Reynaud's disease

Question 1

What are the two most classical things that cause Raynaud’s phenomenon?

Answer 1

Cold, and emotional stress

Question 2

What is the underlying pathology leading to Raynaud’s phenomenon?

Answer 2

Vasospasm of the arteries to the fingers, toes and occasionally other areas leading to reduced perfusion and the pallor

Question 3

What stages of sensation will the finger/toe go through when warmed after Raynaud’s phenomenon?

Answer 3

Start out cold

Then rubor when blood returns

Then back to normal, with tingling and paraesthesia

Question 4

In what circumstance do you see Raynaud’s phenomenon in the nipple?

Answer 4

In breastfeeding mothers

Question 5

What is primary Raynaud’s disease?

Answer 5

An idiopathic propensity to suffer Raynaud’s phenomenon

Sometimes referred to as an ‘allergy to cold’

Question 6

In what demographic is primary Raynaud’s disease most common?

Answer 6

Young women in their teens and early adulthood

Continues into later life

Question 7

What things are known to make primary Raynaud’s disease worse?

Answer 7

Smoking

Caffeine

Question 8

What are sufferers of primary Raynaud’s more likely to have?

Answer 8

Migraines

Angina

Question 9

What group of diseases are most linked to causing secondary Raynaud’s disease?

Answer 9

Connective tissue disorders

Question 10

What are some common connective tissue disorders that lead to secondary Raynaud’s disease?

Answer 10

Scleroderma

SLE

Rheumatoid arthritis

Sjogren’s syndrome

Ehlers-Danlos syndrome

Dermatomyositis

Question 11

Which eating disorder has been linked to causing secondary Raynaud’s disease?

Answer 11

Anorexia nervosa

Question 12

What major drugs have been known to cause secondary Raynaud’s disease?

Answer 12

Beta-blockers

Bromocriptine

Cytotoxic drugs, particularly bleomycin

Question 13

What occupations are known to cause a secondary Raynaud’s disease?

Answer 13

Jobs involving vibration, particularly drilling, causing hand arm vibration syndrome (HAVS)

Jobs involving being in cold environments for prolonged periods

Exposure to mercury

Question 14

What other conditions can lead to secondary Raynaud’s disease?

Answer 14

Lyme disease

Hypothyroidism

Cryoglobulinaemia

Malignancy

Carpal tunnel

MS

Question 15

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?

Answer 15

The fact that Raynaud’s disease can actually herald the onset of these conditions by very long periods, reaching into decades

Question 16

Raynaud’s phenomenon is the initial presenting symptom in 70% of patients with what condition?

Answer 16

Scleroderma

Question 17

What are some good ways to investigate the poor digital blood flow in Raynaud’s phenomenon?

Answer 17

Digital artery pressure before and after the hands have been cooled

+ve for Raynaud’s if digital artery pressure decreases by 15mmHg with vasospasm

Question 18

What methods other than digital artery pressure can be used to assess blood flow in Raynaud’s phenomenon?

Answer 18

Doppler ultrasound

Nail fold vasculature (under a microscope)

Question 19

What tests can be ordered in Raynaud’s disease?

Answer 19

FBE (normocytic anaemia from chronic disease or renal failure)

U&E (renal impairment)

TFTs (hypothyroidism)

ESR, CRP for inflammatory process

Rheumatoid factor (rheumatoid arthritis)

Question 20

What are some of the diagnostic features that lead to a diagnosis of Raynaud’s phenomenon?

Answer 20

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

Question 21

What is the primary management of primary Raynaud’s disease?

Answer 21

Avoidance of the things that bring it on, such as cold or emotional stress

Avoiding smoking and caffeine

Question 22

What drugs can be helpful in controlling Raynaud’s phenomenon?

Answer 22

Vasodilators (calcium channel blockers such as dihydropyridines nifedipine or amlodipine)

Sympatholytic agents (alpha adrenergic blocker prazosin)

Topical nitrates

ACEI, ARBs

Question 23

What role does losartan play in the management of Raynaud’s phenomenon?

Answer 23

It is an ARB

Reduces frequency and severity of attacks, possibly better than the calcium channel blocker nifedipine

Question 24

What surgical management can be offered to those with Raynaud’s phenomenon?

Answer 24

Sympathectomy, where the nerves to the blood vessels of the fingertips are transected

Microvascular surgery of the affected area

Amputation in severe cases

Question 25

Is there evidence that botulinum toxin could help with Raynaud’s phenomenon?

Answer 25

Yes

2009 study, 19 patients between 15-72 years. 16 patients had pain reduction at rest. All 13 who had ulcers lost them within 60 days.