Raynaud's Phenomenon

What is Raynaud's phenomenon?

Raynaud's phenomenon (also called Raynaud's disease, Raynaud's syndrome, or Raynaud's) is a disorder that affects the blood vessels in the fingers and toes. The condition can also affect blood vessels in the nose, lips and earlobes.

Patients with Raynaud's have spasms, called vasospastic attacks. When these spasms happen, the small blood vessels in the fingers and toes get tighter or close (constrict). The spasms can be caused by extreme changes in temperature (such as going outside in the cold), certain occupational exposures (such as vibration of the hands), or stress. When the blood vessels constrict, the skin in the affected areas becomes white or bluish and cold or numb.

There are two types of Raynaud's: primary, which means it happens on its own, and secondary, which means it is related to another medical condition.

Primary Raynaud's Phenomenon

Primary Raynaud's phenomenon is the most common and most mild type of the condition. Patients with this type of Raynaud's do not have other diseases or medical problems that can cause Raynaud's symptoms. The majority (75%) of patients with primary Raynaud's are women between the ages of 15 and 40. It is rare for patients with this type of Raynaud's to develop other diseases associated with the condition, such as lupus or scleroderma.

Secondary Raynaud's Phenomenon

Secondary Raynaud's phenomenon is less common, but often more serious, than primary Raynaud's. Patients with this type of the condition have another disease or medical condition that causes Raynaud's symptoms. In some cases, the condition causes the walls of the blood vessels to get thicker and constrict very easily. This causes the fingers and toes to get less blood than they normally do. Most patients (85%-95%) with scleroderma (a connective tissue disease) also have secondary Raynaud's. The condition also affects about one- third of patients with systemic lupus erythematosus (lupus). Other connective tissue diseases that can cause secondary Raynaud's are Sjögren's syndrome, dermatomyositis and polymyositis.

Other possible causes of secondary Raynaud's include:

• Traumatic vasospasm from the use of vibrating tools or repeated pounding with the palm of the hand (hypothenar hammer syndrome)
• Carpal tunnel syndrome
• Obstructive arterial disease (blood vessel disease)
• Medications, including beta-blockers, ergotamine preparations, certain chemotherapy drugs, and those that constrict the blood vessels (such as some narcotics and over-the-counter cold medications)
• Thyroid disorders

Symptoms of Raynaud's Patients with Raynaud's phenomenon may have three stages of skin color changes: white (pallor), blue (cyanosis) and red (rubor). The changes can happen in any order, and not everyone with Raynaud's has all three changes. When skin turns white, it may be caused by a collapse of the arteries in an affected body part. When skin turns blue, it means the fingers or toes are not getting enough oxygen-rich blood. The affected body parts can also feel cold and numb. When skin turns red, it means the blood is returning to the affected areas. A Raynaud's attack can last less than a minute to several hours. after an attack is over, the affected body parts may throb and tingle.

How common is Raynaud's?

Raynaud's phenomenon may affect women more often than men. Raynaud's phenomenon also tends to be more common among people in colder climates.

However, people with the disorder who live in mild climates may have more attacks during colder weather. About 25 percent of people with Raynaud's have a family history of the condition.

What causes Raynaud's?

An attack of Raynaud's is usually triggered by exposure to cold or emotional stress.

Under normal circumstances, when a person is exposed to cold, the body works to slow the loss of heat by causing the blood vessels that control blood flow to the skin's surface to move blood from the surface arteries to arteries deeper in the body.

For people who have Raynaud's, however, this normal body response is intensified by contractions of the small blood vessels that supply blood to the fingers and toes. The arteries in the fingers and toes can collapse or constrict, which reduces blood flow and causes changes in skin color.

How is Raynaud's diagnosed?

If your doctor thinks you may have Raynaud's, you will have a complete physical exam and your doctor will review your medical history to rule out other medical problems. Many times the condition itself is easily diagnosed. But, it may be more difficult to figure out what is causing it.

Doctors often study the tiny blood vessels (capillaries) in the nail to help make a diagnosis.

The results of this test (nailfold capillaroscopy) are normal if the patient has primary Raynaud's. But, if the patient has the secondary form the results of this test will be abnormal.

The test involves putting a drop of oil on the skin at the base of the fingernail (nailfold). The doctor then looks at the nailfold under a microscope or a hand-held ophthalmoscope to check for problems with the capillaries. Enlarged or abnormal capillaries could be a sign of a connective tissue disease.

You may need other tests, such as a complete blood count (CBC), urinalysis, and chemistry profile to confirm secondary Raynaud's.

Your doctor may also order tests to help determine which type of Raynaud's you have. These tests can include an antinuclear antibody test (ANA), erythrocyte sedimentation rate (ESR) test and checking for the rheumatoid factor and complement levels.

What treatment options are available for patients with Raynaud's?

The goals of treatment are to reduce the severity of attacks and protect the tissue in the fingers and toes by preventing damage and loss.

You may need to take medication, especially if you have secondary Raynaud's. However, many treatments do not involve medication.

The following prevention and treatment strategies are common steps your doctor will likely recommend:

• Be proactive during an attack: Do not ignore a Raynaud's attack. Taking action can reduce the length and severity of the attack. The first and most important thing you can do is to warm your hands and feet. If you are in cold weather, go indoors. Run warm water over your fingers and toes or soak them in a bowl of warm water. It is also helpful to relax. Ask your doctor about relaxation techniques you can practice.
• Keep warm: It is important to keep your whole body warm. If you go out in the cold, dress in several layers of loose clothing. It is helpful to also wear a hat and gloves or mittens. A hat is very important because much of your body heat is lost through your scalp. Use pocket warmers in your pockets, mittens, boots or shoes to keep your hands and feet warm and dry.

You can follow these other tips to stay warm:

• Don't touch cold metals.
• Don't put your hands in cold water or hold iced drinks.
• Stay out of air-conditioned rooms and the frozen food sections of grocery stores as much as possible.
• Practice good skin care: Prevent dry and cracked skin by using moisturizer or hand cream, especially after washing your hands.
• Quit smoking: Nicotine causes the skin temperature to drop and blood vessels to constrict, which may cause an attack.
• Learn to manage stress: Stress may cause an attack, especially if you have primary Raynaud's. Learn to recognize and avoid stressful situations as much as possible. You may find it helpful to practice relaxation or biofeedback exercises. These techniques can help reduce the number and severity of attacks.
• Exercise: Regular exercise helps your overall well-being, increases your energy level, helps control weight and helps you sleep better. If you have secondary Raynaud's, talk to your doctor about how to safely exercise outdoors in cold weather. Everyone should talk to their doctor before starting any exercise program.
• See your doctor: See your doctor if you are worried or frightened about attacks or if you have questions about caring for yourself. It is important to see your doctor if you have attacks on only one side of the body (one hand or one foot) or if an attack causes any sores on the finger or toes.
• Medications: Medications are used more often to treat patients with secondary Raynaud's than those with the primary type. Common medications include calcium-channel blockers, which relax smooth muscles and open up the small blood vessels. They can also help heal ulcers on the fingers and toes. About two-thirds of patients with either form of Raynaud's get relief with this type of medication. Other possible treatments are alpha-blockers and vasodilators, such as nitroglycerine or nifedipine paste (to help heal skin ulcers).Medications are not always a successful treatment for patients with Raynaud's. Many with the secondary form do not respond as well to treatment as those with the primary form of the disorder.Patients can have different results with different medications, and some patients need to stop taking medications because of side effects. It is also possible that a drug that works well may stop working as well over time. Your doctor will talk to you about the possibility of using medications as treatment. If you do start medication, it is very important to see your doctor for regular follow-up visits to see how well the medication is working.