Practical management of Raynaud's phenomenon – a primer for practicing physicians

Abstract

Purpose of reviewRaynaud's phenomenon (RP) is a common vasospastic condition that results in digital hypoperfusion in response to cold and/or emotional stress and is associated with significant pain and disability. The aim of our review is to provide a practical approach for clinicians to inform assessment and management of patients with RP.Recent findingsAutoantibodies and nailfold capillaroscopy are key investigations to stratify the risk of progression to systemic sclerosis (SSc) in patients RP, which was recently confirmed in the multicenter, very early diagnosis of systemic sclerosis (VEDOSS) project. Research has explored the complex lived-patient experience of RP including digital vasculopathy in SSc and has highlighted the need for outcome measure development to facilitate research in the field. Pharmacological treatment strategies vary significantly internationally and there is continued interest in developing surgical approaches.SummaryWe provide a practical and up-to-date approach to inform the assessment and management of patients with RP including guidance on drug initiation and escalation. Calcium channel blockers are first-line treatment and can be initiated by primary care physicians. We also highlight second-line drug therapies used for refractory RP and the potential role for surgical intervention.

Optical Coherence Tomography Angiography Is a Useful Tool for Distinguishing Primary Raynaud’s Phenomenon from Systemic Sclerosis and/or Very Early Disease of Systemic Sclerosis

“…RP was defined as self-reported or reported by a physician, with a 2-phase color change in fingers or toes consisting of pallor, cyanosis, and/or reactive hyperemia in response to cold exposure or emotion [27]. RP was defined as primary if these symptoms occurred alone without evidence of any associated disorder [3]. Patients with RP, puffy fingers, and ANA positivity were defined as VEDOSS in the presence of SSc-specific autoantibodies such as centromere or Scl-70 and/or abnormal NVC findings (Figure 1) [6,7].…”

“…Vasculopathy is an important early step in the pathogenesis of SSc, and most patients initially present with Raynaud's phenomenon (RP) as the first symptom. RP, classified into the primary (PRP) and secondary forms, is a painful, cold-induced episodic, reversible vasospastic condition of the small arteries, which is usually localized in the fingers and toes, affecting approximately 5% of the general population [3]. It has been shown that there are structural changes in the microvasculature before inflammation and fibrosis become clinically evident in patients who develop SSc.…”

A rare case of severe Raynaud’s phenomenon

“…Treatments for cold hands, winter RP, and numbness were effective, but insufficient, as symptoms persisted for up to 15 years after diagnosis.RP is a vasospastic disease characterized by an exaggerated vasoconstrictive response to cold and/or emotional stress, and is associated with significant pain and disability [1]. The classic color changes were white (ischemia), blue (deoxygenation), and red (reperfusion) [2]. RP usually appears on fingertips, and its boundaries are well recognized.…”