Raynaud's phenomenon: its relevance to scleroderma.

It is now over 125 years since Maurice Raynaud first described his clinical syndrome. ' By definition, it is episodic digital ischaemia provoked by cold and emotion. It is classically manifest by pallor of the affected part followed by cyanosis and rubor. The pallor reflects vasospasm, the cyanosis results from removal of oxygen from the static venous blood, and rubor is caused by reactive hyperaemia following return of flow. Raynaud's phenomenon has an overall prevalence of about 10%,2 though it may affect as many as 20-30% of younger women.3 Although it can be a benign condition (primary Raynaud's disease), it may be associated with an underlying disorder (Raynaud's syndrome). It is particularly associated with the connective tissue diseases (table 1). Raynaud's syndrome occurs in between 90 and 98% of patients with systemic sclerosis,4 and more importantly proves to be the first symptom in 700/o of patients with this disease4 5 and may precede its development by up to 20 years.6 In this review it is proposed to evaluate the relevance ofRaynaud's phenomenon to systemic sclerosis in two ways. Firstly, by reporting the Department of Medicine, evidence supporting Raynaud's phenomenon as Nineweils Hospital, a precursor of systemic sclerosis and, secondly, indee DD1 9SY by discussing its importance as a complicating J J F Belch symptom in fully established systemic sclerosis.