Reynaud's disease Flashcards
What are the two most classical things that cause Raynaud’s phenomenon?
Cold, and emotional stress
What is the underlying pathology leading to Raynaud’s phenomenon?
Vasospasm of the arteries to the fingers, toes and occasionally other areas leading to reduced perfusion and the pallor
What stages of sensation will the finger/toe go through when warmed after Raynaud’s phenomenon?
Start out cold
Then rubor when blood returns
Then back to normal, with tingling and paraesthesia
In what circumstance do you see Raynaud’s phenomenon in the nipple?
In breastfeeding mothers
What is primary Raynaud’s disease?
An idiopathic propensity to suffer Raynaud’s phenomenon
Sometimes referred to as an ‘allergy to cold’
In what demographic is primary Raynaud’s disease most common?
Young women in their teens and early adulthood
Continues into later life
What things are known to make primary Raynaud’s disease worse?
Smoking
Caffeine
What are sufferers of primary Raynaud’s more likely to have?
Migraines
Angina
What group of diseases are most linked to causing secondary Raynaud’s disease?
Connective tissue disorders
What are some common connective tissue disorders that lead to secondary Raynaud’s disease?
Scleroderma
SLE
Rheumatoid arthritis
Sjogren’s syndrome
Ehlers-Danlos syndrome
Dermatomyositis
Which eating disorder has been linked to causing secondary Raynaud’s disease?
Anorexia nervosa
What major drugs have been known to cause secondary Raynaud’s disease?
Beta-blockers
Bromocriptine
Cytotoxic drugs, particularly bleomycin
What occupations are known to cause a secondary Raynaud’s disease?
Jobs involving vibration, particularly drilling, causing hand arm vibration syndrome (HAVS)
Jobs involving being in cold environments for prolonged periods
Exposure to mercury
What other conditions can lead to secondary Raynaud’s disease?
Lyme disease
Hypothyroidism
Cryoglobulinaemia
Malignancy
Carpal tunnel
MS
With regards to the relationship between secondary Raynaud’s disease and the conditions that can cause it, what is important and interesting to keep in mind?
The fact that Raynaud’s disease can actually herald the onset of these conditions by very long periods, reaching into decades
Raynaud’s phenomenon is the initial presenting symptom in 70% of patients with what condition?
Scleroderma
What are some good ways to investigate the poor digital blood flow in Raynaud’s phenomenon?
Digital artery pressure before and after the hands have been cooled
+ve for Raynaud’s if digital artery pressure decreases by 15mmHg with vasospasm
What methods other than digital artery pressure can be used to assess blood flow in Raynaud’s phenomenon?
Doppler ultrasound
Nail fold vasculature (under a microscope)
What tests can be ordered in Raynaud’s disease?
FBE (normocytic anaemia from chronic disease or renal failure)
U&E (renal impairment)
TFTs (hypothyroidism)
ESR, CRP for inflammatory process
Rheumatoid factor (rheumatoid arthritis)
What are some of the diagnostic features that lead to a diagnosis of Raynaud’s phenomenon?
Episodes triggered by things other than cold (emotional stress)
Observed triphasic (white, blue, red) colour changes with well demarcated border between affected areas and normal areas
Episodes accompanied by numbness and/or paraesthesias
What is the primary management of primary Raynaud’s disease?
Avoidance of the things that bring it on, such as cold or emotional stress
Avoiding smoking and caffeine
What drugs can be helpful in controlling Raynaud’s phenomenon?
Vasodilators (calcium channel blockers such as dihydropyridines nifedipine or amlodipine)
Sympatholytic agents (alpha adrenergic blocker prazosin)
Topical nitrates
ACEI, ARBs
What role does losartan play in the management of Raynaud’s phenomenon?
It is an ARB
Reduces frequency and severity of attacks, possibly better than the calcium channel blocker nifedipine
What surgical management can be offered to those with Raynaud’s phenomenon?
Sympathectomy, where the nerves to the blood vessels of the fingertips are transected
Microvascular surgery of the affected area
Amputation in severe cases
