questions
0

Raynaud's Syndrome

Author:
Topic updated on 08/16/13 11:06pm
Introduction
  • Raynaud's Syndrome consists of both
    • Raynaud's Phenomenon
      • vasospastic disease with a known cause
    • Raynaud's Disease
      • vasospastic disease with no known cause (idiopathic)
Raynaud's Phenomenon
  • Vasospastic disease with a known underlying disease
    • epidemiology
      • demographics
        • occasional female predominance
        • age >40 years (generally older than patients with Raynaud's disease)
      • location
        • affects the distal aspect of digits
    • pathophysiology
      • periodic digital ischemia induced by cold temperature or sympathetic stimuli including pain or emotional stress
      • triphasic color change (white-blue-red progression) 
        • digits turn white from vasospasm and interruption of blood flow 
        • blue discoloration follows from cyanosis and venous stasis 
        • finally digits turn red as a result of rebound hyperemia
        • dysesthesias often follow color changes
    • associated conditions
      • connective tissue disease
        • scleroderma (80-90% incidence of Raynaud's phenomenon)
        • SLE (18-26%)
        • dermatomyositis (30%)
        • RA (11%)
      • CREST syndrome
        • calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias
      • neurovascular compression (thoracic outlet syndrome)
  • Presentation
    • symptoms
      • asymmetric findings
      • rapid progression
    • physical exam
      • peripheral pulses often absent
      • frequent trophic skin changes (including ulceration and gangrene)  
      • abnormal Allen test
  • Studies
    • labs
      • blood chemistry - often abnormal
    • invasive studies
      • microangiology - often abnormal
      • angiography - often abnormal 
  • Treatment
    • nonoperative
      • lifestyle modifications, treat underlying cause
        • indications
          • mainstay of treatment
        • modalities
          • smoking cessation and avoidance of cold exposure is critical 
Raynaud's Disease
  • Vasospastic disease with no known cause (idiopathic)
    • epidemiology
      • seen in young premenopausal women (age <40 years)
    • pathophysiology
      • similar to Raynaud's phenomenon
  • Presentation
    • symptoms 
      • often bilateral
      • slow progression
    • physical exam
      • peripheral pulses usually present
      • trophic skin changes are uncommon
      • normal Allen test 
  • Studies
    • labs usually normal
    • invasive studies usually normal
    • diagnosis 
      • based on Allen and Brown criteria
Allen and Brown Criteria for Raynaud's Disease
  • Intermittent attacks with discoloration of acral parts
  • Bilateral involvement
  • Absence of clinical arterial occlusion
  • Gangrene and trophic changes are rare
  • Symptoms present for >2 years
  • Absence of other disease to explain findings
  • Predominance in women
  • Treatment
    • nonoperative
      • medical management
        • indications
          • first line of treatment
        • modalities
          • smoking cessation and avoidance of cold exposure is critical
          • thermal biofeedback techniques
          • medications include
            • calcium channel blockers
            • ASA
            • intra-arterial reserpine
            • dipyridamole (Persantine)
            • pentoxifylline (Trental)
    • operative
      • digital sympathectomy
        • indications
          • severe cases that fail conservative treatment
      • microvascular reconstruction
        • indications
          • may be indicated in rare situations

 

Please Rate Educational Value!
5.0
Average 5.0 of 1 Ratings

Qbank (0 Questions)





Evidence & References Show References




Topic Comments