A 38-year-old female patient presented to the rheumatology clinic with a 3-week history of a painful fingertip ulcer. The pain was so severe that it was keeping her awake at night. For 20 years (since her teens) her hands had been turning white then purple in the cold weather, going red (with tingling) when rewarming. Her feet also felt cold. Her family doctor had told her that this was Raynaud’s phenomenon, which was very common. However, each winter her symptoms seemed to be worsening, and even a slight temperature change would bring on an attack. The previous winter she had had some finger ulcers which had, however, been less painful than the current one and which had healed spontaneously. Also of concern to her was that for 6 months the skin of her fingers had felt tight, and she had recently been experiencing some difficulty swallowing, with heartburn. There was no past medical history of note. She had smoked five cigarettes a day for 2 years. There was no history of...