SU27.3 | Vasospastic Disorders — Summary & Reflection

KEY TAKEAWAYS

Vasospastic disorders are reversible, exaggerated arterial spasm, not fixed occlusion. Raynaud's phenomenon causes episodic, cold- or stress-triggered digital colour change in the classic triphasic sequence white (pallor) → blue (cyanosis) → red (reactive hyperaemia). Primary Raynaud's (Raynaud's disease) is idiopathic, affects young women, is symmetrical, causes no tissue loss and is benign. Secondary Raynaud's (syndrome) has an identifiable cause — above all systemic sclerosis (scleroderma), but also other connective-tissue diseases, vibration injury, thoracic outlet/cervical rib, drugs and atherosclerotic/embolic disease — and may cause digital ulcers and gangrene. Red flags for secondary disease: older onset, asymmetry, digital ulcers/pitting scars, abnormal nailfold capillaries and connective-tissue symptoms. Investigate with pulses, nailfold capillaroscopy, FBC/ESR and ANA (then anti-centromere, anti-Scl-70), and imaging where fixed disease or thoracic outlet is suspected. Manage stepwise: keep warm, avoid cold, stop smoking, treat the underlying cause; calcium-channel blockers (nifedipine) first-line; IV prostacyclin or sympathectomy for severe digital ischaemia.

REFLECT

Think about how you would respond to a patient who tells you their fingers go white and blue in the cold. Would you simply reassure them, or would you pause to ask the questions that separate benign primary disease from a dangerous secondary cause — their age at onset, whether both hands are equally affected, whether there are any ulcers or skin changes, and whether they have any joint, swallowing or dryness symptoms? Reflect on the value of examining the nailfold capillaries and palpating all the pulses rather than just looking at the colour, and on how recognising Raynaud's as the possible first sign of scleroderma could lead you to a diagnosis years earlier than it would otherwise be made.