Raynaud's phenomenon

Raynaud's phenomenon is characterised by an exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress. It may be primary (Raynaud's disease) or secondary (Raynaud's phenomenon).

Raynaud's disease typically presents in young women (e.g. 30 years old) with bilateral symptoms.

Secondary causes of Raynaud's phenomenon

• connective tissue disorders
  • scleroderma (most common)
  • rheumatoid arthritis
  • systemic lupus erythematosus
• leukaemia
• type I cryoglobulinaemia, cold agglutinins
• use of vibrating tools
• drugs: oral contraceptive pill, ergot
• cervical rib

Factors suggesting underlying connective tissue disease

• onset after 40 years
• unilateral symptoms
• rashes
• presence of autoantibodies
• features which may suggest rheumatoid arthritis or SLE, for example arthritis or recurrent miscarriages
• digital ulcers, calcinosis
• very rarely: chilblains

Management