Raynaud's

Question 1

What is Raynaud’s?

Answer 1

• Vasospasm of digits
• Painful and characterised by typical sequential colour changes in response to cold stimulis
• Precipitated by stress

Question 2

Colour changes raynaud’s

Answer 2

• White - inadequate blood flow
• Blue - venous stasis
• Red - re warming hyperaemia

Question 3

What is Raynaud’s syndrome?

Answer 3

• When raynaud’s is idiopathic
• Common in young women, may improve as get older
• Can be familial
• Treatment is to keep hands warm and avoid smoking

Question 4

What is Raynaud’s phenomenon?

Answer 4

• Symptoms develop over 30yrs usually
• Due to underlying disease
• Abnormal nail fold cpillaries or puffy fingers or photosensitive rash suggests rheumatic cause

Question 5

Conditions associated with Raynaud’s phenomenon

Answer 5

• Scleroderma
• SLE
• Dermatomyositis and polymyositis
• Sjogrens

Question 6

Physical causes of Raynauds phenonmenon

Answer 6

• Heavy vibrating tool usage
• Cervical rib - compressing blood flow
• Sticky blood eg cryoglobinaemia

Question 7

Drug causes of Raynaud’s phenonmenon

Answer 7

• Beta blockers
• Cyclosporin
• Interferons

Question 8

Treatment for Raynauds phenonmenon

Answer 8

• Keep warm
• Avoid smoking
• CCBs first line eg Nifedipine
• Phosphodiesterase 5 inhibitors eg Sildenafil
• Prostacylins eg Iloprost
• Sympathectomy surgery - if very bad in lower limbs

Weak evidence for ACEi, SSRIs, systemic and topical nitrates

Question 9

Complications Raynauds Phenomenon

Answer 9

• Digital ulcers
• Severe digital ischaemia
• Infection

Question 10

Episodes for raynauds syndrome

Answer 10

• Lasts minutes
• Symmetrical
• Bilateral
• Tissue necrosis rare

Question 11

Episodes for Raynauds phenomenon

Answer 11

• Episodes last for hours
• Pattern assymetrical
• Few digits affected

Question 12

Investigation for Raynaud’s

Answer 12

• Nail fold capillaroscopy - non invasive
• Available in Rheum
• Useful to diagnose scleroderma and diabetes mellitus
• Shows structural changes in peripheral microcirculation

Question 13

Infection causes Raynauds

Answer 13

• Hepatitis B
• Hepatitis C
• CMV
• Parvovirus B19

Question 14

What else, other than cold, can bring on Raynauds?

Answer 14

Stress

Question 15

Primary pathophysiology of Raynauds

Answer 15

• Adrenoreceptors more sensitive to cold - constrict when not meant to

Question 16

Pathophysiology of secondary raynauds

Answer 16

• Normal vessel activity vasoconstriction is disrupted eg by fibrous tissue

Question 17

Clues that Raynauds is secondary to CTD

Answer 17

• Vasospasm is all year round
• Abnormal nail fold capillaries - seen in capillaroscopy
• Digital ulcers

Question 18

Capillaroscopy findigns for Raynauds

Answer 18

• Dilated capillary loops - compensating for
• Avascular areas

Question 19

Questions used to screen if Raynauds is secondary

Answer 19

• Arthralgia
• Rashes
• Alopecia
• Constitutional - weight loss, night sweats, fever
• Neuropsychiatric