Raynaud phenomenon

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 16 Aug 2025

Last updated: 04 Oct 2024

Raynaud 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 pharmacologic treatment. Keeping warm, smoking cessation, regular exercise, and avoiding stress are recommended. Pharmacologic treatment can be considered in people with mild disease who do not respond to lifestyle measures. Potential treatment options include calcium-channel blockers, angiotensin-II receptor antagonists, selective serotonin-reuptake inhibitors (SSRIs), topical nitrates, alpha-blockers, and ACE inhibitors.

Secondary RP can be severe, especially when associated with systemic sclerosis (SSc). Other underlying conditions, exposures, or drugs can also cause secondary RP. In severe secondary RP, calcium-channel blockers, phosphodiesterase-5 inhibitors, prostacyclins, atorvastatin, and bosentan are potential treatment options, with only the most severe cases warranting surgical intervention.

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

Pain relief and wound care of digital ulcers may be important adjunctive treatments.

Definição

Raynaud phenomenon (RP) is characterized by vasospasm that causes digits to change color to white (pallor) from lack of blood flow, usually brought on by cold temperatures. Affected areas subsequently turn blue due to deoxygenation and/or red due to reperfusion. Both primary and secondary RP can be painful; however, secondary RP can lead to complications from prolonged periods of ischemia.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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
autoamputation

Detalhes completos

Fatores de risco

female
family history
connective tissue disease
use of certain drugs
vibration injury
Buerger disease
prolonged cold exposure/frostbite
colder climate
smoking
ischemia
migraine
glaucoma

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis
antinuclear antibody
CBC
erythrocyte sedimentation rate
C-reactive protein
urinalysis

Detalhes completos

Investigações a serem consideradas

capillaroscopy

Detalhes completos

Algoritmo de tratamento

AGUDA

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

CONTÍNUA

primary or mild secondary RP

Colaboradores

Autores

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 been reimbursed for consulting with several pharmaceutical manufacturers unrelated to Rayaud phenomenon. JP’s institution receives research grants from BMS, Janssen, and Seattle Genetics. She has acted as a consultant for AbbVie, Amgen, AstraZeneca, BI, BMS, Celltrion, EMERALD, Frensenius Kabi, GSK, Janssen, JMP, Lilly, Mallinckrodt Pharmaceuticals, Mitsubishi Tanabe Pharma, Novartis, Organon, Pfizer, Sandoz, Samsung, and Viatris. JP is a speaker and advisory board member for AbbVie, Amgen, AstraZeneca, BI, BMS, Frensenius Kabi, GSK, Janssen, JMP, Lilly, Novartis, Organon, Pfizer, Sandoz, UCB, and Viatris. She receives no patents or royalties. JP is an author of a number of references cited in this topic.

Revisores

Elena Schiopu, MD

Professor of Medicine

Rheumatologist

Medical College of Georgia at Augusta University

Charlie Norwood Veterans Affairs Medical Center

Augusta

Declarações

ES declares that she has no competing interests.

Ariane L. Herrick, MD FRCP

Reader in Rheumatology and Consultant Rheumatologist

Musculoskeletal Research Group

University of Manchester

Manchester

Declarações

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Curtiss P, Svigos K, Schwager Z, et al. Part I: epidemiology, pathophysiology, and clinical considerations of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol. 2024 Feb;90(2):223-34. Abstract

Belch J, Carlizza A, Carpentier PH, et al. ESVM guidelines - the diagnosis and management of Raynaud's phenomenon. Vasa. 2017 Oct;46(6):413-23.Full text Abstract

Kowal-Bielecka O, Fransen J, Avouac J, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis. 2017 Aug;76(8):1327-39.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Normal response to cold
- Cyanosis/cryoglobulinemia
- Chilblains (perniosis)
Больше Отличия
Рекомендации
- The 2024 British Society for Rheumatology guideline for management of systemic sclerosis
- EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis
Больше Рекомендации
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Quitting smoking
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Raynaud phenomenon

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

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

primary or mild secondary RP

Colaboradores

Autores

Janet Pope, MD, MPH, FRCPC

Disclosures

Revisores

Elena Schiopu, MD

Declarações

Ariane L. Herrick, MD FRCP

Declarações

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

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice