Raynaud’s phenomenon (Raynaud’s disease)

• What is Raynaud’s Phenomenon (Raynaud’s disease)
• Statistics on Raynaud’s Phenomenon (Raynaud’s disease)
• Risk Factors for Raynaud’s Phenomenon (Raynaud’s disease)
• Progression of Raynaud’s Phenomenon (Raynaud’s disease)
• Symptoms of Raynaud’s Phenomenon (Raynaud’s disease)
• Clinical Examination of Raynaud’s Phenomenon (Raynaud’s disease)
• How is Raynaud’s Phenomenon (Raynaud’s disease) Diagnosed?
• Prognosis of Raynaud’s Phenomenon (Raynaud’s disease)
• How is Raynaud’s Phenomenon (Raynaud’s disease) Treated?
• Raynaud’s Phenomenon (Raynaud’s disease) References

What is Raynaud’s Phenomenon (Raynaud’s disease)

Raynaud’s Phenomenon is a disease that is caused by involuntary narrowing of blood vessels most commonly in the regions supplying the fingers, toes, ears and tip of the nose. This can cause death of the tissue in those areas due to lack of blood supply. Raynaud’s phenomenon causes distinct colour changes in the affected parts of the body and is usually brought on by certain triggers for example cold and emotional stress. Attacks generally last for minutes to hours and can vary. There are two main forms of Raynaud’s phenomenon are divided into primary and secondary. The primary form of Raynaud’s phenomenon is not associated with other diseases and is generally less severe, whereas the secondary form of Raynaud’s phenomenon is associated with a group of conditions referred to as connective tissue disease and has worse consequences.

Statistics on Raynaud’s Phenomenon (Raynaud’s disease)

Raynaud’s phenomenon can be associated with diseases of the arteries such as Buerger’s disease and atherosclerosis, rheumatoid arthritis, scleroderma and systemic Lupus erythematosus. It can also follow repeated trauma, particularly vibrations such as those caused by typing or playing the piano. An overdose of ergot compounds or methysergide may also be a cause of Raynaud’s phenomenon.

When Raynaud’s phenomenon occurs without any underlying disorder, it is then known as Raynaud’s disease. This is a common disease affecting 5% of the population and occurring predominantly in young women.

Risk Factors for Raynaud’s Phenomenon (Raynaud’s disease)

The risk factors include:

• Smoking
• Working with vibrating machinery.
• Emotional distress.
• Exposure to the cold.
• Women affected more often than men.

Causes of Raynaud’s phenomenon

• Primary or idiopathic Raynaud’s phenomenon : Raynaud’s disease

• Secondary
  • Collagen vascular diseases: scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polymyositis
  • Arterial occlusive diseases: atherosclerosis of the extremities, thromboangiitis obliterans, acute arterial occlusion, thoracic outlet syndrome
  • Pulmonary hypertension
  • Neurologic disorders: intervertebral disc disease, syringomyelia, spinal cord tumors, stroke, poliomyelitis, carpal tunnel syndrome
  • Blood dyscrasias: cold agglutinins, cryoglobulinemia, cryofibrinogenemia, myeloproliferative disorders,
    Waldenstrom’s macroglobulinaemia
  • Trauma: vibration injury, hammer hand syndrome, electric shock, cold injury, typing, piano playing
  • Drugs: alpha-adrenergic receptor blockers, bleomycin, vinblastine, cisplatin

Progression of Raynaud’s Phenomenon (Raynaud’s disease)

Over 90% of patients with Raynaud’s phenomenon are female and, at the time of presentation, are often aged under 25. Up to 5% of patients initially presenting with only symptoms of Raynaud’s eventually develop an autoimmune rheumatic disease.

How is Raynaud’s Phenomenon (Raynaud’s disease) Diagnosed?

The tests for Raynauds phenomenon include:

• Blood tests – full blood count, biochemistry profile
• urinalysis
• Other tests – depending on if a second cause is suspected

Prognosis of Raynaud’s Phenomenon (Raynaud’s disease)

The outcome varies depending on the cause and the severity of the phenomenon and whether it has been associated with another disease.

How is Raynaud’s Phenomenon (Raynaud’s disease) Treated?

Conservative treatment

This consists of the doctor providing advice with regard to avoiding precipitants. These include keeping the extremities warm, reducing emotional stress and avoiding drugs such as nicotine and other drugs that can cause narrowing of the blood vessels. They may also tell you that you can prevent an attack from progressing by placing your hands in warm water.

Medications

The medications that are used are calcium channel blockers e.g. nifedipine, alpha blockers e.g. Prazosin, and other drugs like fluoxetine and losartan. Medications are generally used only after conservative treatment fails.

Other therapies

Some surgical techniques can be used if ulceration of the fingers is a major problem.

Raynaud’s Phenomenon (Raynaud’s disease) References

1. Boin F. & Wigley F. 2005 ‘Understanding, assessing and treating Raynaud’s phenomenon’, Curr,. Opin. Rheumtol., vol. 17, pp 752 – 760
2. Coffman J.D. 1991 ‘Raynaud’s Phenomenon: An update’, Hypertension, vo. 17, pp. 593 – 602
3. Kumar V et.al. Robbins Pathological Basis of Disease. 6th ed. Philadelphia. WB Saunders 1999
4. ‘Harrisons Chapter 303 – Systemic Sclerosis (Scleroderma) and Related Disorders’ [online], McGraw Hill’s AccessMedicine, Available at URL http://www.accessmedicine.com (last accessed 12/06/2006)
5. Tagliarino H, Purdon M, & Jamieson B. 2005 ‘Understanding, assessing and treating Raynaud’s phenomenon’, Journal of Family Practice, vol 54, pp 553 – 555