TY - JOUR T1 - Pauling and Frech reply JF - The Journal of Rheumatology JO - J Rheumatol SP - 1544 LP - 1545 DO - 10.3899/jrheum.190565 VL - 46 IS - 11 AU - JOHN D. PAULING AU - TRACY M. FRECH Y1 - 2019/11/01 UR - http://www.jrheum.org/content/46/11/1544.abstract N2 - To the Editor:We thank Dr. Hughes for his interest1 in our article2 reporting factors influencing Raynaud phenomenon (RP) symptom reporting in patients with systemic sclerosis (SSc). We presented data demonstrating differences in Raynaud symptom reporting using the Raynaud Condition Score (RCS) diary depending on season of enrollment2. A weaker-than-expected relationship between external temperature (using Meterological Office data) and contemporaneous collection of the RCS diary (Spearman ρ ∼ −0.25) suggests that other factors beyond cold exposure may contribute to Raynaud burden in SSc2. Dr. Hughes has presented an analysis of the effect of season on Raynaud by evaluating the influence of seasonal variation on Internet searches using the term “Raynaud phenomenon”. Consistent with an anticipated relationship between cold exposure and Raynaud symptoms, a clear pattern emerges highlighting increasing health-seeking Internet search activity for Raynaud during the colder months, with troughs during warmer seasons. An evaluation of mean monthly UK temperatures over the same period of analysis suggests seasonal factors beyond external temperature may contribute to information-seeking behavior for Raynaud symptoms. … Address correspondence to J.D. Pauling, Senior Lecturer and Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK. E-mail: JohnPauling{at}nhs.net ER -