Reynauds Flashcards
An 18-year-old healthy woman presents with fingertips that turn white, then blue and red, in the cold. She is otherwise well and is a non-smoker. Her symptoms have been occurring for 3 years.
Impression
Given the triphasic clinical picture of white, then blue then red fingers in the cold, this is likely a presentation of Raynauds phenomenon.
- Primary: starts younger than 30, idiopathic, not associated with any systemic autoimmune condition or otherwise. affects 1in5 young women, due to exaggerated physiological response to the cold. This is Raynauds DISEASE
- Secondary, onset >30yrs, caused by underlying condition (autoimmune
Important differentials to consider (secondary causes of Raynauds phenomenon)
- erythromelalgia
- acrocyanosis
- cold agglutinin disease
- arterial thrombosis
- chilblains (perniosis)
Raynauds syndrome - History
History
- Sx: white then blue then red extremities (brought on by cold), pain (SOCRATES). ulcerations, rashes, other systemic features of autoimmune, paraesthesias
- Famhx, any other autoimmune disease,
- Risks: Female, glaucoma, Fam Hx, COCP, smoking
Raynauds phenomenon - Examination
Examination
- General observation + vitals
- UL/LL vasc
- autoimmune features: rash, arthritis, facial features, etc
- systems review
Raynauds phenomenon - Investigations
Investigations
Largely a clinical diagnosis.
- Key/diagnostic: nailbed capillary microscopy (only abnormal in secondary)
- Bedside: urinalysis
- Bloods: ESR/CRP, FBC, ANA/ENA
Raynauds phenomenon - Management
Management
Complications
- digital ulceration and ischaemia (if severe), may progress to critical digital ischaemia and require hospitalisation and medical/surgical intervention
Supportive;
- limit risk factors: smoking cessation, COPC
- patient education and counselling
Pharmacological
- avoid Beta blockers (can worsen sx)
- use of vasodilators if sx are severe: Amlodipine (dihydropyridine CCBs),
- topical GTN
Surgical
- sympathectomy if severe (altho rarely indicated)
