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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 years

 

Red Flags

If severe ischaemia of 1 more digits admit under surgical team

 

Referral Criteria

 

  • Male
  • onset over age 40 years
  • evidence of connective tissue disease – Suspected Connective Tissue  Disease
  • digital ulceration
  • not responding to primary care treatments after several months

 

 

Investigations

 

FBC UE LFT BONE 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
  • Wear gloves, warm footwear, keep whole body warm, consider thermal heating devices
  • Avoid cigarette smoking
  • exercise regularly
  • Review medications/ avoid B Blockers, recreational drugs
  • Consider occupation health assessment if using vibrating machinery
  • Avoid stress if a trigger

 

Treatment

 

  • nifedipine – slow release preparations maybe better tolerated

 

 

References

NICE CKS 2016

Personal communication with Dr Jenkinson, Consultant Rheumatologist, RCHT

 

Useful patient information

 

Scleroderma and Raynaud's UK  ( http://www.sruk.co.uk)

https://patient.info/heart-health/raynauds-phenomenon-leaflet

 

Date Reviewed                        06/01/2020

Next Review Date        06/01/2021

Author                          Dr B Wesson ( RMS GP Lead for Rheumatology)Guidelines

 

 

Version No.      2.2