Raynaud phenomenon Site Describe what happens during an episode? Time changes: Onset Offset Constant vs episodic Duration Progression Previous episodes Can you think of what might have caused it? Did anything in your life change around that time? Stress Cold weather Certain activities How has it been affecting your life? Anything makes it worse? Anything makes it better? E.g. warming heads or feet, wearing gloves Associated features: Colour changes Sensation changes Tingling Numbness Pain Ulcers or sores Joint pain Swelling Fatigue Weight loss General malaise Rashes Medications history Prescription medications BB Vasoconstrictive medications Chemotherapy drugs Hormonal therapies Over the counter medications Past medical history Allergies and vaccinations Surgical history Family history Social history Diet Exercise Smoking Alcohol Recreational drugs Occupation Differentials Idiopathic Drugs Beta blockers Ergotamine Bleomycin Smoking Occupation trauma such as: Handling vibrating tools Typing Hyperviscocity disease Polycythaemia Cryoglobulinemia Vasculitis diseases Buerger’s disease: Small ot medium vessels Predominately affects arms and legs. Acute ischemic events and amputations -> the 6 Ps. Connective tissue disease: Scleroderma and CREST syndrome: Raynaud’s phenomenon Oesophageal hypomotility -> systemic sclerosis -> smooth muscle atrophy and fibrosis -> oesophageal dysmotility and decreased LESP -> dysphagia, GERD, heartburn, aspiration and Barrett oesophagus and stricture formation. Sclerodactyly -> tightening of the skin over the fingers -> manifests in red-blue discolouration of the skin -> edema, fibrosis and waxy appearance and limited range of motions. Telangiectasia -> small dilated intradermal blood vessels -> red to dark blue in colour with a diameter of less than 1 mm. SLE Joint pain Fatigue Fever Weight loss Skin rash Oral ulcers Photosensitivity -> maculopapular rash. Mixed CTDs