A 27 year old female complains of intermittent pain in her fingers usually brought about in cold weather. She describes episodes of numbness and burning of the fingers. Her fingers usually become very pale if she does not wear gloves when going outdoors. What is the SINGLE most likely diagnosis?
A. Kawasaki disease
B. Takayasu arteritis
C. Buerger’s disease
D. Embolism
E. Raynaud’s phenomenon
Raynaud’s phenomenon is defined as episodes of pallor or cyanosis in response to cold or emotional stimuli.
Fingers or toes ache and change colour:
pale (ischaemia)
blue (deoxygenation)
red (reactive hyperaemia)
The pallor is caused by vasoconstriction of blood vessels (arteries and arterioles) that results in reduced blood flow, while cyanosis is created by deoxygenation of slowflowing blood. After rewarming the hands, the blood flow will rebound (hyperemia) and the skin will appear reddened or blushed.
It is common for patients with Raynaud’s phenomenon to complain of cold sensitivity and to have other areas of the skin involved, including the ears, nose, and lower extremities. Episodes come as sudden attacks and are most often triggered by rapid changes in ambient temperature. Attacks may begin in one or two fingers but typically involve all fingers and/ or toes symmetrically and bilaterally.
Primary Raynaud’s phenomenon (Raynaud’s disease) denotes a patient without an associated underlying disease. Secondary Raynaud’s phenomenon is used to describe patients with a defined secondary or associated disease (scleroderma).