Raynaud's phenomenon in a patient with silicone implants: How far is ASIA syndrome and not mixed connective tissue disease?

Raynaud's phenomenon represents a harbinger of polyautoimmunity and although it is usually associated with systemic sclerosis, the discussion surrounding its classification in rheumatology is interesting given the current understanding of capillaroscopic findings in rheumatic diseases and improvements in immunological diagnostics. We present the case of a young woman who presented with biphasic Raynaud's phenomenon (pallor, cyanosis) associated with polyarthralgia affecting small joints of hands and feet in the context of immunological profile suggestive of undifferentiated connective tissue disease (ANA -anti-nuclear antibodies- 1:1280, mottled pattern and anti-RNP -anti-U1 ribonucleoprotein- at high titers: >200). Considering personal history of cohesive silicone buttock implants in 2012, a probable case of ASIA (Autoimmune/inflammatory Syndrome Induced by Adjuvants) syndrome was considered, given the presence of one major and two minor criteria. However, a debate arises regarding the clinical spectrum of mixed connective tissue disease and the controversial ASIA syndrome.