RHEUMATOLOGY

Raynaud’s phenomenon  

  • Clinically presents as episodes (min-hours) of blanching and/or cyanosis of digits followed by erythema, tingling and pain
  • Due to vasospasm and structural diseases of blood vessels following cold exposure or emotional stress
  • Symptoms
    • Hypersensitivity to cold Temperatures
    • Color changes of digits during cold or stress exposure
    • “White attacks” suggest severe ischemia
    • Mottling with acrocyanosis is more common and benign
    • Sensation of numbness, clumsiness or “pins and needles”
    • One finger may be more sensitive than the others
  • Signs
    • Pallor or Cyanosis of fingers or toes
    • Thumb is not involved
  • If severe, can result in infarction of tissue at fingertips → digital pitting scars, gangrene or autoamputation of the fingers/toes
  • Scleroderma is the most common cause of secondary Raynaud’s phenomenon
  • Secondary Causes of Raynaud’s Phenomenon
    • Connective Tissue Disease
      • Scleroderma (95% have Raynaud’s)
      • Systemic Lupus Erythematosus
      • Sjogren’s Syndrome
      • Dermatomyositis
    • Trauma
      • Occupational tool use (vibratory tool)
    • Carpal Tunnel Syndrome
    • Occlusive vascular disease
      • Atherosclerosis
      • Systemic Vasculitis
      • Thromboembolism
      • Thromboangiitis Obliterans (Buerger’s Disease)
    • Medications
    • Hyperviscosity state (e.g. Polycythemia Vera)
    • Paraproteinemia
    • Cryoglobulinemia

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