Clinical Review

Diagnosis and management of Raynaud’s phenomenon

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e289 (Published 07 February 2012) Cite this as: BMJ 2012;344:e289
  1. Beth Goundry, foundation year 2 doctor ,
  2. Laura Bell, general practice specialist trainee year 2,
  3. Matthew Langtree, core medical trainee year 2,
  4. Arumugam Moorthy, consultant rheumatologist
  1. 1Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
  1. Correspondence to: A Moorthy moorthyarumugam{at}hotmail.com
  • Accepted 5 January 2012

Summary points

  • Raynaud’s phenomenon is caused by episodic vasospasm and ischaemia of the extremities, particularly the digits, in response to cold or emotional stimuli

  • Attacks comprise a colour change in extremities from white (ischaemia), to blue (deoxygenation), and then to red (reperfusion)

  • Primary Raynaud’s phenomenon is an exaggerated response to stimuli, with no known underlying cause

  • Secondary Raynaud’s phenomenon is usually caused by connective tissue disease and patients are more likely to develop tissue damage

  • Nifedipine is currently the only drug licensed for use in Raynaud’s phenomenon

  • Key areas of ongoing research include a topical nitroglycerin and a rho kinase inhibitor (vasodilator)

Raynaud’s phenomenon is caused by episodic vasospasm and ischaemia of the extremities in response to cold or emotional stimuli, which result in a characteristic triphasic colour change in extremities—usually fingers or toes—from white, to blue, to red. Raynaud’s phenomenon may be primary, in direct response to stimuli, or secondary to an underlying condition. In 10-20% of cases it may be the first presentation of, or may precede the onset of, a connective tissue disease (such as scleroderma or mixed connective tissue disease), so that underlying causes must be ruled out.

Sources and selection criteria

We searched the Cochrane Library and PubMed (2001-11) using the term “Raynaud’s”. Recommendations made at the May 2011 conference “Raynaud’s phenomenon: new insights, new treatments” organised by the vascular medicine section of the Royal Society of Medicine were reviewed. We also consulted published guidelines and information from the European League Against Rheumatism, Raynaud’s and Scleroderma Association, and Arthritis Research UK.

Raynaud’s phenomenon is triggered by a change in temperature rather than simply exposure to cold. Patients can have attacks throughout the year—for example, if they move from a warm environment to an air conditioned one, stand in a cold wind (even on a relatively warm day), or hold a cold …

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