What are the symptoms of Raynaud's disease?

Symptoms of Raynaud's Phenomenon

Raynaud's phenomenon typically presents as episodic color changes in digits, including a white phase (pallor), a blue phase (cyanosis), and a red phase (erythema), accompanied by pain and/or paresthesia due to sensory nerve ischemia. 1

Classic Triphasic Color Changes

• White phase (pallor): Caused by vasoconstriction of digital arteries
• Blue phase (cyanosis): Results from deoxygenated blood in the affected digits
• Red phase (erythema): Occurs during reperfusion as reactive hyperemia 1, 2

Key Clinical Features

• Episodes are typically triggered by:

  • Cold exposure
  • Emotional stress
  • Vibration
  • Vasoconstrictive drugs 1, 3

• Attacks usually affect fingers and toes, but can involve other extremities

• Duration of attacks varies from minutes (average 23 minutes) to hours 4

• Pain, numbness, and tingling sensations commonly occur during attacks 1

• Symptoms are usually bilateral and symmetric 2

Primary vs. Secondary Raynaud's

Primary Raynaud's (Raynaud's Disease)

• Benign condition without underlying disease
• Accounts for approximately 90% of cases 2
• Typically has milder symptoms
• Digital ischemia and tissue loss occur extremely rarely 5

Secondary Raynaud's (Raynaud's Phenomenon)

• Associated with underlying conditions such as:
  • Connective tissue disorders (systemic sclerosis, lupus, rheumatoid arthritis)
  • Vascular pathologies (atherosclerosis, thromboangiitis obliterans)
  • Hematological disorders (prothrombotic states, hyperhomocysteinemia)
  • Medication-induced causes
  • Occupational exposure to vibration 1, 2
• More severe symptoms with risk of complications
• May present with digital ulcers, which have high risk of progression to gangrene (22.5%) and osteomyelitis (11%) 1

Distinguishing Features from Similar Conditions

Raynaud's must be differentiated from other conditions causing color changes in extremities:

• Acrocyanosis: Non-paroxysmal, persistent, painless bluish-red discoloration
• Erythromelalgia: Paroxysmal burning pain with redness, triggered by warmth rather than cold
• Perniosis: Inflammatory skin condition caused by cold exposure 2, 4

Clinical Significance

• Raynaud's phenomenon is the initial manifestation in 70% of patients with systemic sclerosis, often present for years before development of the full connective tissue disease 5
• Regular assessment for complications is necessary for secondary Raynaud's, with monitoring of treatment response by tracking frequency and severity of attacks 1

Recognizing the characteristic triphasic color changes and understanding the distinction between primary and secondary Raynaud's is crucial for proper diagnosis and management of this condition.