Raynaud's Phenomenon

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Raynaud's phenomenon

Raynaud's Disease

A thermal image demonstrating the loss of heat in a Reynaud's sufferer

Raynaud's phenomenon (RAY-noz) is a medical condition recognized within the discipline of medicine. It manifests as a vasospastic disorder leading to discoloration of the fingers, toes, and sometimes other extremities. Though the exact cause remains unidentified, triggers classically include emotional stress and cold exposure. The discoloration typically follows a chronological pattern: white, then blue, and finally red. This condition exists in two forms: Raynaud's disease (or primary Raynaud's), which is idiopathic in nature, and Raynaud's syndrome (or secondary Raynaud's), which occurs due to an underlying condition.

Raynauds with Skin Lesions

Incidence

Raynaud's phenomenon tends to be more prevalent among women. Data from the Framingham Study indicated that while 5.8% of men were affected, the prevalence in women stood at 9.6%.

Epidemiology

Primary Raynaud's often has a genetic linkage and is typically observed before the age of 30. Lifestyle choices like smoking exacerbate the frequency and severity of episodes. Additionally, hormonal influences play a role. Those affected are statistically more prone to suffer from migraine and angina compared to those without the condition.

Secondary Raynaud's has been associated with:

Connective tissue disorders, including:

• • scleroderma
  • Systemic lupus erythematosus
  • rheumatoid arthritis
  • Sjögren's syndrome
  • dermatomyositis
  • polymyositis

Obstructive ailments such as:

• • atherosclerosis
  • Buerger's disease
  • Subclavian aneurysms
  • thoracic outlet syndrome

Medications and drugs including:

• • Beta-blockers
  • Chemotherapeutic agents, notably chemotherapeutics and specifically bleomycin
  • cyclosporin
  • gotamine
  • sulfasalazine

Occupational risks:

• • Vibrational jobs, especially drilling
  • Exposure to the chemical vinyl chloride
  • Exposure to cold temperatures, such as in frozen food packaging

Other conditions:

• • hypothyroidism
  • cryoglobulinemia
  • malignancy
  • reflex sympathetic dystrophy

Significantly, Raynaud's can precede some of these diseases by over 20 years, often making it their inaugural symptom. Such is the case with CREST syndrome, wherein Raynaud's is a component.

Symptoms

Individuals with this condition experience painful, cold, and pale extremities. This can cause distress, affect quality of life, and potentially lead to serious complications. Unilateral Raynaud's, particularly localized only to hands or feet, is usually indicative of secondary Raynaud's, given that primary Raynaud's affects the whole body. However, some patients might not recognize symptoms in their feet. During pregnancy, this phenomenon typically subsides due to enhanced peripheral blood flow.

Investigations

Distinguishing between primary and secondary Raynaud's often begins with a comprehensive history. Subsequent investigations primarily target the identification or exclusion of potential underlying causes. These include:

Digital artery pressure tests both pre and post cooling of hands, with a drop of 15mmHg or more being diagnostic. Doppler ultrasound for assessing blood flow. Full blood count which can indicate a normocytic anaemia hinting at anemia of chronic disease or renal failure. Urea & Electrolytes to detect kidney issues. Thyroid function tests to diagnose hypothyroidism. Various tests like autoantibody screen, rheumatoid factor, ESR, and CRP to either pinpoint specific causative diseases or determine a general inflammatory process. Examination of nail fold vasculature under a microscope.

Treatment

The treatment approach primarily depends on the categorization of Raynaud's. Addressing the root cause is the primary strategy for Raynaud's syndrome, but it also encompasses treatments meant for Raynaud's disease. Primary Raynaud's management generally centers around averting triggers such as:

Environmental factors like cold, vibrations, etc. (while emotional stress is recognized, conscious avoidance is often unattainable). Wearing warm clothing, especially mittens. Regulating hormones and evaluating the oral contraceptive pill taken. Low oestrogen pills are preferred, with the progesterone only pill often prescribed. Abstaining from smoking. Medications like calcium channel blocker, commonly nifedipine, to avert arterioconstriction. However, side effects such as headache, flushing, and ankle swelling sometimes make patients discontinue medication. Some research supports using Angiotensin II receptor antagonists, especially Losartan, to reduce attack frequency and severity. In severe, unmanageable cases, options like sympathectomy, prostaglandin infusions, or even amputation might be considered.

See Also

• CREST syndrome
• Circulatory system