Differences between the clinical presentations of primary and secondary Raynauds Phenomenon
The onset of primary RP usually occurs in women aged 15 to 30 years. The fingers are most commonly affected, but 40% of patients have attacks in the toes as well. Ears, nose, tongue, lips, and nipples may also be involved. The thumbs are frequently spared. The well-demarcated color changes involve part or all of one or more digits (never the “whole hand”) on exposure to cold. The color changes may be accompanied by numbness during the ischemic phase and by a throbbing pain during the reactive hyperemic phase. The frequency, duration, and severity of attacks vary widely, with some patients having several attacks per day and others having two or three per winter. Primary RP patients do not develop trophic complications such as digital ulceration, pitting, fissuring, or gangrene. NCM examination and serologies are normal/negative.
The onset of secondary RP is usually in the third and fourth decades and may be seen in either men or women depending on the underlying condition. The symptoms of digital vasospasm are the same as those of primary RP; however, secondary RP patients are more prone to trophic complications. Signs and symptoms related to an underlying condition may be discovered by a careful history and physical examination. NCM examination and serologies can be abnormal depending on the underlying disease.
