🔑 Key Learning

  • Vasospastic disorder affecting the fingers and toes
  • Triggered by cold or emotional stress → white/pale, painful, numb
  • Can be primary or secondary (especially connective tissue diseases)
  • 1st line treatment = nifedipine (CCB)

🧬 Pathophysiology

  • Cold or stress triggers excessive vasoconstriction of digital arteries
  • Results in transient ischaemia followed by reperfusion

đź‘€ Clinical Features

  • Classic triphasic colour change of digits:
    1. White (pallor) – due to ischaemia
    2. Blue (cyanosis) – due to deoxygenated blood
    3. Red (hyperaemia) – on rewarming
  • Associated symptoms: pain, tingling, numbness
  • Often symmetrical in primary, asymmetrical in secondary
Raynaud's syndrome
Figure 173: Secondary Raynaud's in Sjögren's syndrome, Intermedichbo, CC BY-SA 3.0

     

đź’ˇ Causes

Primary Raynaud’s (Raynaud’s Disease)

  • Idiopathic, more common in young women
  • Usually mild

Secondary Raynaud’s (Raynaud’s Phenomenon)

  • Associated with underlying disease. Long list of causes. Commonly:
    • Systemic sclerosis
    • SLE
    • Rheumatoid arthritis

đź’Š Management

  • 1st line: Nifedipine (calcium channel blocker)
  • 2nd line: IV prostacyclin (epoprostenol) infusion (for severe cases)
  • Advise on lifestyle: keeping hands warm, smoking cessation

đź“ť Exam Clues & Clinchers

  • Triphasic colour change, pain, numbness triggered by cold → think Raynaud’s
  • 1st line treatment: nifedipine