History Symptoms Prevalence Epidemiology Raynauds? Treatment References

Raynauds epidemiology


It is important to distinguish Raynaud's disease from syndrome. In order todiagnose these two forms of Raynaud's, a doctor may look for signs ofarthritis or vasculitis, and may conduct a number of laboratory tests.

Primary Raynaud's (disease)

Raynaud's disease, or "Primary Raynaud's", is diagnosed if the symptoms are idiopathic, that is, if they occur by themselves and not in association with other diseases. Some refer to Primary Raynaud's disease as "being allergic to coldness". It often develops in young women in their teens and early adulthood. Primary Raynaud's is thought to be at least partly hereditary, although specific genes have not yet been identified. Smoking worsens frequency and intensity of attacks, and there is a hormonal component. Caffeine also worsens the attacks. Sufferers are more likely to have migraine and angina than controls.

Secondary Raynaud's (syndrome)

Raynaud's syndrome, or "Secondary Raynaud's", occurs secondary to a wide variety of other conditions. Secondary Raynaud's has a number of associations:

  • Connective tissue disorders:
    • scleroderma
    • systemic lupus erythematosus
    • rheumatoid arthritis
    • Sjögren's syndrome
    • dermatomyositis
    • polymyositis
    • mixed connective tissue disease
    • cold agglutinin disease
    • Ehlers-Danlos Syndrome
  • Eating disorders
    • anorexia nervosa
  • Obstructive disorders
    • atherosclerosis
    • Buerger's disease
    • Takayasu's arteritis
    • subclavian aneurysms
    • thoracic outlet syndrome
  • Drugs
    • Beta-blockers
    • cytotoxic drugs - particularly chemotherapeutics and most especially bleomycin
    • ciclosporin
    • ergotamine
    • sulfasalazine
    • anthrax vaccines whose primary ingredient is the Anthrax Protective Antigen
  • Occupation
    • jobs involving vibration, particularly drilling, suffer from vibration white finger
    • exposure to vinyl chloride, mercury
    • exposure to the cold (e.g. by working as a frozen food packer)
  • Others
    • Physical Trauma, such as that sustained in auto accident or other traumatic events
    • hypothyroidism
    • cryoglobulinemia
    • malignancy
    • reflex sympathetic dystrophy
    • carpal tunnel syndrome
    • Magnesium Deficiency
    • Erythromelalgia, (the opposite of Raynaud's, with hot and warm extremities) often co-exists in patients with Raynaud's)
  • Mitigation

It is important to realize that Raynaud's can herald these diseases by periods of more than 20 years in some cases, making it effectively their first presenting symptom. This can be the case in the CREST syndrome, of which Raynaud's is a part.

Patients with Secondary Raynaud's can also have symptoms related to their underlying diseases. Raynaud's phenomenon is the initial symptom that presents for 70% of patients with scleroderma, a skin and joint disease.

When Raynaud's phenomenon is limited to one hand or one foot, it is referred to as Unilateral Raynaud's. This is an uncommon form, and it is always secondary to local or regional vascular disease. It commonly progresses within several years to affect other limbs as the vascular disease progresses.

Examination

A careful medical history will often reveal whether the condition is primary or secondary. Once this has been established, an examination is largely to identify or exclude possible secondary causes.

  • Digital artery pressure: pressures are measured in the arteries of the fingers before and after the hands have been cooled. A decrease of at least 15 mmHg is diagnostic (positive).
  • Doppler ultrasound to assess blood flow.
  • Full blood count: this can reveal a normocytic anaemia suggesting the anaemia of chronic disease or renal failure.
  • Blood test for urea and electrolytes: this can reveal renal impairment.
  • Thyroid function tests: this can reveal hypothyroidism.
  • An autoantibody screen, tests for rheumatoid factor, Erythrocyte sedimentation rate and C-reactive protein, which may reveal specific causative illnesses or a generalised inflammatory process.
  • Nail fold vasculature: this can be examined under the microscope.

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