Raynauds Phenomenon

Scope

  • Raynauds phenomenon – reversible digital ischaemia, with classic triphasic colour change, due to digital arterial vasospasm
  • Common – ~10% of the population, females>males
  • Usual age of onset 20-40yrs
  • 90% is idiopathic or Primary
  • Secondary Raynauds can occur in SLE, Sjogren`s, Scleroderma & other Autoimmune Rheumatic Diseases
  • Patient information

Assessment

Signs and Symptoms

  • Raynauds phenomenon – reversible digital ischaemia, with classic triphasic colour change, due to digital arterial vasospasm
  • Common – ~10% of the population, females>males
  • Usual age of onset 20-40yrs
  • 90% is idiopathic or Primary
  • Secondary Raynauds can occur in SLE, Sjogren`s, Scleroderma & other Autoimmune Rheumatic Diseases
  • Patient information

Investigations if Secondary Raynauds suspected

  • FBC RFT LFT
  • PV, CRP
  • ANA (add ENA & DsDNA if ANA positive)
  • Blood Pressure & urinalysis

Management

  • Review precipitating factors - B blockers, cigarettes, recreational drugs
  • Keep arms & whole body warm
  • Gloves, heated gloves
  • Occupational health assessment if vibrating machinery involved
  • Nutrients such as Vitamin C (ascorbic acid) 500 - 1000mg daily & Vitamin E (tocopheryl acetate) 200 - 400mg daily and Gamolenic Acid (GLA) approx 320mg daily (found in evening primrose, starflower and linseed/flaxseed oils & Omega-3 fish oils)
  • Medications licensed for Raynauds: nifedipine. Unlicensed medication but may be helpful: lisinopril, losartan, sildenafil (now off patent and much cheaper), fluoxetine
  • Regular moisturising for painful skin fissuring; consider Diprosalic ointment or Haelan Tape
Long-term Condition Self-Management Programme

GPs and patients can refer to Improving Lives Plymouth for patient support with any long-term physical or low level mental health condition. The service helps people to better manage their condition and to achieve a better quality of life.

Referral

Referral Criteria

Please refer if

  • Onset over aged 40
  • Not responding to Primary Care Treatments
  • Evidence of Autoimmune Rheumatic Disease
  • Digital ulceration
  • (Refer to Vascular Surgeons if unilateral Raynauds)

Refer to Long Term Conditions Self-Management Programme

Supporting Information

Patient Information

Improving Lives Plymouth - Long Term Conditions Self-Management Programme

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: February 2017
Updated: October 2018

 

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