Executive summary
- Raynaud’s = episodic colour change (white/blue/red) triggered by cold/stress, often with numbness or pain.
- Primary is common and benign; secondary may signal connective tissue disease and can cause ulcers/ischemia.
- First-line: warmth strategies + trigger reduction + smoking cessation.
- If persistent symptoms: consider nifedipine MR/retard titrated to effect/tolerability (often off-label dosing in primary care pathways).
Spot secondary Raynaud’s (high-yield red flags)
- Onset age >30, severe/asymmetric attacks, tissue injury.
- Digital ulcers, pitting scars, or gangrene.
- Features of connective tissue disease (sclerodactyly, telangiectasia, inflammatory arthralgia, dysphagia, sicca, dyspnoea).
- Abnormal nailfold capillaries (if assessed) or strongly positive autoimmune history.
Pharmacological treatment (practical dosing)
- Nifedipine MR/retard: CKS cites doses commonly in the range 10–20 mg two to three times daily depending on preparation and tolerability (follow local formulary; MR formulations are generally preferred).
- Adverse effects: headache, flushing, ankle oedema, dizziness—review after dose changes.
- If intolerant/ineffective: alternatives (e.g., amlodipine) may be considered; specialist pathways may advise other agents for refractory disease.
Urgent referral thresholds
Digital ulcers, suspected critical ischemia, rapidly worsening symptoms, or systemic sclerosis features warrant urgent rheumatology/vascular input per local pathway.
Frequently asked questions
Do I need blood tests for everyone?
Not for clear primary Raynaud’s with long-standing mild symptoms. Investigate if red flags suggest secondary causes (autoimmune screen guided by local pathway).
What’s the best initial non-drug advice?
Keep core and hands warm, avoid rapid temperature shifts, stop smoking, manage stress triggers, and review vasoconstrictive drugs where possible.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.