Raynaud' phenomenon

Question 1

What is it?

Answer 1

an exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress. It may be primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon).

Question 2

who?

Answer 2

young women

Question 3

bilateral or unilateral

Answer 3

bilateral

Question 4

secondary 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

factors suggesting underlying CTD

Answer 5

onset after 40 years
unilateral symptoms
rashes
presence of autoantibodies
features which may suggest rheumatoid arthritis or SLE, for example arthritis or recurrent miscarriages
digital ulcers, calcinosis
very rarely: chilblains

Question 6

Mx

Answer 6

refer to secondary care

1st line - calcium channel blockers e.g. nifedipine

IV prostacyclin (epoprostenol) infusions - lasts weeks/months