From the Guidelines
The most likely cause of secondary Raynaud's phenomenon is connective tissue disorders, particularly systemic sclerosis (scleroderma) 1. Secondary Raynaud's occurs as a result of an underlying condition, unlike primary Raynaud's which occurs on its own. Other common causes include:
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Sjögren's syndrome
- Mixed connective tissue disease Certain medications can also trigger secondary Raynaud's, including:
- Beta-blockers
- Migraine medications containing ergotamine
- Some chemotherapy agents
- Certain over-the-counter cold medications Occupational factors such as repetitive trauma from using vibrating tools or typing can lead to secondary Raynaud's, as can certain blood disorders, thyroid problems, and arterial diseases. When evaluating a patient with suspected secondary Raynaud's, it's essential to look for symptoms of underlying conditions such as skin thickening, joint pain, dry eyes and mouth, or unexplained fatigue, as noted in the management of systemic sclerosis 1. The mechanism typically involves abnormal vasoconstriction of small blood vessels in response to cold or emotional stress, but in secondary Raynaud's, this response is exacerbated by the underlying disease process or external factor, which is a key consideration in the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis 1. Some studies have investigated the efficacy of various interventions in patients with Raynaud's phenomenon, including the use of gloves and heating devices for the hands, avoidance of direct contact with cold surfaces, and a thorough drying of the skin 1. However, the primary focus should be on identifying and managing the underlying condition causing secondary Raynaud's, as this can significantly impact morbidity, mortality, and quality of life 1.
From the Research
Secondary Raynaud's Phenomenon
The most likely cause of secondary Raynaud's phenomenon is an underlying autoimmune connective tissue disease, such as:
- Systemic sclerosis (SSc) 2, 3, 4
- Systemic lupus erythematosus (SLE) 5 Other potential causes of secondary Raynaud's phenomenon include:
- Vaso-occlusive processes 6
- Endothelium injury by autoantibodies and circulating immune complexes 5
- Collagen-vascular diseases 5
Key Factors
Key factors that contribute to the development of secondary Raynaud's phenomenon include:
- Vasospasm within the digital macro- and microvasculature 3
- Progressive obliterative microangiopathy 3
- Digital ischemia 3, 6, 4
- Autoantibodies and circulating immune complexes 5
Diagnosis and Management
Diagnosis and management of secondary Raynaud's phenomenon involve:
- Comprehensive clinical assessment 2, 4
- Targeted investigations, such as nailfold capillaroscopy and testing for autoantibodies 2, 4
- Patient education and lifestyle adaptations 2
- Pharmacological treatment, including calcium channel blockers, phosphodiesterase type 5 inhibitors, and intravenous prostanoid therapy 6, 4
- Surgical intervention, such as digital sympathectomy, in severe cases 6, 4