Raynaud’s Phenomenon Raynaud’s disease

• Causes
• What will the health professional do?
• Tests for the symptoms
• How is it treated

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.

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

What will the health professional do?

The health professional will first take a history from you, and ask you to describe your symptoms in detail. Then the doctor will perform a physical examination, and depending on what he finds he may run some tests as described below to determine a possible cause.

Tests for the symptom?

The tests for Raynauds phenomenon include:

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

How is it 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.

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