Raynaud’s Disease and Syndrome

Episodic arteriolar spasm – leads to reduced blood flow in end arterioles
Leads to sequence of clinical features called Raynaud’s syndrome
- Local syncope – arteriospasm causes WHITE cold palm, pain, numbness and tingling
- Local asphyxia – arteriospam then leads to accumulation of deoxygenated blood, causing digits turn a BLUISH colour and patient feels a burning sensation
- Local recovery – due to relief of arteriospasm, blood returns to circulation, causing a RED colour
- Local gangrene – if spasm persists >1 hour then digits undergo ulceration and gangrene

Raynaud’s disease – primary

Idiopathic etiology
Most common in females
Occurs in the upper limb – usually bilateral (thumb is spared)
- Due to arteriolar spasm as a result of abnormal sensitivity to cold
Peripheral pulses are present (unlike in Buerger’s disease where they are dimished)
Aggravated by – smoking, caffeine, oestrogen, non-selective beta blockers

Raynaud’s syndrome – secondary

Has known etiology, occurs secondary to a wide variety of other conditions
Connective tissue disorders – scleroderma, SLE, rheumatoid arthritis, Sjögren’s syndrome
Obstructive disorders – atherosclerosis, Buerger’s disease, thoracic outlet syndrome
Drugs – beta-blockers, bleomycin, bromocriptine
Occupation – jobs involving vibrations e.g. road drills
As a part of CREST syndrome

Investigations

Doppler US of hand
MR Angiography of hand
Digital arterial pressures
Nail fold capillary microscopy – to detect associated connective tissue disorders (scleroderma)
X-ray
Serology – antinuclear antibody (ANA) screening
Others – blood sugar, lipid profile, hypercoagulability

Treatment