Scleroderma

A 37-year-old woman comes to the office because of fragile nails and fingertip ulcerations. She says that prior to the lesions her fingertips and toes would undergo strange color changes with associated numbness. However, she did not think that this was significant and she attributed it to the recent cold weather. She has a history of gastroesophageal reflux disease (GERD), hypertension, and asthma. She drinks alcohol occasionally but does not smoke. Her temperature is 37.5°C (99.5°F), pulse is 70/min, respirations are 14/min, and blood pressure is 130/79 mmHg. Physical examination reveals digital ulcerations and patched of lighter-colored skin. Cardiac and respiratory examinations are normal. Which of the following is a symptom that can be associated with her disease?