Devgire Vikrant, Hughes Michael
Core Medical Trainee, Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield.
Consultant Rheumatologist, Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF.
Br J Hosp Med (Lond). 2019 Nov 2;80(11):658-664. doi: 10.12968/hmed.2019.80.11.658.
Raynaud's phenomenon is a common vasospastic condition which carries a significant burden of pain and hand-related disability (Hughes and Herrick, 2016). The prevalence of Raynaud's phenomenon in the general population has been reported to be approximately 5% (Garner et al, 2015). Raynaud's phenomenon can occur either as a primary ('idiopathic') phenomenon or secondary to a wide range of underlying medical conditions and drug causes. Therefore, hospital-based specialists are frequently involved in the care of patients with Raynaud's phenomenon and need to be aware of associated conditions and prescribed medications for Raynaud's phenomenon. In particular, Raynaud's phenomenon is often the earliest manifestation of an underlying autoimmune connective tissue disease (e.g. systemic sclerosis). A comprehensive clinical assessment is required including performing targeted investigations (e.g. nailfold capillaroscopy and systemic sclerosis-associated autoantibodies). Patient education and lifestyle adaptations is first-line treatment for Raynaud's phenomenon. There is a wide range of pharmacological options including oral and intravenous drug therapies available to treat Raynaud's phenomenon. Surgical intervention is sometimes required for refractory Raynaud's phenomenon and tissue ischaemia. This review describes the clinical manifestations of Raynaud's phenomenon including potential secondary causes and presents an approach to assessment and management.
雷诺现象是一种常见的血管痉挛性疾病，会带来严重的疼痛负担和手部相关功能障碍（休斯和赫里克，2016年）。据报道，普通人群中雷诺现象的患病率约为5%（加纳等人，2015年）。雷诺现象可作为原发性（“特发性”）现象出现，也可继发于多种潜在的疾病和药物原因。因此，医院的专科医生经常参与雷诺现象患者的护理工作，需要了解雷诺现象的相关疾病和所开药物。特别是，雷诺现象往往是潜在自身免疫性结缔组织病（如系统性硬化症）的最早表现。需要进行全面的临床评估，包括进行针对性检查（如甲襞毛细血管镜检查和系统性硬化症相关自身抗体检测）。患者教育和生活方式调整是雷诺现象的一线治疗方法。有多种药物治疗选择，包括口服和静脉药物疗法可用于治疗雷诺现象。对于难治性雷诺现象和组织缺血，有时需要进行手术干预。本综述描述了雷诺现象的临床表现，包括潜在的继发原因，并提出了评估和管理方法。
