Raynaud’s Disease:

Ask 3 questions. If all positive its Raynaud’s

1. Are your fingers unusually sensitive to the cold?
2. Do your fingers change color when they are exposed to cold temperatures?
3. Do they turn white, blue, or both?

Typical Case:
Young Female, Age: 15 - 30
Clues that may raise concern for secondary Raynaud’s:
 Age of onset > 40,
 Male
 Digital ulcerations
 Asymmetric attacks,
 Ischemic signs proximal to the fingers & toes
 Abnormal nailfold capillaroscopy.
 Nailfold capillaroscopy is an inexpensive, quick, and non-invasive exam
technique that can help differentiate primary from secondary Raynaud’s.
Digital Ischemia/ Gangrene: Always Secondary Raynaud’s.

Primary Raynaud’s:
 A typical attack may last < 1 hour. But can also persist for hours.
 Symmetric, episodic & without evidence of peripheral vascular disease.
 Negative ANA & normal inflammatory markers.
 No evidence of tissue gangrene, digital pitting, or tissue injury.

Associations:
 Connective tissue diseases
 scleroderma,
 lupus
  mixed connective tissue disease (MCTD)

Most Important Investigation:

 CBC ESR
 ENA Panel
 Anti CCP Ab
 Nailfold capillaroscopy

Treatment:
 Nifedipine SR at 30–60mg per day.
 CCB: Amlodipine (5-10 mg), felodipine, Nisoldipine & isradipine.
 If a patient is intolerant to CCB: Losartan 50 mg (ARB) may be considered.
 Iloprost IV (For Systemic Sclerosis) every 8 weeks.
 Bosentan (pulmoten 62.5 mg) in Systemic Sclerosis. 150 tk
 Sildenafil (25 mg tds); Tadalafil (10 mg alternate day)
 Prazosine (1 mg bd)
 Fluoxetine 20 mg
 Add: Aspirin

 If Gangrene: Digital Sympathectomy

 NO effect: Atorvastatin, Nitric oxide gel.
How effective is CCB:
CCB in primary Raynaud’s also showed a decrease in frequency of attacks by
around 1.7 attacks per person per week.