Raynaud's Phenomenon

Question 1

What is Raynaud’s phenomenon?

Answer 1

Vasospasm of the digits. It is painful and is characterised by a sequence of colour changes.

Be aware there is primary & secondary Raynauds. Raynauds disease sometimes used to describe primary raynauds and raynauds syndrome/phenomenon used to describe secondary raynauds.

Question 2

What is primary Raynauds (sometimes called Raynauds disease)

Who is it common in?

Is it familial?

Treatment

Answer 2

• This term is used when Raynaud’s phenomenon is idiopathic
• Common in young women
• May be familial
• Treatment:
  
  • Keep warm
  • Avoid smoking
  • Avoid caffeine
  • If lifestyle doesn’t work, can try nifedipine

Question 3

State the colour changes seen in Raynaud’s phenomenon and for each describe what is happening in terms of blood flow

Answer 3

1. White: inadequete blood flow
2. Blue: venous stasis
3. Red: re-warming hyperaemia

Question 4

Raynaud’s phenomenon which develops in a pt over 30yrs should alert you to underlying disease; true or false?

Answer 4

True

Question 5

State some triggers for a Raynaud’s attack

Answer 5

• Cold
• Stress
• Vibration
• Chemicals that interfere with circulatory system e.g. caffeine

Question 6

State some potential causes of Raynaud’s phenomenon

Answer 6

• Associated with diseases such as:
  
  • Scleroderma
  • SLE
  • Dermatomyositis & polymyositis
  • Sjogren’s syndrome
• Physical causes:
  
  • Use of heavy vibrating tools
  • Cervical rib
  • Sticky bood e.g. cyroglobulinaemia
• Drug induced:
  
  • Beta blocker

Question 7

Discuss how you can distinguish if Raynaud’s phenomenon is due primary Raynaud’s or Raynaud’s phenomenon?

Answer 7

Raynaud’s Syndrome

• Lasts a few minutes
• Usually symmetrical & bilateral
• Tissue necrosis is rare

Raynaud’s phenomenon due to underlying disease

• May last for hours
• Often asymmetrical with only a few digits affected

Question 8

What can you use to investigate structural changes in the peripheral microcirculation to help with diagnosis of Raynaud’s?

Answer 8

Nail-fold capillaroscopy

Question 9

State some potential complications of Raynaud’s phenomenon

Answer 9

• Digital ulcers
• Infection
• Gangrene

Question 10

Discuss the management of Raynaud’s phenomenon

Answer 10

Conservative

• Advised to keep warm
• Smoking cessation
• Avoid caffeine
• Refer to rheumatologist for investigation of underlying cause

Pharmacological

• 1st line= dihydropyrinde CCBs e.g. Nifedipine
• 2nd line= consider phosphodiesterase 5-inhibitors and prostacyclins