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Raynauds Phenomenon

Raynauds phenomenon = reversible ischaemia due to digital arterial vasospasm

10% of the population, more common in females

90% idiopathic

usually occurs age 20-40

Patient information here

 

Referral Criteria

 

·         Male

·         onset over age 40

·         evidence of connective tissue disease

·         digital ulceration

·         not responding to primary care treatments after several months

 

 

Investigations

FBC UE LFT BONE ESR and CRP

urinalysis

ANA if female >40 yrs, male, or features to suggest scleroderma or other CTD.

 

Outside these groups, ANA is not useful. There is a high frequency of positive ANA with primary raynauds, please do not refer those with Raynauds and positive ANA unless female >40yrs, male or clinical features of scleroderma or other CTD.

 

 

Primary Care Management

 

Avoid precipitating factors

 

§  gloves, keep whole body warm, thermal heating devices

§  stress – refer if significant

§  vibrating machinery – consider occupational health assessment

§  B blockers, cigarettes, oral contraceptives, recreational drugs

§  Low BMI; if BMI <20, advice re weight management

 

Treatment

 

o    nifedipine – slow release preparations maybe better tolerated

 

Reference

[1] Map of medicine

[2] Personal communication Drs Endean, Hutchinson. Rheumatology consultants Royal Cornwall Hospital May 2016