Raynaud's phenomenon is characterised by an exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress

Aetiology

• May be primary (Raynaud's disease) or secondary (Raynaud's phenomenon)
• Primary disease usually presents in women under 30 with bilateral symptoms
• Secondary causes of Raynaud’s include:
  • Connective tissue disorders
    • Scleroderma (most common)
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
  • Leukaemia
  • Type I cryoglobulinaemia, cold agglutinins
  • Use of vibrating tools
  • Drugs: oral contraceptive pill, ergot
  • Cervical rib

Clinical presentation

• Spasming of the vessels of the hand, lead to colour changes, particularly in cold weather

Management

• All patients with suspected secondary Raynaud's phenomenon should be referred to secondary care
• First-line: calcium channel blockers e.g. nifedipine
• IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months