Raynaud's
phenomenon5% of patients develop autoimmune rheumatic disease.
Occupation
- Outdoor working
- Vibration
- Chemicals eg vinyl chloride
Drugs
beta-blockers
Secondary causes of Raynaud's
- Rheumatological
- Systemic sclerosis (90% of patients with this condition have Raynaud’s phenomenon)
- Mixed connective tissue disease (85%)
- Systemic lupus erythematosus (40%)
- Dermatomyositis or polymyositis (25%)
- Rheumatoid arthritis (10%)
- Sjögren’s syndrome
- Vasculitis
- Haematological
- Polycythaemia ruba vera
- Leukaemia
- Thrombocytosis
- Cold agglutinin disease (Mycoplasma infections)
- Paraproteinaemias
- Protein C deficiency, protein S deficiency, antithrombin III deficiency
- Presence of the factor V Leiden mutation
- Hepatitis B and C (associated with cryoglobulinaemia)
- Occlusive arterial disease
- External neurovascular compression, carpal tunnel syndrome, and thoracic outlet syndrome
- Thrombosis
- Thromboangiitis obliterans
- Embolisation
- Arteriosclerosis
- Buerger’s disease
History
- Arthralgia
- Mouth ulcers
- Alopecia
- Photosensitivity
- Muscle weakness
- Skin rashes
- Dry eyes/mouth
- CVS/RS problems
Investigations
- FBC
- ESR
- U&E
- LFT & electropohoresis
- ANA, ENA, Scl-70, Anti-Ro, Anti-La
- Urinalysis
- CXR & Xray hands
- Nail fold capillaroscopy
Management
- Stop smoking
- Exposure to cold
- Vibrating tools
Drug treatment
-
Calcium channel blockers
- Nifedipine SR 20mg daily
- Diltiazem 60mg tds
- Nicardipine 20mg tds
- Felodipine 5-10mg daily
- Isradipine 1-2mg bd
- Maxepa 5 caps daily?
- Epogam 4-6 caps bd?
- ARBs
- Topical nitrates
- SSRIs
- Statins
- Phosphodiesterase type 5 inhibitors?
