowen; R J Chalk; B L Collins; L L Corless; J E & M Collins; N P Curtis; D H M Dalrymple; F G & M O Delf; D G Doyle; A P & L Durrant; M Gates; A F Gibson; C A Gray; C M & J E Griffith; W E & J M Guiel; R H & B L Gunston; D S & B Hayer; C Hoddy & A E Paine; M & W Hutton; R Hopkins; J King; S M E Keating; D Kerr; T H & F E E Labrum; M Lamb; R & L Limond; C A Llewelyn; B Lowe; W A & E Moore; E R C Mouat; R S & J M McGibbon; D T & D Newton; L & N Nesbitt; M C Nicholls; V & B Prior; E J M Pott; B E Purbrick; P Rebbeck; A M & K Richards; B F & J F Roberts; M V & M I Robson; M E Roberts; J C Rush; H J & E Rylance; D Smith; M K Sangan; N Smith; T M Sheehan; J & J Thornton; C K Todor; R H & B J Trevains; M & W J Tucker; I M Webb; M A & H L Wrixon; D A & B Wyllie; L Westerman & H Jennings; C P & S F Wigfield and P A Yap. Great Eastern Run Bethan Collins and her husband Richard Munn (pictured right) took part in the Great Eastern Run and raised £681.00 for the RSA. Many thanks! Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 12 Info RRP Always read the label No More Cold Hands Battery Heated Gloves/Mittens Lectra Gloves are waterproof, durable everyday gloves with the added benefit of having battery heat when it gets extra cold. Insert ‘D’ size alkaline batteries (which will last 4-6 hours) or rechargeable batteries to take the chill off. To find the right size please measure the circumference of your knuckles excluding the thumb. Quote the measurement for size. £39.99 + £3.50 (p+p) Optional Charger with 4 ‘D’ size rechargeable batteries £19.99 No More Cold Feet Battery Heated Socks The Lectra Socks were originally developed for commercial fishermen. The ‘D’ size alkaline battery provides 4-6 hours of continuous heat, more when used intermittently. Rechargeable batteries can be used as well. The heating elements safely buried in a channel located in the toe area. Please quote your shoe size to order. £29.99 + £3.50 (p+p) Optional Charger with 4 ‘D’ size rechargable batteries £19.99 Unit 3, Home Farm, Holt Road, Horsford, Norwich NR10 3AG Tel: 01603 890555 • Fax: 01603 898777 Charity Flowers Treat that special someone to a delightful bouquet of flowers. RSA have teamed up with Charity Flowers Direct to offer supporters a superb flower delivery service and 15% of the order cost is donated to the RSA. Charity Flowers Direct is the only flowers by post service wholly owned by a charity and where all the profits are donated to charitable causes. Every time your choose Charity Flowers Direct, you will be making a valuable contribution to our important work. Why not treat someone by ordering from Charity Flowers Direct. All flower bouquets are packed in a presentation box together with cut flower food and your own personal message. All flowers are sent by first class post. To order your flowers now visit www.charityflowers.co.uk or call the 24 hour phone line on 08705 300 600 remembering to choose RSA when you order. 11 Final.qxd:Vol1-09.qxd 4/2/09 12:51 Page 1 EX02 Products DWP Information Day in Birmingham The following was sent to us by Tom Reddings, Secretary of the Burton-uponTrent Support Group, following his attendance at the DWP Information Day in Birmingham, which he attended on behalf of the RSA. Purpose To provide information to the Department of Work and Pensions (DWP) staff, especially those who make decisions on benefits. Feedback Ten other organisations including Lupus, Fibromyalgia, Sickle Cell and a hospice attended the event. All groups had notice boards and leaflets. The DWP staff visited the stands and we described the conditions and difficulties. Most staff were very interested and took leaflets. We tried to ensure that everyone had at least one leaflet with the RSA contact numbers for further enquiries. Many knew of Raynaud's but few knew about scleroderma. I estimate we spoke to about 40 people. Volunteers from other organisations also exchanged information. After a sandwich lunch Colin Smith led a discussion. Firstly he spoke of improvements that the DWP are making to ease claiming benefits. He then took questions and comments from the volunteers. Some of the volunteers are directly involved in making claims for sufferers, e.g. for people who are deaf. Neither my wife nor I were sufficiently conversant with the issues which two of our members are experiencing. However, on other matters the two way exchange seemed to be very useful. Colin thanked all participants and promised to include us in any future meetings. Conclusion It was very good to increase awareness of Raynaud’s and scleroderma to the staff of the DWP and provide them with contact details of the RSA. Family Weekend The date for the Family Weekend 2009 is 16th, 17th & 18th October in Chester. Any families who are interested in joining us please contact us asap for an application form as we need to confirm the booking. This is for families who have a child with scleroderma who is 18 or under. When Anne went down the Bob Run in St Moritz, exo2 kindly provided her with a heated gilet which was very effective. They now have a new range of heated garments. Over Christmas Fiona and Anne tried out a few of their new items namely the heated jacket, the neck warmer and back warmer. Heated neckwarmer (HEATWAVE Neckwarmer) When Anne first put this on it felt rather bulky around her neck due to the velcro fastening, but after wearing it for a short time she got used to it (even wearing it in bed) and enjoyed the heat. It is ideal if you have problems with neck pain but also your body feels warmer when your neck is warm. The miniature power pack and charger heat the neck warmer for up to 6 hours per session. While in use the power pack fits elegantly into a small pocket on the side of the neck warmer. Heated back warmer (HEATWAVE Heated Back Support) The back warmer has a portable battery pack and the velcro means that it fastens easily around the waist. This allows the back warmer to provide heat to the lower back area. After having it on a few minutes Anne and Fiona could really feel the heat. There are struts inside for lumbar support. They both thought it was excellent and would certainly recommend it to others. Heated jacket (STORMWALKER 2 Heated Jacket) This jacket has a heating element in the lower back and both front pockets and the power pack fits snuggly into one of the pockets. You can unzip the sleeves if preferred. The jacket really made a huge difference when going out (Anne wore it indoors as well!). The heat generated feels really warm and cosy. Anne said that she could happily wear it all day every day! Personally she would like it to be slightly longer but as it is reasonably lightweight and not bulky, it is fine to wear under a coat. The other advantage is that the switch on the power pack can be turned on and off as required. The heated panel located at the lower back/kidney area, is designed to attain a temperature of approximately 43OC, lasting for up to 3 hours on a single charge, or several days when used for quick 'boosts' of warmth. The heated panel technology is so versatile and robust it can even be hand washed! All the items have batteries which are mains rechargeable and easy to use. If you would like to speak to Anne or Fiona about these garments please call the Association on 01270 872776. The following was sent to us by a member who purchased the sleeveless jacket: “Just to let you know what a great product the exo 2 jacket is! I have Raynaud’s and wear it all day between December and March (even when indoors!), and get it out for chilly days. It has greatly reduced my symptoms. I would go as far as saying that this has changed my life”. Nikki Adams EXO2 are offering a 25% discount to our members on any purchase they make via their webshop on www.exo2.co.uk or alternatively you can send a cheque made out to their parent company, Typhoon International Ltd. The discount code which needs to be included in the comments section during website purchase or on the letter accompanying any cheques is RA2509. Ladies Day Tickets, Aintree The RSA still have a few tickets available for Ladies Day on 3rd April at the Grand National Race Course, Aintree. Treat yourself or others to a day of sporting fun and fine dining in the corporate hospitality suite in aid of the RSA. The package includes: Official Admission Ticket, Exclusive Luxury Facility, Coffee, biscuits and morning papers, Champagne reception, Complementary Bar-Open all day, Four Course Silver served Lunch (Club class), Traditional Afternoon Tea, On-site Betting Facilities, Live TV Monitors & Replays, On-site Car Parking, Events Team Management & Hostess Service. Don’t miss out on what could be a memorable day. We have obtained the tickets through Nationwide Sports Hospitality. They will be sent out 4 weeks prior to the event. For further details contact Anne Mawdsley at the RSA on 01270 872776. Annual Conference, Chester September 26th 2009 PUBLISHED BY: RAYNAUD’S & SCLERODERMA ASSOCIATION Charity Reg. No. 326306 112 Crewe Road, Alsager, Cheshire ST7 2JA Tel: 01270 872776 Fax: 01270 883556 Email: info@raynauds.org.uk Website: www.raynauds.org.uk EDITOR: Anne H Mawdsley MBE Raynaud's & Scleroderma Association © Copyright 2009. All Rights Reserved.