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Comparison of primary and secondary Raynaud's phenomenon

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

primary RP - generally begins during the teens and early 20's; represents an exaggerated physiological response to cold stimuli (1); not generally associated with any other disease entity
- symmetrical involvement
- no tissue necrosis or gangrene
- ESR normal
- normal nail fold capillaries
- negative for anti nuclear antibodies (2,4)
secondary RP - the development of RP at an older age (i.e. > 30 years), and particularly in males, suggests the possibility that RP is secondary to some underlying connective tissue disease (CTD) (1). RP occurs in over 90% of patients with systemic sclerosis and in up to 40% of patients with systemic lupus erythematosus and idiopathic inflammatory myositis(1). Features that make a secondary cause of RP more likely include:
- digital ulceration, or year-round symptoms
- pain and discomfort is higher in severity
- abnormal nail fold capillaries (viewed with an ophthalmoscope with the +20 lens)
- assymetric upper limb pulses or bruits
- puffiness/tightness of the finger skin
- a raised ESR
- positive ANA or other antibodies (Ro/La/Scl-70 etc)
- clinical features suggestive of an underlying connective tissue disease (3,4)

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