Raynaud’s phenomenon in the occupational context

The search for articles was carried out in the Medline (via PubMed), Embase, Web of Science, Scientific Electronic Library Online (SciELO), and Latin America and Caribbean Health Sciences Literature (Lilacs) databases.

RESULTS

64 articles were obtained from the electronic search; 18 articles met the eligibility criteria. All studies discussed the exposure to vibrations in the upper limbs. In 6 of them, the thermal issue was directly or indirectly addressed. No studies have addressed exposure to vinyl chloride.

CONCLUSIO

In general, a higher prevalence of Raynaud’s phenomenon was found among vibratory tool operators compared to non-exposed workers, with an increase in the number of cases the higher the level of vibration and the time of exposure. Cold is a triggering and aggravating factor of the Raynaud phenomenon and seems to play an important role in the emergence of vascular manifestations of the hand-arm vibration syndrome.

Raynaud Disease; Peripheral Vascular Diseases; Vibration; Vinyl chloride; Cold Temperature

First author	Year	Study design	Country	Characteristics (population)	Characteristics (occupation)	Type of exposure
Kluger⁸	2017	Transversal	Finland	1000 people invited by email; response rate: 45%, 98 women and 350 men	Tattoo artists who are members of the French Union of Tattoo Artists	Vibration: tattoo gun
Pettersson⁹	2014	Transversal	Sweden	Workers with ONIHL*; received the questionnaire: 246 men/78 women; response rate: 41%	Most common occupations: teachers, military, and welders	Vibration: questions to estimate minutes/day and years of exposure. Cold: time outdoors when working
Roquelaure¹⁰	2012	Transversal	France	3.710 workers, 2.161 men (58%) and 1.549 women (42%)	Almost all occupations except farmers, artisans, tenants, self-employed	Vibration tools (≥2hours/day): 460 workers. Cold temperature <15^oC (≥4hours/day): 220 workers
Aiba¹¹	2012	Cohort	Japan	704 workers (685 men and 19 women). Mean observation time: 10.6 ± 7.4 years	Workers using an impact wrench	Vibration: 8 vibrating tools selected to be evaluated during work. Acceleration: 4.9 - 22.6 m/s2
Inaba¹²	2010	Transversal	Japan	120 men; 74 answered a questionnaire in the winter and 83 in the summer	Electricians (construction workers)	Vibration: 95% of electricians used vibration tools. Cold: local metrological information
Burström¹³	2010	Transversal	Sweden	Cases: 19,251 men exposed to vibration of hands/arms. Controls: 3,350 office workers	Cases: construction workers with exposure to hand and arm vibration	Vibration: 0-5 scale (occupational hygienists). Cold: local metrological information
Bovenzi¹⁴	2010	Cohort	Italy	Cases: 249 workers with exposure to vibration. Controls: 138 workers without exposure	Forestry workers (chainsaws with anti-vibration device) and quarry workers	Vibration: ISO 5349. Estimation of daily exposure: direct observation for one week (chronometer)
Bovenzi¹⁵	2008	Cohort	Italy	Cohort of 128 forestry workers. At the end of the follow-up, 57 workers (44.5%) had retired	Forestry workers: chainsaw operators	Vibration: sample of 9 chainsaws during operating conditions as per ISO 5349
Bovenzi¹⁶	2008	Cohort	Italy	183 forestry workers and 33 quarry workers completed the follow-up	Forestry workers: chainsaws. Quarry workers: tools for processing marble	Vibration: measurements taken during tool operating conditions as per ISO 5349
Bovenzi¹⁷	2005	Transversal	Italy	Cases: 100 female workers using orbital sanders. Controls: 100 female office workers	G(A) orbital sanders; (B) orbital sanders/hand sanding; (C) hand sanding	Vibration: measurements performed on 9 orbital sanders. Acceleration: 6.8 m/s2
Futatsuka¹⁸	2005	Transversal	Japan	73 quarry drill operators; 29 controls: manual tasks in the same companies	Quarry drill operators (rock drill)	Vibration: ISO 5349. Acceleration (drills): 45-55 m/s2; 160-210 min/day. Temp: South of Vietnan >25oC
Barregard¹⁹	2003	Transversal	Sweden	900 car mechanics received a questionnaire; 806 replied	Mechanics of cars	Vibration: working time (average): 12 years. Exposure: 14 minutes/day. Vibration level: 3.5 m/s2
Allen²⁰	2002	Transversal	Ireland	Three groups of men (79 riveters, 52 healthy controls, and 79 claimants)	Workers: riveters. Controls: no vibration. Claimants: yard/public services	Vibration: exposure time of 0.2 - 18 years among riveters and 1.5 - 48 years among claimants
Palmer²¹	2000	Transversal	United Kingdom	Questionnaires answered by 12.907 people aged 16-64 years (6.913 men/5.994 women)	Unspecified, random selection of record lists	Vibration: exposure assessed by questionnaire
Aiba²²	1999	Cohort	Japan	383 workers (men): use of impact wrench in electric light pole factory, 1982 to 1999	Workers using an impact wrench	Vibration: ISO 5349 and JIS B 49000. Exposure: 102 to 117 minutes/day. Cold: not characterized
Palmer²³	1998	Transversal	England	153 gas distribution agents (response rate 81%). Average of 16 years using vibrating tools	Gas distribution agents (pneumatic tools)	Vibration: ISO 5349. Vibratory tools (time of use - questionnaire): 1.2 to 5.5 hours/week (on average)
Bovenzi²⁴	1998	Transversal	Italy	Cases: 822 workers exposed to vibration, Controls: 455 healthy men not exposed	Grinders, mechanics, quarry drillers, construction/forestry workers, etc.	Vibration: ISO 5349; 8.3 m/s2 (percussion); 2.8-4.7 m/s2 (percussion/rotary); <2 m/s2 (rotary hand tools)
Miyashita²⁵	1998	Transversal	Japan	4652 private forestry workers (at least 1 medical examination for VS** from 1974 to 1996)	Forestry workers exposed to hand and arm vibration (chainsaws)	Vibration: estimation of career time operating vibratory tools

First author	Evaluation of the Raynaud phenomenon	Outcome
Kluger⁸	Questionnaire by e-mail. RP*: finger whitening related to cold. No evaluation was performed by a physician	448 questionnaires: 30 reported symptoms of RP; 11 appeared after the beginning of tattooing activity. Daily work hours: association with RP
Pettersson⁹	RP* classified by the questionnaire (with image)	RP* considered in 37% of those who reported exposure to hand and arm vibration and in 15% of those who did not report the exposure
Roquelaure¹⁰	Doctor asked about RP* features (last 12 months), defined as finger whitening episodes triggered by exposure to cold	87 cases of RP* diagnosed, 56 (women) and 31 (men). Female: association with psychosocial factors. Male: association with exposure to cold
Aiba¹¹	Medical evaluation with questions about the signs/symptoms related to RP* and typical image to aid in reporting	RP: 39 workers during the period. Incidence of RP: 6.27 people per 1000 individuals-year. Prevalence: 0.6% (1982), 6.2% (1987), 4.9% (2008)
Inaba¹²	Self-administered questionnaire. “White finger in response to cold environment”. No evaluation by a physician and no picture of RP*	Prevalence of RP* among construction electricians: 43.2% (winter) and 7.2% (summer)
Burström¹³	Self-administered questionnaire. Prevalence of RP* estimated by the questionnaire, without medical evaluation	Prevalence of white fingers: 13.4% (hand/arm vibration); 8.4% (controls). Higher odds ratio: intense vibration categories and workers in the North
Bovenzi¹⁴	Criterion 1: reliable history (images of RP*). Criterion 2 (more restrictive): history of “white fingers” and cold provocation test	Prevalence of RP*: Criterion 1: 21.7% (vibration) and 7.3% (controls). Criterion 2: 10.8% (vibration) and 0.7% (controls)
Bovenzi¹⁵	Physical examination; RP* related to occupation if provoked by cold and first episode after the beginning of occupational exposure	Prevalence of RP* related to vibration (beginning of the study): 26.6%; 11 new cases during the follow-up; cumulative incidence: 11.7%
Bovenzi¹⁶	Physical examination; RP* related to occupation if provoked by cold and first episode after the beginning of occupational exposure	Prevalence of RP* related to vibration (beginning of the study): 18.1% (forest workers:14.8%; quarry workers:36.4%). Incidence:1.7% (3 cases)
Bovenzi¹⁷	Physical examination; RP* related to occupation if provoked by cold and first episode after the beginning of occupational exposure	Daily vibration: higher in group A (4.7 m / s2) than in group B (3.9 m / s2); no significant difference (RP*) between furniture sander and controls
Futatsuka¹⁸	Subjective complaints assessed by interview. Peripheral circulation and neurosensory tests	No workers suffering from “white fingers”. Hypoaesthesia, weakness, and coldness in fingers/hands: significantly higher in the drill operators
Barregard¹⁹	Diagnosis based on the history of well-marked pallor episodes on the fingers or parts of the fingers (induced by cold)	Estimated prevalence of RP* related to vibration: approximately 15% among car mechanics
Allen²⁰	Questionnaire: medical and occupational history. Vasospasm: provocative test (cold) and systolic pressure of the finger	Riveters (6.3%) and claimants (83.5%) reported RP* symptoms. Positive test for vasospasm (finger cooling): riveters (30.4%); claimants (19%)
Palmer²¹	Questionnaire considering well-marked alterations of finger coloration caused by cold conditions	Pallor of the fingers (history): 14.2%. Cold-induced: 11.8%. Clear demarcation: 4.6%. Time of exposure (vibration): associated with symptoms
Aiba²²	Questionnaire: medical and occupational history. Doctor asked about RPrelated factors (images of RP)	Prevalence of RP* related to vibration: 1.7% (1982), 4.86% (1986), disappearing in 1994. During the period: preventive measures introduced
Palmer²³	Interview with doctor or nurse, questionnaire, physical examination, and hand immersion test in cold water (2-8oC for 4 minutes)	Prevalence of pallor of the fingers: 24%. Risk increased significantly with the hours of use of vibratory tools and the level of vibration
Bovenzi²⁴	Diagnosis: positive history for pallor episodes involving at least 1 finger and occurring after exposure to localized upper limb vibration	Prevalence of RP*: 17.2% among workers exposed to vibration, ranging from 9.0% among grinders to 51.6% among foundry workers
Miyashita²⁵	Medical evaluation records	Prevalence of workers who complained of “white fingers” induced by vibration: 25.9% (1978), 25.7% (1988) and 15.1% (1996)

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[1] CORRESPONDING AUTHOR: Rafael Alves Cordeiro. Instituto Oscar Freire Rua Teodoro Sampaio, 115 - Cerqueira César, São Paulo - SP, Brasil – 05406-000 – Phone: 55 (11) 3061-7291 Email: rafael19abc@hotmail.com