Raynaud's phenomenon

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Introduction

Reversible vasospasm of the digital arteries which may result in ischemia of the digits.

Etiology

Epidemiology

  • primary
    • common
    • most patients 15-20 years
    • predominance of females
    • affects 3-5% of male population, 4-9% of female population
    • < 50% of affected individuals seek medical attention
  • secondary
    • most individuals > 35 years
    • no sex preference
    • suspect if patient is male, >35 or <15 years of age
  • 8% of men, 11% of women (mean age 54 years)[8]

Pathology

Clinical manifestations

  • primary Raynaud's phenomenon
  • secondary Raynaud's phenomenon
    • symptoms similar to primary Raynaud's phenomenon, but may be more severe with rapid progression
    • symptoms may be unilateral
    • manifestations of precipitating etiology may be present
    • digital pitting scar or gangrene may occur
  • most cases without underlying connective tissue disease are mild[8]

Criteria for diagnosis of primary Raynaud's phenomenon

Laboratory

Diagnostic procedures

Complications

< 10% of patients with isolated Raynaud's phenomenon will develop systemic connective tissue disease within 10 years

Differential diagnosis

Management

More general terms

Additional terms

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 525-26
  2. Guide to Physical Examination & History Taking, 4th edition, Bates B, JB Lippincott, Philadelphia, 1987
  3. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 288-90
  4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 874-75
  5. 5.0 5.1 5.2 5.3 5.4 5.5 Medical Knowledge Self Assessment Program (MKSAP) 11,14,16,17. American College of Physicians, Philadelphia 1998,2006,2012,2014
  6. Principles of Ambulatory Medicine, 4th edition, Barker et al (eds), Williams & Wilkins, Baltimore, 1995, pg 893
  7. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1139
  8. 8.0 8.1 8.2 8.3 Journal Watch 25(11):91, 2005 Suter LG, Murabito JM, Felson DT, Fraenkel L. The incidence and natural history of Raynaud's phenomenon in the community. Arthritis Rheum. 2005 Apr;52(4):1259-63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15818710
  9. 9.0 9.1 Prescriber's Letter 13(1): 2006 Viagra and Raynaud's phenomenon Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220111&pb=PRL (subscription needed) http://www.prescribersletter.com
  10. Hirschl M et al, Transition from primary Raynaud's phenomenon to secondary Phenomenon identified by diagnosis of an associated disease: Results of ten years prospective surveillance. Arthritis Rheum 2006; 54:1974 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16732585
  11. 11.0 11.1 Prescriber's Letter 15(12): 2008 Drugs that Aggravate or Improve Raynaud's Phenomenon Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=241207&pb=PRL (subscription needed) http://www.prescribersletter.com
  12. Neumeister MW et al. Botox therapy for ischemic digits. Plast Reconstr Surg 2009 Jul; 124:191. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19568080
  13. 13.0 13.1 Lambova SN, Muller-Ladner U. The role of capillaroscopy in differentiation of primary and secondary Raynaud's phenomenon in rheumatic diseases: a review of the literature and two case reports. Rheumatol Int. 2009 Sep;29(11):1263-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19547979
  14. 14.0 14.1 Shenoy PD, Kumar S, Jha LK et al Efficacy of tadalafil in secondary Raynaud's phenomenon resistant to vasodilator therapy: a double-blind randomized cross-over trial. Rheumatology (Oxford). 2010 Dec;49(12):2420-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20837499
  15. 15.0 15.1 Wigley FM, Flavahan NA Raynaud's Phenomenon N Engl J Med 2016; 375:556-565. August 11, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27509103 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1507638
  16. 16.0 16.1 Roustit M, Giai J, Gaget O et al On-Demand Sildenafil as a Treatment for Raynaud Phenomenon: A Series of n-of-1 Trials. Ann Intern Med. 2018. Oct 30. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30383134 <Internet> http://annals.org/aim/article-abstract/2709822/demand-sildenafil-treatment-raynaud-phenomenon-series-n-1-trials
  17. RNational Institute of Arthritis and Muscluloskeletal and Skin Diseases (NIAMS) Raynaud's Phenomenon https://www.niams.nih.gov/health-topics/raynauds-phenomenon

Patient information

Raynaud's disease patient information