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. 2020 Nov;20(6):580-587.
doi: 10.7861/clinmed.2020-0754.

Raynaud's phenomenon

Ashraful Haque  1 , Michael Hughes  2
Affiliations

Raynaud's phenomenon

Ashraful Haque et al. Clin Med (Lond). 2020 Nov.

Abstract

Raynaud's phenomenon (RP) is a common vasospastic condition which affects ~5% of the general population. The majority of individuals have primary RP; however, Raynaud's can also occur secondary to a broad range of underlying medical conditions and drug therapies. RP is a cardinal feature in patients with systemic sclerosis and is often the earliest symptom of the disease. Unlike primary RP, patients with secondary RP can develop persistent digital ischaemia, including ulcers and gangrene. Patients require a comprehensive clinical assessment and investigation, in particular, the detection of autoantibodies and nailfold capillaroscopic abnormalities. Non-pharmacological management is indicated in all patients. There are a wide range of available drug therapies to treat RP, including when complicated by digital ulceration, and surgical intervention is sometimes required. Future research is needed to understand the complex pathogenesis of RP and to measure the impact and severity of RP to develop optimised approaches to management.

Keywords: Raynaud's phenomenon; digital ulcers; systemic sclerosis.

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Figures

Fig 1.
Fig 1.
Photograph of a hand with an example of digital vascular compromise from Raynaud's phenomenon.
Fig 2.
Fig 2.
Photographs of hands with persistent digital ischaemia including ulceration and gangrene in secondary forms of Raynaud's phenomenon. Reproduced with permission from Hughes M, Allanore Y, Chung L, Pauling JD, Denton CP, Matucci-Cerinic M. Raynaud's phenomenon and digital ulcers in systemic sclerosis. Nat Rev Rheumatol 2020;4:208–21.
Fig 3.
Fig 3.
Nailfold capillaroscopy. a) Normal capillaries with a uniform, regularly distributed and ‘hairpin’-like appearance. b) Abnormal capillaries of patient with systemic sclerosis showing progressive structural altera­tions.
Fig 4.
Fig 4.
Flowchart for treatment of Raynaud's phenomenon. ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blockers; CCB = calcium-channel blockers; IV = intravenous; PDE5 = phosphodiesterase type 5; RP = Raynaud's phenomenon; SSRI = selective serotonin reuptake inhibitor.
See this image and copyright information in PMC

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