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Raynaud's phenomenon

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Editors-In-Chief: Asghar Fakhri, M.D.; Duane S. Pinto, M.D. and C. Michael Gibson, M.S., M.D.

Synonyms and keywords: Raynaud phenomenon; Raynaud’s disease

Overview

Editors-In-Chief: Asghar Fakhri, M.D., Duane S. Pinto, M.D. and C. Michael Gibson, M.S., M.D.

Overview

Raynaud’s phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 – 1881). The cause of the phenomenon is unknown, but emotional stress and cold are classically triggers, and the discoloration follows a characteristic pattern in time: white, blue and red. It comprises both Raynaud’s disease (primary Raynaud’s), where the phenomenon is idiopathic, and Raynaud’s syndrome (secondary Raynaud’s), where it is secondary to something else.

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Pathophysiology

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Causes

Editors-In-Chief: Asghar Fakhri, M.D., Duane S. Pinto, M.D. and C. Michael Gibson, M.S., M.D.

Overview

Causes

Causes by Organ System

Cardiovascular Arteriosclerosis obliterans, Arteriovenous fistula, Atherosclerosis, Embolism, Peripheral emboli, Peripheral vascular disease, Subclavian aneurysms, Atrial myxoma, Polyarteritis nodosa, Takayasu arteritis, Temporal arteritis, Thromboangitis obliterans, Wegener’s granulomatosis
Chemical / poisoning Arsenicals, Lead, Polyvinyl chloride, Thallium, Vinyl chloride
Dermatologic No underlying causes
Drug Side Effect Amphetamines, Arsenic trioxide, Atenolol, Beta-blockers, Bleomycin, Bromocriptine, Cabergoline, Clonidine, Cyclosporin, Cytotoxic drugs, Ergometrine, Ergotamine, Hormonal contraceptives, Imipramine, Lysuride, Melarsoprol, Methylphenidate, Methysergide, Pergolide, Piribedil, Pramipexole, Propranolol, Pseudoephedrine, Ropinirole, Sulfasalazine , Vinblastine
Ear Nose Throat No underlying causes
Endocrine Acromegaly, Hypothyroidism, Growth hormone secreting pituitary adenoma
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Fabry disease
Hematologic Cold agglutinins, Cryoglobulinemia, Mixed essential cryoglobulinaemia, Leukemia, Myeloma, Polycythaemia rubra vera, Waldenstrom macroglobulinaemia, Paroxysmal cold haemoglobinuria
Iatrogenic No underlying causes
Infectious Disease Hepatitis B antigenemia, Mycoplasma pneumoniae, Poliomyelitis
Musculoskeletal / Ortho Carpal tunnel syndrome, Cervical rib, Scalenus-anticus syndrome, Scoliosis, Thoracic outlet syndrome,Dermatomyositis, Polymyositis, Rheumatoid arthritis
Neurologic Intervertebral disc herniation, Peripheral neuropathy, Poliomyelitis, Reflex sympathetic dystrophy, Syringomyelia, Transverse myelitis, Spinal tumor, Multiple sclerosis
Nutritional / Metabolic Fabry disease
Obstetric/Gynecologic No underlying causes
Oncologic Atrial myxoma, Growth hormone secreting pituitary adenoma, Leukemia, Malignancy leading to paraneoplatic raynaud phenomenon, Myeloma, Phaeochromocytoma, Polycythaemia rubra vera, Spinal tumor, Waldenstrom macroglobulinaemia
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric Anorexia nervosa
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Amyloidosis, Antisynthetase syndrome, Calcinosis-Raynaud-sclerodactyly-telangiectasia syndrome, Dermatomyositis, Mixed connective tissue disease, Multiple sclerosis, Paroxysmal cold haemoglobinuria, Polyarteritis nodosa, Polymyositis, Rheumatoid Arthritis, Rheumatoid disease, Scleroderma, Sicca syndrome, Sjogen’s Syndrome, Systemic lupus erythematosus, Systemic sclerosis, Takayasu arteritis, Temporal arteritis, Thromboangitis obliterans, Wegener’s granulomatosis
Sexual No underlying causes
Trauma Hand arm vibration syndrome, Hypothenar Hammer Syndrome
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Erythromelalgia, Exposure to the cold, Frost bite, Raynaud disease, Smoking, Amyloidosis

Causes in Alphabetical Order


It is important to realise that Raynaud’s can herald these diseases by periods of more than 20 years in some cases, making it effectively their first presenting symptom. This can be the case in the CREST syndrome, of which Raynaud’s is a part.

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Differentiating Raynaud’s phenomenon from other Diseases

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Epidemiology and Demographics

Editors-In-Chief: Asghar Fakhri, M.D., Duane S. Pinto, M.D. and C. Michael Gibson, M.S., M.D.

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Overview

Age

There is a familial component to primary Raynaud’s, and presentation is typically before 30.

Gender

The phenomenon is more common in women than men, with the Framingham Study finding that 5.8% of men and 9.6% of women suffered from it.

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Risk Factors

Editors-In-Chief: Asghar Fakhri, M.D., Duane S. Pinto, M.D. and C. Michael Gibson, M.S., M.D.

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Overview

Risk Factors

Smoking worsens frequency and intensity of attacks, and there is a hormonal component. Raynaud’s phenomenon also occurs without another disease, medication, or cause. This is called primary Raynaud’s phenomenon. It most often begins in people younger than age 30.

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Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Natural History

Complications

  • Gangrene or skin ulcers may occur if an artery becomes completely blocked (most likely to occur in people who also have arthritis or autoimmune conditions)
  • Permanently decreased blood flow to the area can lead to thin and tapered fingers, with smooth, shiny skin and slow growing nails

Prognosis

The outcome varies depending on the cause and the severity of the condition.

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Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other diagnostic studies

Treatment

Treatment

Medical therapy | Primary prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1
Related Chapters


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