Raynaud's Phenomenon

Episodic vasospasm of digits → triphasic colour change: white (ischaemia) → blue (cyanosis) → red (reactive hyperaemia). Triggers: cold exposure, emotional stress, vibration. Primary (Raynaud's disease, ~80%): • Younger onset (15–30y), F:M 4:1. • Symmetric, bilateral, no organ involvement. • Normal nailfold capillaroscopy. • Negative ANA / autoimmune screen. • Family history common. • No tissue damage. Secondary (Raynaud's phenomenon, ~20%): • Older onset, more severe. • Asymmetric, single-digit involvement. • Tissue damage (digital ulcers, gangrene). • Abnormal nailfold capillaroscopy (dilated / drop-out). • Positive autoimmune. • Causes: scleroderma (CREST), SLE, MCTD, dermatomyositis, RA, vasculitis, antiphospholipid syndrome, occupational (vibration), drugs (beta-blockers, ergot, methylphenidate, OCP), thoracic outlet syndrome. Workup: ANA, anti-centromere (CREST), anti-Scl-70 (scleroderma), anti-dsDNA (SLE), anti-Ro/La (Sjögren's), complement, RF, anti-CCP, antiphospholipid, FBC + ESR + CRP. Nailfold capillaroscopy.