Raynaud’s phenomenon

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition where the blood supply to the fingers and toes, and occasionally the nose and ears, is suddenly interrupted. It is due to spasm of the small blood vessels of the digits. During an attack, the skin of the affected part gets cold, colour changes occur (white or blue) and there is numbness and pain.

The typical patient complains of high sensitivity to cold. The symptoms are usually induced by exposure to cold, such as holding something cold or when the weather is cold. Other stimuli can also provoke an attack, like emotional changes (e.g. stress or anxiety), drugs, hormones and tobacco smoke. Teenage women are affected more commonly. Almost 10% of people may occasionally have some degree of Raynaud’s symptoms.

During an attack, the hands and fingers first become white and numb. Then, they turn blue as circulation starts very slowly. Finally, they turn bright red and warm (as the arteries relax and fresh blood rushes in) and there may be some pain.

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Are there more than one types of Raynaud’s?

Raynaud’s disease or Primary Raynaud’s: This is the term used for Raynaud’s phenomenon when no underlying abnormality can be found. This varies from a very mild form which is just a nuisance to a severe form which requires treatment.

Raynaud’s syndrome or Secondary Raynaud’s: This is the term used for Raynaud’s phenomenon when it is associated with some other illness or external influence. Conditions associated with Raynaud’s are connective tissue diseases (e.g. systemic sclerosis), thoracic outlet compression syndrome, occupational disease (e.g. vibration white finger disease) and treatment with certain drugs.

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How is Raynaud’s diagnosed?

Most commonly Raynaud’s phenomenon is diagnosed from the history, and occasionally on examination if seen during an attack. Blood tests may help, as can examining the small blood vessels at the base of the nail (nailfold capillaroscopy).

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Is this condition hereditary?

There is no evidence at present that either Raynaud’s or systemic sclerosis are inherited. However, there is a genetic predisposition, so that the chances of being affected are greater if a relative has the problem.

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What can I do to help myself?

There are certain things you can do which may help. These include cessation of vasoconstricting agents, such as nicotine, education and warming of body parts.

• Smoking – If you are a smoker, you must quit. Tobacco contains nicotine which causes the blood vessels to constrict decreasing the blood flow to the finger tips. The most effective way is to set a day to give up completely rather than try to reduce it gradually. If you need help, ask your doctor.
• Exercise – Gentle exercise will help your circulation. Avoid sitting for long periods. Get up and walk around the room moving arms and legs to maintain the circulation. In cold weather, take exercise indoors.
• Eat for warmth – Try to eat lots of small meals to maintain your energy. Choose foods rich in protein (milk, meat, fish and fresh vegetables) and have hot meals and plenty of hot drinks.
• Clothing – Do not let your fingers and toes get cold, but keep them adequately covered (with warm gloves and socks). The spasm of the vessels may be reversed in a warm environment when the constricted arteries relax and return to their normal size. Tight clothing should be avoided as this may restrict blood flow.

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How is Raynaud’s treated?

Raynaud’s symptoms improve by warming the extremities. Some patients benefit from the use of electrically heated gloves and socks.

Your physician may prescribe a vasodilator, i.e. a drug to diminish the systemic vascular tone and relax the blood vessels, such as nifedipine (Adalat) preferably in the form of controlled-release tablets.

Occasionally, your specialist may feel an operation, called sympathectomy, may be of benefit. This involves either cutting or destroying the nerves that cause the arteries to constrict. This operation is more successful for Raynaud’s of the feet than the hands.

If the pain is severe enough to interfere with social or work lifestyle or if ulcers occur at the tips of the digits, it is essential that a vascular specialist examines you. Permanent symptoms indicate permanent occlusion (blockage) of the arteries, and this is a more serious problem than the temporary vasospasm of Raynaud’s disease.

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Related conditions

Vibration white finger disease (also known as hand-arm-vibration syndrome) – Workers exposed to vibrating instruments, such as pneumatic road drills or chain saws, tend to develop Raynaud’s particularly if the tools are heavy and the vibrations of low frequency. The severity of symptoms correlates with the length of exposure. The condition may become permanent even after quitting the job. It is an industrial disease and patients may be eligible for industrial injuries disablement benefit.

Chilblains – These usually appear on the fingers, toes, and ears. The skin may first become itchy, and then red, swollen and very tender to touch. Chilblains occur as a result of defective circulation on exposure to cold. Clothing that rubs should be avoided.

Erythromelalgia – This is a chronic disorder characterized by warmth, pain and redness in the lower part of the legs and the feet. Many insividuals with erythromelalgia have symptoms of Raynaud’s.

Rheumatoid Arthritis – Arthritis affects the lining of the joints. This lining produces a fluid that lubricates the joint and when affected by rheumatoid arthritis it becomes inflamed and swollen. More fluid is produced causing a red, painful swollen joint. About 10% of rheumatoid arthritis sufferers have Raynaud’s syndrome.

Systemic Lupus Erythematosus – This is characterized by a rash of the cheeks and the dorsum of the nose, and chronic inflammation of the connective tissue and blood vessels. There is fatique, joint pain, mouth ulcers, hair loss and Raynaud’s syndrome (in 30-40%).

Drugs or Chemical Substances – Some chemical substances in industrial environment (vinyl chloride) or drugs, like beta-blockers, certain pills for migraine or contraceptive pills may aggravate Raynaud’s. Therefore – if you suffer from Raynaud’s – consult your doctor before taking these drugs.

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What is the prognosis?

People who develop Raynaud’s as teenagers often have a form that is benign and will disappear with age. Unfortunately, this is not true in all cases, and sometimes Raynaud’s persists. There is no cure at present, but there are many effective treatments available to alleviate specific symptoms.

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