Rynaud's

Question 1

What is Raynaud’s?

Answer 1

• Exaggerated vasoconstrictive response of the digital arteries and cutaneous arterioles to cold or emotional distress
• May be primary (disease) or secondary (phenomenon)

Question 2

What are some secondary causes of Raynaud’s?

Answer 2

• Connective tissue disorders (scleroderma (most common), RA, SLE)
• Leukaemia
• Type 1 cryoglubinaemia, cold agglutinins
• Using vibrating tools
• Drugs (oral contraceptive pill, ergot)
• Cervical rib

Question 3

What factors may suggest an underlying connective tissue disorder?

Answer 3

• Onset after 40 years
• Unilateral symptoms
• Rashes
• Presence of autoantibodies
• Features which may suggest rheumatoid arthritis or SLE, for example arthritis or recurrent miscarriages
• Digital ulcers, calcinosis

Question 4

What is the management of Raynaud’s phenomenon?

Answer 4

• Possible secondary causes are referred to secondary care
• First-line: calcium channel blockers, e.g. nifedipine
• IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months