ESVM guidelines – the diagnosis and management of Raynaud’s phenomenon

Abstract

Abstract. Regarding the clinical diagnosis of Raynaud’s phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational studies; few randomized studies are available, almost all relating to drug treatment, and thus these guidelines were developed as an expert consensus document to aid in the diagnosis and management of Raynaud’s phenomenon. This consensus document starts with a clarification about the definition and terminology of Raynaud’s phenomenon and covers the differential and aetiological diagnoses as well as the symptomatic treatment.

Lymphaticovenular anastomosis and venous arterialization in coexisting Raynaud's phenomenon and lymphedema: A case report

“…Raynaud's phenomenon and lymphedema both severely impact quality of life and are refractory to treatment (Bakar & Tuğral, ; Belch et al, ). Therefore, complex decongestive therapy remains the gold standard for the management of both conditions.…”

“…At a critical level of ischemia, patients with Raynaud's phenomenon develop intractable pain and nonhealing ulcers with the potential for necrosis. The optimal medical management of patients presenting with this condition remains unclear (Belch, Carlizza, Carpentier, et al, ). However, venous arterialization (VA) may be considered as a salvage procedure when no distal vessels are available for vascular reconstruction (Zeng & Hammert, ).…”

Hands as cold as ice

“…[1][2][3][4][5] Primary RP is a benign idiopathic condition, whereas secondary RP is associated with systemic sclerosis (SSc) among other conditions. [1][2][3][4][5] Abnormal nailfold capillaroscopy and the presence of SSc-specific autoantibodies can facilitate early diagnosis of SSc, and thus allow differentiation between primary and secondary RP. [1][2][3][4][5] Digital ischaemia and ulceration cause significant pain and functional impairment in progressing RP.…”

“…[1][2][3][4][5] Abnormal nailfold capillaroscopy and the presence of SSc-specific autoantibodies can facilitate early diagnosis of SSc, and thus allow differentiation between primary and secondary RP. [1][2][3][4][5] Digital ischaemia and ulceration cause significant pain and functional impairment in progressing RP. Patient education and lifestyle modification regarding cold avoidance are therefore crucial aspects of management.…”

“…Patient education and lifestyle modification regarding cold avoidance are therefore crucial aspects of management. [1][2][3][4][5] While pharmacological treatment with calcium-channel blockers, selective serotonin re-uptake inhibitors, phosphodiesterase-5 inhibitors, topical vasodilators and prostaglandins aims to counteract vasoconstriction, surgical intervention with localised digital sympathectomy, tissue debridement or amputation may be indicated in selected cases with severe digital ulceration and/or refractory rest pain. [1][2][3][4] The patient's symptoms did not significantly interfere with her quality of life, and she therefore opted for conservative management with cold avoidance and hand re-warming strategies during winter months.…”