Raynaud's Disease and Phenomenon

Raynauds Disease and Phenomenon are circulatory disorders. During an attack, blood vessels narrow. This causes blood flow to the fingers and sometimes ears, nose, and lips to be severely reduced. Cold temperatures or emotional stress, such as excitement or nervousness, are the usual causes of attacks. Although blood vessels naturally become narrower under these circumstances, Raynauds is an abnormally exaggerated response.
There are two types:
Primary Raynauds (Raynauds disease) - the most common form. Primary Raynauds occurs by itself, in the absence of other medical conditions.
Secondary Raynauds (Raynauds phenomenon) – the more severe form. People with secondary Raynauds also have an underlying medical condition that causes Raynauds. Some common conditions associated with Raynauds include:
  • Scleroderma
  • Lupus
  • Rheumatoid arthritis
  • Sjogrens syndrome
  • Carpal tunnel syndrome

Causes

The cause of primary Raynauds is not known, but it is probably related to an abnormality of the sympathetic nervous system. Secondary Raynaulds is believed to be caused by the associated disease.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Female
  • Age: 15-40 years old
  • Jobs or leisure activities: Activities that subject the hands to repeated stress may increase the chance of developing Raynauds. For example:
    • Typing
    • Playing piano
    • Regular operation of vibrating tools, as in construction
    • Exposure to certain chemicals
  • A connective tissue disease
  • Smoking
  • Certain medications, such as:
    • Beta-blockers
    • Cancer chemotherapy
    • Cold remedies
    • Migraine medications

Symptoms

An attack of Raynauds may last a few minutes to a few hours. During an attack, symptoms may include:
  • Skin discoloration – during an attack, skin color may change to white, blue, and red.
    • White occurs when the arteries narrow or collapse.
    • Blue appears when the fingers, toes, or other areas are not getting enough oxygen-rich blood.
    • The skin turns red when the attack subsides and blood returns.
  • Throbbing and tingling sensations - may occur at the end of the attack as blood flow increases and returns to the extremities
People with secondary Raynauds may experience other medical problems related to Raynauds, such as:
  • Skin thinning and ulcerations
  • Gangrene (tissue death)
  • Many other symptoms related to their underlying connective tissue disorder

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
Nailfold Capillaroscopy – study of the capillaries under a microscope
Blood Tests –to help distinguish between Raynaulds disease and phenomenon:
  • Antinuclear Antibody Test (ANA)
  • Erythrocyte Sedimentation Rate (ESR)

Treatment

There are several ways to reduce the symptoms of Raynauds during an attack:
Create Warmth for Fingers and Toes
  • Run warm (not hot) water over fingers and toes as quickly as possible. However, do not place anything hot on your skin, as it may cause damage.
  • If you are outside, move inside.
  • Place your hands on a warm area of the body, such as under your armpits or on the abdomen.
Stimulate Blood Flow
Try to stimulate blood circulation by wiggling your fingers and toes, and making wide circles with your arms.
Medications
When the above measures fail, vasodilator medications (such as nitroglycerin and nifedipine) may help relieve symptoms.
Surgery
Rarely, surgery may be done when symptoms are persistent and debilitating. This involves cutting the nerves that supply the affected fingers.
Treating Underlying Medical Condition
If you have Raynauds phenomena, successful management of the underlying connective tissue or vascular disorder can help to relieve symptoms.

Prevention

There are no guidelines for preventing Raynauds Disease and Phenomenon. To prevent symptoms of Raynauds:
  • Stay warm. Avoid cold temperatures when possible.
  • Dress in layers.
  • Always wear clothing that covers extremities (hats, gloves, socks, etc.).
  • Learn to adapt to stressful situations.
  • Avoid caffeine.
  • Don't smoke. If you smoke, quit.
  • Exercise regularly.
  • Consider using biofeedback training to control body temperature.
To minimize the risk of complications from Raynauds:
  • Keep skin on fingers and toes lubricated and protected.
  • Avoid injuries.