Raynaud's phenomenon / symptoms "like-fingers" (ICD-10: I 73.0)
Contents
Definition
Raynaud's phenomenon «Dead fingers» and cold fingers. Image reference: Niklas D (Own work) Wikimedia Commons. CC BY SA 3.0
Blood vessel contractions (vasospasm) lead to cold finger episodes due to reduced blood circulation most often in the fingers and toes, triggered by cold or stress. Named after the French doctor Maurice Raynaud (1834-1881).
Occurrence
As many as 8-10% of the population have Raynaud's phenomenon from time to time.
- Over 80% are «primary», ie not related to the underlying disease (reference: Brand FN, 1997)
Symptoms
Three stages. Episodes have a duration most often less than 15 minutes:
- Loss of normal color in the skin (white finger or toes) with reduced feeling
- Blueish discoloration and pain (blood circulation resumed)
- Redness of the skin and increased heat before normalization
Primarily Raynaud's phenomenon
Occurs without any other underlying disease. Most have had symptoms from childhood or early adulthood.
- It is very unusual that primarily Raynaud's phenomenon causes wounds (ulcers) on the fingers.
Secondary Raynaud's phenomenon
Occur later in life and may be caused by an underlying disease. The list of possible reasons is long (See Wikipedia here). Among the rheumatic diseases are
Rheumatic diseases
-
Cold agglutinin disease
-
Mixed connective tissue disease (MCTD)
-
Systemic lupus erythematosus (SLE)
-
Systemic sclerosis
Medication
- Beta-blockers
- Cell poison treatment with bleomycin, vinblastine, vincristine og cisplatin (against Lymphoma, testicular cancer and others)
- Caffeine (coffee) (large doses)
- Nicotine and snuff (large doses)
- Substances (amphetamine, cocaine)
Medical examinations
Typically primarily Raynaud's phenomenon usually does not require a wide medical examination, but if suspected of underlying disease (secondary Raynaud's phenomenon), the general practitioner will conduct medical investigations
- Blood samples (lowering reaction (SR), Hgb, platelets, leukocytes, TSH, T4, ANA with subgroups)
- Further interpretation of the results, and more special medical investigation for example with nail-fold capillaroscopy is a specialist task that many rheumatologists do
Raynaud's phenomenon is investigated capillaroscopy. Research Laboratory and Academic Unit of Clinical Rheumatology, University of Genova, Genova, Italy. CC BY NC 3.0
Incorrect diagnosis? (Similar diseases / differential diagnoses)
- Atherosclerosis (Atherosclerosis)
- Disposable causes
- High age
- Bürger's disease (thrombangitis obliterans)
- large Smokers
- Blood clot (arterial embolism)
- Frostbite
- hypothyroidism (low metabolism)
- Cryoglobulinemia
- Frequent paraproteinemia (electrophoresis)
- Malignant disease / cancer
- Neuropathy
- Thoracic outlet syndrome
- Mostly one-sided in one hand
- Necrosis (tissue decay) is described here (Vaskulitt.no)
Treatment
Primary Raynaud's phenomenon usually does not require any drug treatment.
- Avoid cold, prevent with good mittens and gloves
- Calcium blockers (eg Adalat) have shown some effect, but also some unpleasant side effects (headache, dizziness, low blood pressure) (reference: Cochrane 2016). Follow-up monitoring of blood pressure after treatment start may be relevant
- The supply of Adalat has at times been limited in the pharmacies. Amlodipine (Norvasc) 2,5-5mg and lercanidine 10mg (Zanidip) may be alternatives. Careful tapping of the dose (to avoid side effects) may be appropriate. One can start with amlodipine 2,5mg / day (half a 5mg tablet) and then increase to a maximum of 10-20mg / day. (Reference Lee EY, 2014)
- Sildenafil tablets (Revatio) are sometimes used after special thorough evaluation, without approved indication
- By secondary Raynaud's phenomenon may require special measures to prevent ulcer development (digital ulcers) or severe pain. rheumatic disease exists, local rheumatologist will help
- In Oslo is Rheumatology Department at Oslo University Hospital, Rikshospitalet Department for patients with systemic connective tissue disease or vasculitis
