From the Guidelines
Raynaud's phenomenon and Raynaud's disease differ primarily in their underlying causes and associations with other medical conditions, with Raynaud's disease being a milder form that occurs on its own without an underlying medical condition. Raynaud's phenomenon is the general term for episodes where blood vessels in the extremities (typically fingers and toes) narrow excessively in response to cold or stress, causing color changes and discomfort. The key distinction between the two lies in the presence or absence of an underlying condition, with Raynaud's disease, also called primary Raynaud's, occurring without such a condition and being typically milder [ 1 ].
In contrast, Raynaud's phenomenon that occurs secondary to another condition (secondary Raynaud's) is often more severe and may cause tissue damage. Primary Raynaud's usually begins at a younger age, affects more women than men, and rarely leads to tissue damage. Secondary Raynaud's typically develops after age 40 and is associated with conditions like scleroderma, lupus, rheumatoid arthritis, or certain medications [ 1 ].
Some key points to consider in managing both conditions include:
- Avoiding triggers such as cold, trauma, stress, smoking, vibration injury, or certain drugs (for example, bleomycin, clonidine, and ergot alkaloids) [ 1 ]
- Keeping extremities warm with proper clothing and considering physical therapy to stimulate blood flow [ 1 ]
- Using medications like calcium channel blockers (such as nifedipine 30-60mg daily) or vasodilators in more severe cases [ 1 ]
- Treating the underlying condition and monitoring for complications like digital ulcers or tissue necrosis in secondary Raynaud's [ 1 ]
From the Research
Definition and Classification
- Raynaud's phenomenon (RP) is a symptom complex caused by digital vascular compromise, characterized by episodic vasospasm of the digital arteries, resulting in pallor, cyanosis, and/or rubor 2, 3.
- RP can be classified into two main categories: primary (idiopathic) and secondary, with secondary RP being associated with underlying diseases or conditions, such as connective tissue diseases, including scleroderma and systemic lupus erythematosus 3, 4.
Primary vs. Secondary Raynaud's
- Primary RP is generally considered a distinct disorder, but it may comprise several entities, including a functional vasospastic disorder, a physiologically appropriate thermoregulatory response, subclinical atherosclerosis, and "cold intolerance" 2.
- Secondary RP, on the other hand, encompasses a broad range of rheumatological, haematological, endocrinological, and vascular pathology, and can result in more severe digital ischaemia, including digital ulcers and gangrene 2, 5.
- The key difference between primary and secondary RP is the presence of underlying pathology in secondary RP, which can lead to more severe and persistent digital ischaemia 3, 6.
Clinical Features and Management
- RP can range from relatively benign but intrusive vasospasm to progressive obliterative microangiopathy, and its management may differ depending on the underlying cause 2.
- Non-pharmacological management, including avoiding cold and smoking cessation, is often indicated in all patients, while pharmacological treatment, such as calcium channel antagonists, may be necessary in some cases 3, 5.
- The treatment of RP must be tailored to the individual, taking into account the underlying cause and the severity of the condition 4.