Exposure to certain chemicals (e.g. vinyl chloride, silica, solvents)
Clinical Features and Diagnosis
Raynaud phenomenon itself is a clinical diagnosis: [Ref]
Appearance
Classic triphasic phase of an attack:
Phase 1: sudden vasospasm → blanching (white)
Phase 2: deoxygenation → cyanosis (blue)
Phase 3: reactive hyperaemia → reperfusion(red)
The initial phase 1 of blanching must be present to diagnose Raynaud phenomenon. However, the remaining phases are not necessarily always present, and not necessary for diagnosis.
Location
Raynaud phenomenon classically and primarily affects the fingers and hands
The colour change is usually sharply defined and circumferential (i.e. affecting both the front and the back of the fingers)
The colour changes tend to start distally at the fingertips and spread down to 1 or more fingers
Less commonly, other extremities may be affected, such as the tip of the nose, ears, tongue, lips, and areolar tissue
Sensory symptoms
Transient numbness is often experienced during the phase 1 blanching
Followed by paraesthesia during the phase 3 reperfusion
Episodes are intense, painful and may be irreversible without treatment
Complications like tissue damage are possible
Evidence of underlying cause
+ve ANA titre
Work-Up
Standard work-up in a patient who presents with Raynaud’s phenomenon: [Ref]
Physical examination
Assess for trophic changes (digital pitting, nail changes, digital ulcers)
Assess for signs of underlying autoimmune or connective tissue disorder (e.g. telangiectasia, sclerodactyly, skin tightening around the mouth, malar rash, synovitis, patchy alopecia)
Exclude obstructive vascular disease or distal arterial disease
