Raynaud's

Raynaud's phenomena may be primary (Raynaud's disease) or secondary (Raynaud's phenomenon)

Raynaud's disease typically presents in young women (e.g. 30 years old) with symmetrical attacks

Factors suggesting underlying connective tissue disease

• onset after 40 years
• unilateral symptoms
• rashes
• presence of autoantibodies
• features which may suggest rheumatoid arthritis or SLE, for example arthritis or recurrent miscarriages
• digital ulcers, calcinosis
• very rarely: chilblains

Secondary causes

• connective tissue disorders: scleroderma (most common), rheumatoid arthritis, SLE
• leukaemia
• type I cryoglobulinaemia, cold agglutinins
• use of vibrating tools
• drugs: oral contraceptive pill, ergot
• cervical rib

Management

• first-line: calcium channel blockers e.g. nifedipine
• IV prostacyclin infusions: effects may last several weeks/months