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

• 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 Criteria

Please refer 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)

Evidence

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

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: July 2016