Approach to Raynaud’s Phenomenon

Differential diagnosis

• Primary Raynaud’s phenomenon
• Secondary
  • Connective tissue disease
    • Systemic sclerosis
    • Systemic lupus erythematosus
    • Rheumatoid arthritis
    • Mixed connective tissue disease
    • Polymyositis / dermatomyositis
  • Drugs
    • Tryptans
    • Oral contraceptive pill
    • Hormone replacement therapy
    • ACE inhibitors
    • β blockers
    • Amphetamines
  • Underlying malignancy
    • Acute lymphoblastic leukaemia
    • Lymphoma
    • Myeloma
  • Infections
    • Hepatitis B
    • Hepatitis C
  • Smoking

Management

• Finger warmers
• Topical nitrates
• Calcium channel blockers (nifedipine)
• Phosphodiesterase 5 inhibitors
• Iloprost (prostaglandin analogue)