Raynaud's Syndrome
Primary = no associated underlying factors
Else secondary.
High incidence; 3-18% to some extent;
F>>M
Risk factors
- up to 50% of people who handle vibrating machinary e.g.
jackhammers will develop it.
Associated with autoimmune disorders
- ANA, RF, double-stranded DNA antibodies
- dematomyositis, onnective tissue disorders, Sjogren, CREST
Also with myeloproliferative / haematologic disorders, obstructive
arterial disorders, environmental exposure, drugs.
Presents with pallor, cyanosis, reactive
hyperemia.
- ie ischaemic phase (white fingers) then hyperemic (blue fingers)
phases
Usually hands, sometimes feet
Induced by cold, somtimes emotional stimuli.
Dysphagia, arthralgia, xerostomia.
Look for associated diseases on history
Do serology above
Hand-ice immersion test: measures finger temp every 5 minutes after
a 20s plunge in icy water.
- much delayed in RS
Treated with conservative therapy
- avoid cold, wear gloves stop smoking, change occupation away from
vibrating tools and temperature changes
- avoid vasospastic medicines e.g. B-blockers.
Most will not need pharmocological therapy.
- if they do, Ca channel blockers are drug of choice; e.g.
nifedipine.
--> decreases severity and frequency of attacks
Other vasodilators variably effective; refer rheumatology; SSRIs,
topical nitrates.
If Severe ischaemi, can consider Iloprost (IV prostacyclin
antagonism).
Plasmaphoresis, sympathectomy and amuptation in rare cases
- e.g. with severe distal ischaemia refractory to therapy and
ulceration
- sympathetctomy can be cerviothoracic; transthoracic approach
prefered.
- distal sympathectomy sometimes by hand surgeons