Evaluation and management of patients with Raynaud's syndrome

The wide spectrum of associated disorders, the previous lack of understanding of pathogenesis, and the older, arbitrary terminology in relation to ultimate prognosis have led to confusion in the evaluation and management of Raynaud's syndrome. A unified concept of pathogenesis, in which vasospasm and arterial occlusive disease are the fundamental lesions, is presented herein. The associated disorders found in our 219 patients with continuous follow-up are listed and related to the underlying pathogenetic mechanisms. Our approach to diagnosis led to the discovery of an associated condition in 71 percent of our patients. The evaluation can be done in a cost-effective manner. The emphasis of treatment should be on conservative medical management, with avoidance of cold and tobacco and judicious use of pharmacologic agents remaining the cornerstones of therapy. Cervicothoracic sympathectomy has no role in the treatment of Raynaud's syndrome.