Raynaud | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

340

Pages:

5
Author:

Mariam A. A.

Raynaud’s Phenomenon Definition Vasospasms of the digits Epidemiology More common in females Risk Factors Cold exposure Stress Emotion Smoking Exercise Causes Primary On its’ own Usually females No associated illness Secondary Connective tissue disease e.g. systemic sclerosis Suspected in patients with other common clinical features of connective tissue disease such as arthralgia or fatigue Other diseases e.g. atherosclerosis or malignancy May lead to digital ischemia Clinical Features Episodic blanching Cyanosis Erythema Management Lifestyle Keep warm and use of gloves and avoid cold exposure Usually enough to control symptoms Manage stress Avoid triggers such as smoking Medical CCB e.g. nifedipine First line If ineffective -> can consider sildenafil (PDE5 inhibitor) Avoid beta blockers Can worsen symptoms Management of underlying cause Botulinum toxin A injection Sympathectomy is seldom indicated Complications in severe cases Digital ulcers Most common Infections Tissue damage in rare cases Digital Ischemia Usually manifests as ulceration When Raynaud is due to systemic sclerosis digit ischemia happens due to the combination of the severe effects of RP and calcinosis Ulcers happen at: Tips of digits Trauma sites Extensor surfaces of contracted digits Other causes Atherosclerotic disease with distal emboli Illicit IV drug use Hyper viscosity syndromes E.g. haematological malignancy e.g. myeloma Systemic vasculitis Thromboembolic disease Thromboagiitis obliterans Management Optimise management of Raynaud’s phenomenon Ulcers: Protection Regular dressings using preparations such as povidone iodine Moisture-donating dressings Soften dry eschar Follow by debridement to allow healing (if needed) If ulcers fail to heal: Excision of underlying calcinosis Resistant to treatment ulcer Hospital admission Signs of infection: Increasingly painful, red and swollen Manage same as cellulitis and erysipelas There is a possibility of spreading and causing septic arthritis or osteomyelitis Critical digital ischemia: Sustained digital ulceration or blanching of fingers may case necrosis Medical emergency + hospital admission Potent vasodilators e.g. IV alprostadil or iloprost If evidence of recent vascular thrombosis or thromboembolism Anticoagulants Evidence of infection antibiotics Surgical amputation last resort Prognosis Patients with digital ischemia who receive adequate therapy can recover well