what is Raynaud’s syndrome, disease and phenomenon

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In 1862 , Maurice Raynaud described episodic digital ischemia provoked by cold and emotion and this phenomenon has since been called Raynaud’s syndrome . Its defined as episodic pathologic attacks of white, blue and red fingers produced by cold provocation or emotional stress or both. A higher frequency of vasospastic symptoms in other organs, such as migraine and variant angina indicates that the syndrome has a more general manifestation.

The patients are usually divided onto two groups, dependent on the etiology .  the most common form of the disorder is primary Raynaud’s phenomenon ( Raynaud’s disease ). This form is called primary because no underlying disease has been found and etiology is ,so far , unknown . the other form is secondary Raynaud’s phenomenon , in which the etiology and underlying disease in most case are thought to be known . today we know that a large number of different causes can produce the phenomenon .
Image

The triphasic response with characteristic color changes of raynaud’s on exposure to cold , the hand’s become immediately white and then blue , on warming the hands ,they become intensely red and painful .

When conducting your examination , remember the difference between Raynaud’s disease and Raynaud’s phenomenon .

Variants Raynaud’s disease Raynaud’s phenomenon
Age Usually < 40 years Usually > 40 years
Associated conditions None Many systemic disease
Symmetrical involvement Yes No ( can Involve one hand)
Nail fold capillaries Normal Abnormal
Tissue necrosis or gangrene Never occurs Can occur
ESR Normal Elevated
Serologic findings ( antinuclear autoantibody ( ANA) ) Negative Positive

Causes of Raynaud’s phenomenon.

Primary Raynaud’s phenomenon (also known as Raynaud’s disease or idiopathic episodic vasospasm)
Secondary Raynaud’s phenomenon
Autoimmune diseases

Scleroderma or CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, esophageal involvement, sclerodactyly, and telangiectasia)
Systemic lupus erythematosus
Mixed connective tissue disease
Vasculitis

Polyarteritis nodosa
Polymyositis
Thromboangütis obliterans
Temporal arteritis
Polymyalgia rheumatica
Drug induced

Beta blockers
Ergotamine
Clonidine
Bleomycin
Lithium
Rheologic changes

Macroglobulinemia
Polycythemia
Cryoglobulinemia
Cryofibrinogenemia
Cold agglutinins
Other causes

Macrothrombosis and microthrombosis or embolism
Atherosclerosis
Smoking
Allergy
External causes

Vibration (from vibrating tools)
Digital trauma (piano players)
Nerve lesion or compression

About Dr.Nabil Paktin

Cardiologist , M.D.,F.A.C.C.

Posted on December 30, 2012, in Uncategorized. Bookmark the permalink. Leave a comment.

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