Diagnosis and management of Raynaud's phenomenon Beth Goundry, Laura Bell, Matthew Langtree, Arumugam Moorthy Raynaud's phenomenon is caused by episodic vasospasm and ischaemia of the extremities in response to cold or emotional stimuli, which result in a characteristic tripha sic colour change in extremities usuallyfingers or toes from white, to blue, red. Raynaud's phenomenon may be primary, in direct response to stimuli, or secondary to an underlying condition. 10-20% ofcases it may be the frst presentation of, or may precede the onset of, a connective tissue disease (such as scleroderma or mixed connective tissue disease), so that underlying causes must beruled out. Raynaud's phenomenon is triggered by a change in temperature rather than simply exposure to cold. Patients have attacks throughout the year-for example, if they move from a warm environment air conditioned one, stand in a cold wind (even on a relatively warm day), or hold a cold milk bottle.
A recent consensus statement on terminology produced by the vascular medicine section of the Royal Society of Medicine recommended abandoning the terms Raynaud's syndrome and Raynaud's disease because of the lack of consensus on their use (Raynaud's phenomenon: new insights, new treatments. Conference organised by the Vascular Medicine Section of the Royal Society of Medicine. 2011 May). In this review we refer to primary and secondary Raynaud's phenomenon. Recent advances in the management and treatment ofthis phenomenon have followed on from the findings of randomised controlled trials of treatment strategies. Were view observational studies, randomised controlled trials, systematic reviews, and guidelines to provide an overview ofthe clinical presentation of Raynaud's phenomenon, its risk factors, its diagnosis, and the current and potential treatments.
Who gets Raynaud's phenomenon? The prevalence of Raynaud's phenomenon varies widely across countries and populations. Non-population based studies of prevalence show that 3-12.5% of men and 6-20% of report symptoms of Raynaud's phenomenon.