Malady Wise

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Raynaud's Phenomenom

Overview

  • Exaggerated phenomenon to cold temperature or emotional stress

  • Sharp demarcated colour changes of the skin of the digits

Primary

  • No associated cause

  • Age 15 to 30

  • Females > males

Risk factors

  • Family history

  • Smoking

  • Manual occupation

  • Migraine

  • CV disease

Associated conditions

  • Fibromyalgia

  • Migraines

Secondary

  • Systemic sclerosis, SLE, MCTD, Sjogren’s, Dermatomyositis/Polymyositis

  • Various drugs and toxins including amphetamines

  • Haematology abnormalities include cryoglobulinemia

  • Hypothyroidism

Incidence

  • Surveys estimate 3 to 20% in females and 3 to 14% in males

Features

  • Digits, ear, nose, face, knees, nipples

  • Typical episode is cold fingers, demarcated colours, white then blue then red

  • White or blue lasts 15 to 20 minutes

Additional lab tests if concerns about secondary Raynaud’s

  • CBC

  • Urinalysis

  • ANA

  • TSH

  • ESR/CRP

  • If sclerodactylyl

    • AB for Ssc

  • If suspected inflammatory myopathy

    • CK / ENA

  • If suspected SLE or cryoglobulinemia

    • C3/C4

  • If suspected paraproteinemia

    • SPEP

Vascular Imaging

  • If single digit or asymmetric attacks, absent pulses, asymmetric BP or evidence of chronic ischaemia

DDx

  • Excessive cold sensitivity

  • External compression of blood vessels

  • Peripheral neuropathy

  • CRPS

  • Occlusive vascular disease

  • Acrocyanosis

  • Chilblains

Treatment

  • Avoidance of cold exposure

  • Maintain whole body warmth and digital warmth

  • Consider reducing caffeine

  • Consider reducing cold exposure during surgery

  • Avoid vasoconstricting jobs

  • Smoking cessation

  • Calcium channel blockers = Amlodipine

  • PDE5

  • Topical nitrates