27 Jun 2014

What is raynauds phenomenon ?

Raynauds phenomenon is due to episodic digital ischemia (decreased blood supply to digits). On exposure to cold there is color change to digits which change on rewarming. Emotional stress may precipitate Raynaud’s  phenomenon. Color changes are well demarcated and confined to fingers and toes.

Phases of raynauds phenomenon
Phase of  blanching/pallor - On exposure to cold there is spasm of arteries in the digits and cause diminished blood supply to digits, so that the the digit appears white. 
Phase of cyanosis - In this phase there is bluish discolouration of digits. There is dilatation of veins and small capillaries and lead to accumulation of de oxygenated blood in the vessels. In both these phases there is coldness and numbness of digits.
Phase of rubor/redness - It occur on rewarming the digit.This is due to dilatation of blood vessels, spasm resolves, so there is reactive hyperemia. In this phase patient experience pain and throbbing sensation. All the three phases need not be present in a given patient. Some patient experience only pallor and cyanosis where as others have only cyanosis.

Classification 
Primary or idiopathic condition is called Raynaud’s disease. Secondary is associated with underlying disease that is known to produce vasospasm.

Raynauds disease
It is more common in females and is usually seen between the age group 20 to 40. Fingers are more commonly affected than toes. Other areas affected may be ear lobes, tip of nose, penis. This is more common in those who suffer from migraine or variant angina. Those with raynauds disease have milder form of Raynaud’s phenomenon.  

Secondary causes of Raynaud’s phenomenon

a) Collagen vascular diseases:
  1. Scleroderma (80-90%)
  2. Dermatomyositis, Polymyositis(30%) 
  3. Rheumatoid arthritis 
  4. Systemic lupus erythematosus(20%)

b) Diseases  producing arterial occlusion: 
  1. Atherosclerosis of the extremities-Common in men more than 50 yrs. 
  2. Thromboangiitis obliterans (TAO) more common in young males who are smokers
  3. Acute arterial occlusion 
  4. Thoracic outlet syndrome

c) Pulmonary  artery hypertension

d) Nervous system disorders:
  1. Intervertebral disk disease
  2. Syringomyelia
  3. Spinal cord tumors
  4. Stroke 
  5. Poliomyelitis
  6. Carpal tunnel syndrome

e) Disease of Blood: 
  1. Cold agglutinins
  2. Cryoglobulinemia
  3. Cryofibrinogenemia 
  4. Myeloproliferative disorders
  5. Waldenstr├Âm’s macroglobulinemia

f) Trauma: 
  1. Vibration injury
  2. Hammer hand syndrome
  3. Electric shock
  4. Cold injury 
  5. Typing
  6. Piano playing

g) Drugs: 
  1. Ergot derivatives
  2. Methysergide
  3. ╬▓-adrenergic receptor
  4. Blockers
  5. Bleomycin 
  6. Vinblastine 
  7. Cisplatin

Complication of Raynaud’s phenomenon 
Rarely progress to digital ischemia, gangrene, ulceration and auto amputation of digits.

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