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Raynaud Phenomenon

Mechanism: Episodic vasospasm of the digital arteries resulting in white → blue → red discoloration of the fingers secondary to cold exposure
  • Syncopal phase: white
  • Asphyxial phase: blue, painful cyanosis
  • Hyperemic phase: red
  • Triggers: cold, emotion, humidity
 
Etiology
  • Primary Raynaud (Raynaud disease)
    • Typically adolescent girls and young women
    • Not associated with underlying medical problems
    • Bilateral and symetrical
    • No trophic abnormalities (pulp ulcerations, gangrene, nail dystrophy, osteoporosis)
    • Normal pulse
    • Normal capillaroscopy
        • notion image
  • Secondary Raynaud phenomenon
    • Uncommon
    • Associated with underlying medical disorder
        • notion image
        notion image
 
Abordagem
  • Capilaroscopia periungueal
  • Hemograma
  • Fator reumatoide
  • Anticorpos antinuclear, anticentrómero (CREST), anti.Scl70
  • Crioglobulinas e aglutininas
  • RxT
  • Rx mãos
      • notion image
 
Tratamento
  • Medidas gerais
    • Manter mãos quentes, luvas
    • Evitar tabaco
    • Evitar roupa justa
    • Evitar beta-bloqueantes e vasoconstritores nasais
  • Vasodilatadores
    • Calcium channel blockers
      • Nifedipina 10mg PO 3x/dia
        • Libertação prolongada - afalar
        • Efeitos secundários: Headcahes, hot flashes, edema of lower limbs, GERD
      • Amlodipina
      • Nicardipine
      • Diltiazem 2% cold cream QBP 50g
      • Nitroglycerin ointment (diluted to 50% in petroleum jelly do reduce risk of headaches)
    • Pentoxifilina 400mg 2id (trental)
    • Alpha-blockers
      • Prazozine
  • Antiagregante plaquetário
    • Ticlopidina 250mg
    • Low-dose aspirin, clopidogrel
  • Angiotensin II receptor blockers (eg. losartan 50mg id) may also be effective
  • Endothelin receptor antagonists
    • Bosentan 125mg 2id
  • Parenteral prostaglandins
    • ilomedin
  • Phosphodiesterase type 5 inhibitors (eg. sildenafil, tadalafil)
    • Risk: hypotension
  • Fluoxetine 20mg id
  • Botox injections
  • Biofeedback
  • Statins as vasoprotective effect
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