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Raynauds prevalence

The phenomenon is more common in women than men, with the Framingham Study finding that 5% of men and 8% of women suffer from Raynaud Phenomenon.

Raynaud phenomenon results from an exaggerated vasoconstriction of digital arteries and arterioles. These vascular changes induce paroxysmal pallor or cyanosis of the digits of the hands or feet; infrequently, the nose, earlobes, or lips can also be involved. Characteristically, the involved digits show red, white, and blue color changes from most proximal to most distal, correlating with proximal vasodilation, central vasoconstriction, and more distal cyanosis ( Fig. 11-28 ). Raynaud phenomenon may be a primary disease entity or be secondary to a variety of conditions.

FIGURE 11-28 Raynaud's phenomenon. A, Sharply demarcated pallor of the distal fingers resulting from the closure of digital arteries. B, Cyanosis of the fingertips. (Reproduced from Salvarani C, et al.: Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 347:261, 2002.)

Primary Raynaud phenomenon (previously called Raynaud disease) reflects an exaggeration of central and local vasomotor responses to cold or emotional stresses. It affects 3% to 5% of the general population and shows a predilection for young women. Structural changes in the arterial walls are absent except late in the course, when intimal thickening can appear. The course of Raynaud phenomenon is usually benign, but when long-standing can result in atrophy of the skin, subcutaneous tissues, and muscles. Ulceration and ischemic gangrene are rare.

In contrast, secondary Raynaud phenomenon refers to vascular insufficiency of the extremities secondary to arterial disease caused by other entities including SLE, scleroderma, Buerger disease, or even atherosclerosis. Since Raynaud phenomenon may be the first manifestation of such conditions, any patient with new symptoms should be evaluated. Of these individuals, some 10% will eventually manifest an underlying disease.

Sufferers can gain some relief from the symptoms by using heated clothing such as gloves, gloveliners, socks, mitters.

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