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Raynaud’s phenomenon



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Joint Bone Spine 74 2007 e1ee8 http france elsevier com direct BONSOI Review Raynaud s phenomenon Martine Gayraud Internal Medicine Department Institut Mutualiste Motnsouris 42 boulevard Jourdan 75014 Paris France Received 2 November 2005 accepted 26 July 2006 Available online 4 December 2006 Abstract Vascular acrosyndromes constitute a common reason for physician visits They are associated with connective tissue disease for example 90 of patients with scleroderma experience Raynaud s phenomenon The rheumatologist must strive to establish the diagnosis to identify a potential underlying cause and to prescribe effective treatment when the symptoms are incapacitating Raynaud s phenomenon is the acrosyndrome most commonly encountered by rheumatologists The diagnosis of Raynaud s phenomenon rests on clinical grounds Nailfold capillaroscopy and immunological tests are useful chiefly for determining the cause Calcium channel antagonists are the treatment of reference for Raynaud s phenomenon Drugs introduced over the last few years for severe refractory forms include prostacyclin and its derivatives endothelin receptor antagonists and phosphodiesterase inhibitors These drugs were developed as a result of new knowledge on the pathogenesis of Raynaud s phenomenon Acrocyanosis which is extremely common and erythromelalgia are the other main vascular acrosyndromes 2006 Elsevier Masson SAS All rights reserved Keywords Raynaud s phenomenon Scleroderma Calcium channel antagonists 1 Definition In 1862 Maurice Raynaud described a paroxysmal phenomenon that included three phases ischemia with pallor of the digits due to vasoconstriction of the digital arteries precapillary arteries and cutaneous arteriovenous shunts hyperemia with redness of the digits and a return to normal Fig 1 Whereas the ischemic phase is required for the diagnosis the hyperemic phase may be lacking The abnormalities usually spare the thumb but involve most of the other digits although they may start in a



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