Raynauds Phenomenon

Scope

  • Raynauds phenomenon – reversible digital ischaemia, with classic triphasic colour change, due to digital arterial vasospasm
  • Common – ~10% of the population, females more than males
  • Usual age of onset 20-40 years
  • 90% is idiopathic or Primary
  • Secondary Raynauds can occur in SLE, Sjogren`s, Scleroderma & other Autoimmune Rheumatic Diseases
  • Patient information

Investigations if Secondary Raynauds suspected

  • FBC RFT LFT
  • PV, CRP
  • ANA (add ENA & DsDNA if ANA positive)
  • Blood Pressure & urinalysis

Management

  • review precipitating factors - beta-blockers, cigarettes, recreational drugs
  • keep arms & whole body warm
  • gloves, heated gloves
  • occupational health assessment if vibrating machinery involved
  • Nutrients such as Vitamin C (ascorbic acid) 500 - 1000mg daily & Vitamin E (tocopheryl acetate) 200 - 400mg daily and Gamolenic Acid (GLA) approx 320mg daily (found in evening primrose, starflower and linseed/flaxseed oils & Omega-3 fish oils) can be purchased by the patient
  • Medication licensed for Raynauds: nifedipine see 2.6 Nitrates, calcium-channel blockers, and other antianginal drugs.
  • Unlicensed medication but may be helpful: lisinopril, losartan, sildenafil (now off patent and much cheaper), fluoxetine
  • regular moisturising for painful skin fissuring; consider Diprosalic® ointment

Referral

Referral Criteria

Refer to Rheumatology (advice and guidance or face to face assessment maybe indicated dependent on the case) if

  • onset over age 40
  • not responding to Primary Care Treatments
  • evidence of Autoimmune Rheumatic Disease
  • digital ulceration
  • (Refer to Vascular Surgeons if unilateral Raynauds)

Supporting Information

Evidence

Personal communication Drs Brown, Earl, Haigh & Mascarenhas, Rheumatology Consultants, Royal Devon & Exeter Hospital February 2015

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: July 2016

Updated: May 2021

Last updated: 27-05-2021

 

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