A 45-year-old woman presents with a 4-month history of severe headaches and pain and blanching of the hands upon exposure to cold. She is a nonsmoker. Over the past 6 months, she has noticed progressive difficulty in swallowing solid food. Physical examination reveals smooth and tight skin over the face and fingers. The serologic test for anti-Scl-70 (anti topoisomerase) is positive. Painful hands in this patient are best described using which of the following terms?

This patient suffers from scleroderma complicated by Raynaud phenomenon. It refers to intermittent, bilateral attacks of vasospasm of the fingers or toes (sometimes affecting the ears or nose), resulting in pallor, paresthesias and pain from ischemia. The symptoms are precipitated by cold or emotional stimuli and relieved by heat. Raynaud phenomenon may occur as an isolated disorder or as a feature of a number of systemic diseases, including systemic lupus erythematosus and scleroderma. Intermittent claudication is associated with peripheral vascular disease (atherosclerosis). Chilblains represent itchy or tender red or purple bumps that occur as a reaction to cold.