{"id":15960,"date":"2023-07-14T11:05:47","date_gmt":"2023-07-14T10:05:47","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=15960"},"modified":"2024-10-07T11:21:07","modified_gmt":"2024-10-07T10:21:07","slug":"raynauds-phenomenon","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/raynauds-phenomenon\/","title":{"rendered":"Raynaud&#8217;s Phenomenon"},"content":{"rendered":"\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:15% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"478\" height=\"845\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Raynauds-hand.png\" alt=\"Raynauds hand\" class=\"wp-image-17617 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Raynauds-hand.png 478w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Raynauds-hand-170x300.png 170w\" sizes=\"auto, (max-width: 478px) 100vw, 478px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p>Characterised by transient sequential <em>colour changes<\/em> of white, blue and red usually in the fingers and\/or toes triggered by cold or emotion. The digits are most commonly affected but Raynaud\u2019s can affect the nose, tongue or nipples. Raynaud\u2019s is classified into primary and secondary subtypes.<\/p>\n\n\n\n<p><em>&#8211; image courtesy of Professor Stuart Ralston<\/em><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\"><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\"><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\"><\/div>\n<\/div>\n\n\n\n<p>Raynaud\u2019s <strong>does not <\/strong>cause a fixed discolouration. If this is observed, it suggests another underlying cause such as:<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Peripheral vascular disease<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Embolism<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Adverse effect of drug or chemical exposure: beta-blockers, vinyl chloride cocaine use, interferon, anti-cancer drugs, bromocriptine,&nbsp; ciclosporin, combined oral contraceptives, clonidine<\/p>\n<\/div>\n<\/div>\n\n\n\n<p><strong>Primary Raynaud\u2019s phenomenon<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Very common and estimated to affect about 10% of women in the UK.<\/li>\n\n\n\n<li>Typical onset in teenage years or early adulthood<\/li>\n\n\n\n<li>Rarely presents for the first time above the age of 40 years.<\/li>\n\n\n\n<li>Occurs with exposure to cold or emotional stress.<\/li>\n\n\n\n<li>Usually, bilateral<\/li>\n\n\n\n<li>No ulceration or tissue necrosis<\/li>\n<\/ul>\n\n\n\n<p><strong>Secondary Raynaud\u2019s phenomenon<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually more severe than primary Raynaud\u2019s<\/li>\n\n\n\n<li>Typically associated with a connective tissue disease<\/li>\n\n\n\n<li>Can be associated with digital ulcers and necrosis<\/li>\n<\/ul>\n\n\n\n<p><strong>M.A &amp; S.R\/H.B. 25-01-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Almost all patients with Raynaud\u2019s can be managed in Primary Care but rheumatology referral should be considered in&nbsp; those with digital ulceration and those suspected to have connective tissue disease.&nbsp; Please refer to the diagnostic algorithm below.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"944\" height=\"712\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-6.png\" alt=\"Management of Raynaud's\" class=\"wp-image-17613\" style=\"width:913px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-6.png 944w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-6-300x226.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-6-768x579.png 768w\" sizes=\"auto, (max-width: 944px) 100vw, 944px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway &gt; Rheumatology &gt; WGH<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Lifestyle advice<\/strong><\/p>\n\n\n\n<p>Lifestyle measures should be tried first:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Keep the whole body warm by wearing layers of clothes, thermal underwear sheep skin gloves and boots and using hand warmers.<\/li>\n\n\n\n<li>Stop smoking and avoid second-hand smoke. Regular smokers are sensitized to the vasoconstrictive properties of nicotine.<\/li>\n\n\n\n<li>Avoid cold exposure and changes in temperature where possible, especially sudden changes such as walking into the frozen food section of a grocery store.<\/li>\n\n\n\n<li>Help terminate an attack by rubbing the hands together, placing the hands under warm water or in a warm place such as the axilla, or rotating the arms in a windmill pattern.<\/li>\n\n\n\n<li>Avoid medication and other exposures which may provoke Raynaud\u2019s, such as decongestants, <a href=\"https:\/\/www.uptodate.com\/contents\/methylphenidate-drug-information?source=see_link\">methylphenidate<\/a>, <a href=\"https:\/\/www.uptodate.com\/contents\/sumatriptan-drug-information?source=see_link\">sumatriptan<\/a>, beta-blockers and <a href=\"https:\/\/www.uptodate.com\/contents\/caffeine-drug-information?source=see_link\">caffeine<\/a>.<\/li>\n\n\n\n<li>Control or limit emotional stress and anxiety.<\/li>\n<\/ul>\n\n\n\n<p><strong>Drug treatments<\/strong><\/p>\n\n\n\n<p>Drug treatments have limited effectiveness in Raynaud\u2019s and often cause adverse effects such as headaches, related to general vasodilatation. No licensed treatments are available for Raynaud\u2019s that can be prescribed in primary care. Calcium antagonists can be tried as first line, followed by PDE-5 inhibitors if calcium antagonists are ineffective or cause adverse effects (see Figure below). Additional treatments which have been tried in Raynaud\u2019s &nbsp;include aspirin, fluoxetine, and statins but the evidence base for the use of these drugs is limited.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"632\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-7-1024x632.png\" alt=\"Drug treatment of Raynaud's\" class=\"wp-image-17614\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-7-1024x632.png 1024w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-7-300x185.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-7-768x474.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-7.png 1031w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Patient information<\/strong><\/p>\n\n\n\n<p>Scleroderma and Raynaud\u2019s UK &#8211; <a href=\"https:\/\/www.sruk.co.uk\/raynauds\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sruk.co.uk\/raynauds\/<\/a><\/p>\n\n\n\n<p>Raynaud\u2019s Phenomen \u2013 Arthritis Research UK &#8211; <a href=\"https:\/\/www.versusarthritis.org\/about-arthritis\/conditions\/raynauds-phenomenon\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.versusarthritis.org\/about-arthritis\/conditions\/raynauds-phenomenon\/<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Characterised by transient sequential colour changes of white, blue and red usually in the fingers and\/or toes triggered by cold or emotion. The digits are most commonly affected but Raynaud&rsquo;s can affect the nose, tongue or nipples. Raynaud&rsquo;s is classified into primary and secondary subtypes. &ndash; image courtesy of Professor Stuart Ralston Raynaud&rsquo;s does not<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[954],"class_list":["post-15960","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-raynauds-phenomenon"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/https-apps-nhslothian-scot-refhelp-raynauds-phenomenon\/\" rel=\"tag\">Raynaud's Phenomenon<\/a>","rttpg_excerpt":"Characterised by transient sequential colour changes of white, blue and red usually in the fingers and\/or toes triggered by cold or emotion. The digits are most commonly affected but Raynaud&rsquo;s can affect the nose, tongue or nipples. Raynaud&rsquo;s is classified into primary and secondary subtypes. &ndash; image courtesy of Professor Stuart Ralston Raynaud&rsquo;s does not","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15960","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=15960"}],"version-history":[{"count":17,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15960\/revisions"}],"predecessor-version":[{"id":21131,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15960\/revisions\/21131"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=15960"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=15960"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}