Raynaud's phenomenon

Last reviewed: 3 Sep 2022

Last updated: 19 Dec 2019

Raynaud's phenomenon (RP) is common, affecting between 3% and 5% of the population.

The diagnosis is made clinically: digits turn white (pallor) then blue with deoxygenation and/or red with reperfusion; pallor is well demarcated.

Primary RP often needs no pharmacological treatment. Keeping warm, smoking cessation, regular exercise, and avoiding stress are recommended.

Secondary RP can be severe, especially when associated with scleroderma. Other connective tissue diseases, malignancy, and atherosclerosis may also be the underlying cause.

In secondary RP, calcium-channel blockers, angiotensin receptor antagonists, ACE inhibitors, SSRIs, systemic and topical nitrates, phosphodiesterase-5 inhibitors, and prostacyclins are potential treatment options.

Complications in secondary RP include severe digital ischaemia, gangrene, digital ulcers, and infection.

Pain relief may be an important adjunctive treatment. There are few data for complementary therapies.

Definition

Raynaud's phenomenon (RP) is characterised by vasospasm that causes digits to change colour to white (pallor) from lack of blood flow, usually brought on by cold temperatures. Affected areas subsequently turn blue due to de-oxygenation and/or red due to reperfusion. It can be a painful condition and can lead to complications.

History and exam

Key diagnostic factors

presence of risk factors
digit pain/discomfort
digital paraesthesia
pallor of digits
red and/or blue discoloration of digits
dilated capillaries at nailbeds
well-defined discoloration
magnification of nailbeds

More key diagnostic factors

Other diagnostic factors

heartburn
dysphagia
puffy hands
tight skin
arthralgia
photosensitivity
oral/nasal ulcers
alopecia
butterfly rash
sclerodactyly
telangiectasia
pleuritic chest pain
digital ulcers
digital pits
digital tuft resorption
gangrene of fingertip/finger
raised painful red lesions on finger tips
auto-amputation

Other diagnostic factors

Risk factors

female
family history
connective tissue disease
vibration injury
Buerger's disease
prolonged cold exposure/frostbite
colder climate
smoking
ischaemia
migraine
glaucoma

More risk factors

Diagnostic investigations

1st investigations to order

clinical diagnosis
antinuclear antibody
FBC
erythrocyte sedimentation rate
creatinine
urinalysis

More 1st investigations to order

Treatment algorithm

ACUTE

severe secondary RP: critical ischaemia with digital ulcers or threatened digital loss

ONGOING

primary or mild secondary RP

Contributors

Authors

Janet Pope, MD, MPH, FRCPC

Professor of Medicine

Division of Rheumatology

Department of Medicine

University of Western Ontario

Schulich School of Medicine and Dentistry

Head

Division of Rheumatology

St. Joseph's Health Care

London

Ontario

Canada

Disclosures

JP has attended advisory boards for Actelion, the manufacturer of bosentan. JP is an author of a number of references cited in this topic.

Peer reviewers

Ariane L. Herrick, MD FRCP

Reader in Rheumatology and Consultant Rheumatologist

Musculoskeletal Research Group

University of Manchester

Manchester

Disclosures

ALH has been a paid speaker for Actelion; a consultant for Actelion and Pfizer; and an investigator in studies sponsored by Actelion, Mediquest, and United Therapeutics. ALH is an author of a number of references cited in this topic.

Bridget Griffiths, MB ChB, MD, MRCP(UK)

Consultant Rheumatologist

Department of Rheumatology

Freeman Hospital

Newcastle upon Tyne

Disclosures

BG declares that she has no competing interests.

Kim Olson, MD

Intern

Veterans Administration Hospital

Minneapolis

Disclosures

KO declares that he has no competing interests.

Thomas Osborn, MD

Associate Professor

Department of Medicine

Mayo Clinic

Rochester

Disclosures

TO declares that he has no competing interests.

Philip Seo, MD, MHS

Assistant Professor of Medicine

Division of Rheumatology

Johns Hopkins University School of Medicine

Co-Director

Johns Hopkins Vasculitis Center

Baltimore

Disclosures

PS declares that he has no competing interests.

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Raynaud's phenomenon

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Treatment algorithm

severe secondary RP: critical ischaemia with digital ulcers or threatened digital loss

primary or mild secondary RP

Contributors

Authors

Janet Pope, MD, MPH, FRCPC

Disclosures

Peer reviewers

Ariane L. Herrick, MD FRCP

Disclosures

Bridget Griffiths, MB ChB, MD, MRCP(UK)

Disclosures

Kim Olson, MD

Disclosures

Thomas Osborn, MD

Disclosures

Philip Seo, MD, MHS

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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