Raynauds Phenomenon Prof Neil McHugh
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Transcript of Raynauds Phenomenon Prof Neil McHugh
Raynaud’s phenomenon
When is it serious?Neil McHugh
Bath Clinic June 2011
Raynaud’s phenomenonMaurice Raynaud (1834 – 1881)
De l'asphyxie locale et de la gangrène symétrique des
extrémités.
Doctoral thesis, published February 25, 1862.
Clinical features or Raynaud’s
Primarily affects fingers Can affect toes, thumbs,
nipples, nose, earlobes Episodes precipitated by
cold exposure and emotional stress
Episodes accompanied by pain +/- numbness
Pulses present Necrosis / tissue damage
suggestive of secondary cause
Initial ischaemia
Pallor
Cyanotic phase
Blue
Hyperaemic phase
Red / purple
Definition of RP
Definite repetitive episodes of biphasic
colour change (at least 2 of pallor, cyanosis, erythema), in either cold or normal environment
Pathogenesis
Causes Primary (~10-15% of healthy population, female
predominance) Secondary
Drugs e.g. Beta blockers Connective tissue disorders e.g. systemic sclerosis Eating disorders Haematological e.g. cold agglutinins Vascular occlusion e.g. vasculitis, thoracic outlet
obstruction, Buerger’s disease Occupation e.g. vibrating tool use Others e.g. hypothyroidism, carpal tunnel syndrome
Is it seconday Raynaud’s? History
Severity, age of onset, gender, symptoms of CTD etc
Clinical examination Radial pulses Skin changes Nailfold changes Joint disease Carpal Tunnel Syndrome
Laboratory investigations FBC, U&E, LFT, CRP, TSH Autoimmune profile Nailfold capillaroscopy Infrared thermography
Systemic sclerosis
Laser Speckle Contrast Imaging
Healthy control Systemic sclerosis
Management General measures
Raynaud’s and Scleroderma Association www.raynauds.org.uk
Scleroderma Society Sclerodermasociety.co.uk
Arthritis Research UK (formerly ARC) www.arthritisresearchuk.org
Maintenance of core temperature Avoidance of cold exposure Cessation of vasoconstrictive Rx e.g. B blockers Gloves (heated) Smoking cessation
Promoting vasodilation Calcium channel blockers
Dihydropyridine Nifedipine better than amlodipine
Nitrates Transdermal or oral
Prostaglandins IV (disappointing results with oral preparation)
Phosphodiesterase V inhibitors Under investigation. Remain expensive.
Preventing vasoconstriction ACEi and ARBs
e.g. losartan May be better in primary RP
Alpha adrenoceptor blockade e.g. prazosin
SSRIs e.g. fluoxetine May be better in primary Raynaud’s
Endothelin receptor antagonists e.g. bosentan Reserved for use in CTD
Novel treatments Rho kinase inhibitors
Responsible for cold-induced expression of alpha-2 adrenoceptors
Statins In part due to Rho kinase inhibition
Antiplatelet treatments? Current trial at RNHRD (for primary and
secondary Raynaud’s)