Raynaud’s Syndrome or Phenomenon
- Thought to be caused by sympathetic nervous overactivity and vasospasm
- Idiopathic (primary Raynaud’s)– symptoms brought on by emotional stress, temp, caffeine
- Rarely develops finger ischemia
- Secondary – associated with autoimmune diseases (scleroderma, RA, SLE)
- Severe finger ischemia can occur
Medical Management of Raynaud’s Phenomenon
- Dihydropyridines calcium channel blockers (CCB) are the first choice for drug therapy (Nifedipine 10 BID, amlodipine, felodipine)
- ARB (losartan) can be taken alone or added to a CCB. ACE inhibitor use has not been proven.
- IV prostanoid (iloprost) reserved for severe disease with critical ischemia
- For secondary Raynaud’s with systemic sclerosis (SLE, scleroderma)
- Treat underlying disease
- Rheumatology consult
- Botox injection at the base of finger has shown to be helpful
Diagnostic Tests to Rule Out Secondary Causes
- Antinuclear antibiodies (ANA)
- Lupus anticoagulant
- Anticardioplipin antibody
- Protein S and C levels
- Antithrombin III
- Hypercoagulability
Source: https://www.nejm.org/doi/full/10.1056/NEJMra1507638