Raynaud's

Question 1

What is Raynaud’s phenomenon?

Answer 1

Exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress.

Leads to colour changes.

Question 2

difference between primary and secondary raynaud’s

Answer 2

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

Question 3

typical presentation of raynaud’s

Answer 3

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

Question 4

secondary causes of raynaud’s

Answer 4

connective tissue disorders
leukaemia
type I cryoglobulinaemia, cold agglutinins
use of vibrating tools
drugs: oral contraceptive pill, ergot
cervical rib

Question 5

what connective tissue disorders are a/w secondary raynaud’s?

Answer 5

scleroderma (most common)
rheumatoid arthritis
systemic lupus erythematosus

Question 6

what features suggest connective tissue disease in raynaud’s phenomenon?

Answer 6

onset after 40 years

unilateral symptoms

rashes

presence of autoantibodies

features which may suggest RA or SLE, e.g. arthritis or recurrent miscarriages

digital ulcers, calcinosis

very rarely: chilblains

Question 7

mx of raynaud’s?

Answer 7

all with ?secondary Raynaud’s phenomenon referred to secondary care

first-line: calcium channel blockers e.g. nifedipine

IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months

Question 8

what are nail fold capillary microscopy findings in raynaud’s?

Answer 8

+ve = underlying pathology suggestive of secondary Raynaud’s

Question 9

what do +ve ab suggest in raynaud’s?

Answer 9

indicate the possibility of a systemic disorder, such as systemic sclerosis, causing secondary Raynaud’s

Question 10

what do rashes in raynaud’s suggest?

Answer 10

very non-specific and may just be eczema.

may be more indicative of secondary Raynaud’s, as many systemic conditions that cause Raynaud’s are also associated with rashes.