Raynaud's Phenomenon
Raynaud's Phenomenon: Excerpt from In a Page: Signs and Symptoms
Raynaud's phenomenon is paroxysmal ischemia of the digits that manifests as changing color of the fingers, and pain and/or numbness. Sharply demarcated blanching, pallor, cyanosis, and/or erythema of the fingers, toes, or nail beds may occur. The usual sequence of color changes is white-to-blue-to-red, with eventual return to normal skin color upon removal of trigger. Repeated attacks may lead to taut, atrophic skin and shortening of the terminal phalanges (sclerodactyly). Rarely, ulcers, gangrene, and clubbing of the nails occur.
Differential Diagnosis
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Primary (idiopathic) disease
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Secondary disease associated with underlying systemic conditions
–Scleroderma or CREST
–Systemic lupus erythematosus
–Rheumatoid arthritis
–Mixed connective tissue disease
–Sjögren's syndrome
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Arteriosclerosis obliterans
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Thromboangiitis obliterans
–Associated with male smokers
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Arterial embolism
–Acute onset
–Pulseless
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Cryoglobulinemia
–Hepatitis C
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Cold agglutinins
–Mycoplasma infection
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Macroglobulinemia
–Multiple myeloma
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Polycythemia vera
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Vasculitis (e.g., Wegener's granulomatosis)
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Hepatitis B
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Hypothyroidism
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Thoracic outlet syndrome (brachial plexus)
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Carpal tunnel syndrome
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Drugs: β-blockers, methysergide, bleomycin, vinblastine, clonidine, cyclosporine, ergot preparations
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Trauma
–Often associated with vibratory tool workers, pianists, typists, or meat cutters
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Hypothenar hammer syndrome
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Reflex sympathetic dystrophy
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Multiple sclerosis
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Syringomyelia
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Poliomyelitis
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Neoplasms
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Vinyl chloride poisoning
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Arteriovenous fistula
Workup and Diagnosis
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Thorough history and physical examination
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CBC with differential may identify various cytopenias associated with connective tissue diseases
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TSH to rule out hypothyroidism
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Hepatitis serologies
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Creatine phosphokinase to rule out polymyositis
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Complement levels are low in SLE
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ANA, ESR, and rheumatoid factor to screen for collagen vascular diseases
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Directed autoantibody testing according to presentation
–Anti-double stranded DNA and anti-Sm (SLE)
–Anti-SSA (Sjögren's syndrome)
–Anti-centromere (CREST syndrome)
–Anti-ribonucleoprotein (mixed connective tissue disease)
–Anti-Scl 70 (scleroderma)
–ANCA (Wegener's granulomatosis)
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Serum cryoglobulins and cold agglutinins
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Serum protein electropheresis to rule out paraproteinemia
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EMG/nerve conduction studies to rule out brachial plexus pathology and carpal tunnel syndrome
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Age-appropriate cancer screening
Treatment
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Treat any underlying disorders
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Stop offending or exacerbating medications
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Quit smoking
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Protect hands from cold or trauma with gloves
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Avoid known triggers (e.g., cold, emotional stress, vibrating tools)
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Vasodilator drugs (e.g., long-acting oral nitrates, low-dose sustained-release nifedipine)
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Surgical treatment may include sympathectomy
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Raynaud Phenomenon (In A Page: Pediatric Signs and Symptoms)
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