Raynaud's phenomenon
Classification & external resources

Hands with Raynaud's phenomenon
ICD-10	I73.0
ICD-9	443.0
DiseasesDB	25933
eMedicine	med/1993
MeSH	D011928

Raynaud's phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 - 1881). The cause of the phenomenon is unknown, but emotional stress and cold are classically triggers, and the discoloration follows a characteristic pattern in time: white, blue and red. It comprises both Raynaud's disease (primary Raynaud's), where the phenomenon is idiopathic, and Raynaud's syndrome (secondary Raynaud's), where it is secondary to something else. Image File history File links No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Medicine is the science and art of maintaining andor restoring human health through the study, diagnosis, and treatment of patients. ... Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ... This article does not cite any references or sources. ... Toes on foot. ... Maurice Raynaud is the French doctor who discovered Raynauds Disease in the late 1800s. ... Stress (roughly the opposite of relaxation) is a medical term for a wide range of strong external stimuli, both physiological and psychological, which can cause a physiological response called the general adaptation syndrome, first described in 1936 by Hans Selye in the journal Nature. ... Raynauds disease (RAY-noz) is a condition that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ...

Incidence

The phenomenon is more common in women than men, with the Framingham Study finding that 5.8% of men and 9.6% of women suffered from it. The Framingham Heart Study is a cardiovascular study based in Framingham, Massachusetts. ...

Epidemiology

There is a familial component to primary Raynaud's, and presentation is typically before 30. Smoking worsens frequency and intensity of attacks, and there is a hormonal component. Sufferers are more likely to have migraine and angina than controls. The cigarette is the most common method of smoking tobacco. ... angina tonsillaris see tonsillitis. ...

Secondary Raynaud's has a number of associations:

• Connective tissue disorders:
  • scleroderma
  • Systemic lupus erythematosus
  • rheumatoid arthritis
  • Sjögren's syndrome
  • dermatomyositis
  • polymyositis
• Obstructive disorders
  • atherosclerosis
  • Buerger's disease
  • subclavian aneurysms
  • thoracic outlet syndrome
• Drugs
  • Beta-blockers
  • cytotoxic drugs - particularly chemotherapeutics and most especially bleomycin
  • cyclosporin
  • ergotamine
  • sulfasalazine
• Occupation
  • jobs involving vibration, particularly drilling
  • exposure to vinyl chloride
  • exposure to the cold (e.g. by working packing frozen food)
• Others
  • hypothyroidism
  • cryoglobulinemia
  • malignancy
  • reflex sympathetic dystrophy

It is important to realise 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. Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen in the skin or other organs. ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Sjögrens syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. ... X-Ray of the knee in a patient with dermatomyositis. ... {{ }} Polymyositis is a type of inflammatory myopathy, related to dermatomyositis and inclusion body myositis. ... Buergers disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. ... Post surgical photo of brain aneurysm survivor. ... Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). ... Beta blockers (sometimes written as β-blockers) are a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias and cardioprotection after myocardial infarction. ... Chemotherapy is the use of chemical substances to treat disease. ... Bleomycin is an anti-cancer agent. ... ... Ergotamine is a vasoconstrictor used for migraine prevention and is sometimes mixed with caffeine. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Vinyl chloride, also known as chloroethene in IUPAC nomenclature, is an important industrial chemical chiefly used to produce its polymer, polyvinyl chloride (PVC). ... This article or section does not cite its references or sources. ... Cryoglobulinemia is the presence of abnormal proteins in the bloodstream which thicken or gel on exposure to cold. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Complex regional pain syndrome (CRPS) is a chronic condition characterized by severe pain following injury to bone and soft tissue. ... Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen. ...

Symptoms

The condition causes painful, pale, cold extremities. This is often distressing, impinges on quality of life, and is potentially dangerous

Unilateral Raynaud's, or that which is present only in the hands or feet, is almost certainly secondary, as primary Raynaud's is a systemic condition. However, a patient's feet may be affected without his realizing it.

In pregnancy, this sign normally disappears due to increased surface blood flow. A pregnant woman near the end of her term Pregnancy is the carrying of one or more offspring in an embryonal or fetal stage of development by female mammals, including humans, inside their bodies, between the stages of conception and birth. ... Blood flow is the flow of blood in the cardiovascular system. ...

Investigations

A careful history will often reveal whether the condition is primary or secondary. Once this has been established, investigations are largely to identify or exclude possible secondary causes. The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ...

• Digital artery pressure: pressures are measured in the digital arteries before and after cooling the hands. A drop of 15mmHg or more is diagnostic.
• Doppler ultrasound: to assess flow
• Full blood count: this can reveal a normocytic anaemia suggesting the anaemia of chronic disease or renal failure
• Urea & 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

One way of defining pressure is in terms of the height of a column of fluid that may be supported by that pressure; or the height of a column of fluid that exerts that pressure at its base. ... Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... This article discusses the medical condition. ... Anemia of chronic disease, increasingly referred to as anemia of inflammation, is a form of anemia seen in chronic illness, e. ... Renal failure is the condition in which the kidneys fail to function properly. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid. ... This article or section does not cite its references or sources. ... An autoantibody is an antibody (a type of protein) manufactured by the immune system that is directed against one or more of the individuals own proteins. ... Rheumatoid factor (RF) is a blood test performed in patients with suspected rheumatoid arthritis (RA). ... The erythrocyte sedimentation rate(ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. ...

Treatment

Treatment options are dependent on the type of Raynaud's present. Raynaud's syndrome is treated primarily by addressing the underlying cause, but includes all options for Raynaud's disease as well. Treatment of primary Raynaud's focusses on avoiding triggers:

• Avoidance of any environmental triggers, e.g. cold, drilling, etc. (although emotional stress is a recognised trigger, it tends to be impossible to consciously avoid).
• Warm clothing for the extremities such as mittens or HeatBands
• Hormone regulation and assessment of the type of hormonal contraception used, if any. Contraception which is low in estrogen is preferable, and the progesterone only pill is often prescribed.
• Smoking cessation.
• Drug treatment is normally with a calcium channel blocker, frequently nifedipine to prevent arterioconstriction. It has the usual side effects of headache, flushing, and ankle edema, and patients often stop treatment, preferring the symptoms of Raynaud's to the symptoms of the drug.
• The extract of the Ginkgo biloba leaves (Egb 761, 80mg) reduces symptoms in two weeks.
• There is some evidence that Angiotensin II receptor antagonists (often Losartan) reduce frequency and severity of attacks.
• In intractable cases, sympathectomy and infusions of prostaglandins, e.g. prostacyclin, may be tried, with amputation in exceptionally severe cases.
• Alpha-1 adrenergic blockers such as prazosin can be used to control Raynaud's vasospasms under supervision of a healthcare provider.
• In a study published in the November 8, 2005 issue of Circulation, sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilatory therapy. The authors, led by Dr Roland Fries (Gotthard-Schettler-Klinik, Bad Schönborn, Germany), report: "In the present study, capillary blood flow was severely impaired and sometimes hardly detectable in patients with Raynaud's phenomenon. Sildenafil led to a more than 400% increase of flow velocity."
• Two separate gels combined on the fingertip (somewhat like two-part epoxy, they cannot be combined before use because they will react) increased blood flow in the fingertips by about three times. One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid. The milliliter of combined gel covered an area of ~3 cm². The gel was wiped off after a few seconds. Tucker, A.T. et al., The Lancet, Vol. 354, November 13, 1999, pp..

Hormonal contraception refers to birth control methods that act on the hormonal system. ... Estriol. ... Progesterone Only Pill (POP) are contraceptive pills that only contain progesterone (or, as used in the USA, the term Progestin for synthetic progesterones). ... Calcium channel blockers are a class of drugs with effects on many excitable cells of the body, like the muscle of the heart, smooth muscles of the vessels or neuron cells. ... Nifedipine (brand name Adalat and Procardia) is a dihydropyridine calcium channel blocker. ... This page is about the condition called edema. ... Binomial name Ginkgo biloba L. The Ginkgo (Ginkgo biloba), sometimes also known as the Maidenhair tree, is a unique tree with no living relatives. ... Losartan, the first ARB Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs), AT1-receptor antagonists or sartans, are a group of pharmaceuticals which modulate the renin-angiotensin-aldosterone system. ... Losartan (rINN) (IPA: ) is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure (hypertension). ... Endoscopic Thoracic Sympathectomy (ETS) is a medical procedure where certain sympathetic nerve ganglia are burned, cut or clamped. ... Chemical structure of prostaglandin E1 (PGE1). ... Prostacyclin is a member of the family of lipid molecules known as eicosanoids. ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play These Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ... Sildenafil citrate, sold under the names Viagra, Revatio and generically under various other names, is a drug used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH), developed by the pharmaceutical company Pfizer. ... In chemistry, epoxy or polyepoxide is a thermosetting epoxide polymer that cures (polymerizes and crosslinks) when mixed with a catalyzing agent or hardener. Most common epoxy resins are produced from a reaction between epichlorohydrin and bisphenol-A. The first commercial attempts to prepare resins from epichlorohydrin occurred in 1927 in...

See also

• CREST syndrome
• Circulatory system

Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen. ... Diagram of the human circulatory system. ...

External links

• Overview at National Institutes of Health
• Overview at Medical College of Wisconsin