Raynaud's Phenomenon

There are two forms of Raynaud's disease, primary and secondary. Primary is the milder form. It my strike in the teenage years and doesn't usually cause damage. The secondary type more often strikes in the 20s or 30s and does cause damage. It may be drug-induced or it may be classed as industrial disease. It may cause problems such as migraine or angina. Secondary Raynaud's occurs in about 90% of Scleroderma cases and in about 80% of people with MCTD (the overlapping form).  

Raynaud's is an abnormality of the blood vessel, which responds to cold and emotions, such as fear or anxiety. An attack may occur from a drop in temperature of as little as 5 degrees. Colour changes occur in the extremities affected, which may be hands or feet or nose or ears. The colour changes that are noted in a Raynaud's spasm come from lack of blood supply which turns the area white, the cyanotic (blue), and red when the blood rushes back into the site.  

Checking the capillaries (small looping vessels shaped like hairpins) seen under a microscope at the base of the fingernail will indicate the presence of Raynaud's. 20% to 30% of persons with Raynaud's have a chance of going on to develop another disease with systemic manifestations (particularly if the endothelial cells in the lung are abnormally reactive and nutritionally starved from fibrous lining). Narrowed blood vessels with abnormal blood supply can lead to gangrene and loss of digits. There is generalized hypersensitivity in the lumen of blood vessels in the lung and hand. Sensitivity to temperature in the secondary Raynaud's means that we should STAY WARM! Kidney crises are known to occur more often in cold weather.  

Ulceration of the fingertips is an indication that intervention with medication is necessary. Choices for treatment are calcium channel blockers, such as Adalat (long acting is now available and there are less side effects). Alpha blockers or nitroglycerine may be added (or the nitro patch). To prevent gangrene a sympathetic block may be done at the fingers or the neck (morphine can make gangrene worse).  

Response to treatment is about 40%. KEEP WARM!!

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