MSK

Question 1

Raynaud’s phenomenon definition

Answer 1

• exaggerated vasoconstriction of the digital arteries and cutaneous arterioles
• precipitated by cold, relieved by heat

Question 2

Raynaud’s disease vs phenomenon

Answer 2

• primary (Raynaud’s disease)
• secondary (Raynaud’s phenomenon)

Question 3

Raynaud’s disease epidemiology/ presentation

Answer 3

young women (e.g. 30 years old) with bilateral symptoms.

Question 4

Raynaud’s phenomenon causes

Answer 4

• connective tissue disorders:
  – scleroderma (most common)
  – rheumatoid arthritis
  – systemic lupus erythematosus
• leukaemia
• type I cryoglobulinaemia, cold agglutinins
• use of vibrating tools
• drugs: oral contraceptive pill, ergot
• cervical rib

Question 5

Raynaud’s presentation

Answer 5

*initial pallor (vasconstriction) -> cyanosis -> redness (hyperaemia)

Question 6

Raynaud’s management

Answer 6

• all patients with suspected secondary Raynaud’s phenomenon should be referred to secondary care
• first-line: calcium channel blockers e.g. nifedipine
• keep hands and feet warm
• stop smoking
• IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months