- 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
- Treat underlying cause if it is secondary
- Avoid precipitating factors
- Vasodilators – nifedipine, nitrates
- Low dose aspirin – 75-100mg/day
- ACE inhibitors/ARBs
- Endothelin inhibitors – bosentan
- To manage pulmonary hypertension
- Sympatholytic drugs – prazosin (alpha-blocker)
- Cervical sympathectomy – for non-healing digital ulcers