Raynaud’s Phenomenon

KEY FEATURES

ESSENTIALS OF DIAGNOSIS

• One or more digits blanch with cold exposure or emotional upset and subsequently show hyperemia when warmed

• Nail fold capillaries are normal by microscopy in primary Raynaud’s phenomenon

• Focal digital-tip necrosis

GENERAL CONSIDERATIONS

• Primary Raynaud’s phenomenon:

  • – Is 10 times more common in women than in men

  • – Starts around puberty

• Raynaud-type symptoms occur in about 20% of women in northern countries

• Secondary Raynaud’s phenomenon:

  • – Starts at an older age

  • – Is due to vasculitis or coagulopathies

  • – Is more likely to result in ischemic digital injury

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

• Exposure to cold, emotional upset, or smoking causes 1 or more digits to blanch with subsequent hyperemia on rewarming

• Primary Raynaud’s phenomenon usually spares the thumb

PHYSICAL EXAM FINDINGS

• Digital-tip necrosis can be seen in secondary Raynaud’s phenomenon

• Physical findings of an autoimmune disease such as arthritis may be found

DIFFERENTIAL DIAGNOSIS

• Primary disease versus secondary causes, such as collagen vascular diseases, vasoactive drugs, and blood viscosity disorders

DIAGNOSTIC EVALUATION

LABORATORY TESTS

• Patients with primary disease have completely normal laboratory tests

• In secondary disease, the CBC, antinuclear antibody titer, rheumatoid factor, erythrocyte sedimentation rate, von Willebrand factor antigen, cryoglobulin, cryofibrnogen, and cold agglutinin titers may be abnormal

IMAGING STUDIES

• Capillary microscopy: useful for distinguishing primary from secondary Raynaud’s phenomenon:

  • – The capillaries are normal in the primary disease

  • – Various degrees of capillary loss are seen in the secondary form

TREATMENT

MEDICATIONS

• Use vasoactive drugs, such as calcium channel blockers, eg, amlodipine 2.5–5 mg PO daily

SURGERY

• Digital sympathectomy in extreme cases

ONGOING MANAGEMENT

COMPLICATIONS

• Digital necrosis

PROGNOSIS

• Excellent in primary disease

PREVENTION

• Stop smoking

• Avoid cold exposure (eg, wear gloves)

• Avoid rings on affected digits

RESOURCES

REFERENCE