-IBIS-1.5.0-
tx
cardiovascular system
Raynaud's
diagnoses

definition and etiology

definition:
spasm of the arterioles, especially in the hands and feet, with the characteristic color changes of pallor, cyanosis, and rubor, respectively

etiology:
There are two classifications of Raynaud's: disease and phenomenon.

Raynaud's disease: This term is used to describe Raynaud's when it begins idiopathically. It is seen most often in young women and rarely causes tissue necrosis. Cold is often a stimuli to initiate the spasms, which may last from minutes to hours.

Raynaud's phenomenon: This term is used to describe Raynaud's when it occurs secondary to another disorder. Primary conditions associated with Raynaud's include connective tissue disorders (e.g. scleroderma, RA, SLE), myxedema, trauma, primary pulmonary hypertension, and neurogenic lesions (e.g. thoracic outlet syndrome). If it becomes frequent and chronic, the digits may become smooth, shiny and tight from the loss of subcutaneous tissue (sclerodactyly). In severe advanced cases, the arterial intima may become thickened and lead to thrombus formation. Distal ulcerations of the fingers can occur. Factors which suggest that Raynaud's is associated with underlying disease include: abrupt onset with acute tissue death; onset late in life (> 50), especially when a male is afflicted; unilateral or asymmetric involvement; and concurrent development of symptoms associated with another condition.

signs and symptoms

signs and symptoms:
usually precipitated by cold exposure or emotional upset
• triphasic color changes: pallor (total whiteness of digits often occurs), cyanosis, rubor; better with rewarming affected digits; not seen proximal to the metacarpophalangeal or metatarsophalangeal joints; the thumb is infrequently involved
• pain may be excruciating: tingling, numbness, and burning are common
• Raynaud's disease: bilateral (the phenomenon may be unilateral); history of the disease for two years with no other symptoms developing, and no progression of the disease
• Raynaud's phenomenon: may develop skin ulcers or gangrene

lab findings:
• (+) for a primary disease with Raynaud's phenomenon
• cold agglutinins may be present

course and prognosis

In Raynaud's phenomenon, the course is gradual and consistent with recurrent attacks when exposed to initiating stimuli, and possible development of skin and arterial changes.
In Raynaud's disease, the attacks may be more random. Conventional treatment consists of drug therapy, and sympathectomy.

differential diagnosis

• chronic arterial disease (thromboangiitis obliterans)
• CVD (esp. scleroderma)
• long-term occupational or industrial use of vibrating machines
• lead or arsenic poisoning
• hematologic disorders (e.g. cold agglutinins)
• cold injury
• occult carcinoma
• drug ingestion (e.g. ergotamine)


footnotes