Raynaud's Phenomenon: All you need to know

Raynaud’s Phenomenon is a process in which the fingers (and less commonly, the toes) turn different colours (white, blue, and red) in response to certain triggers such as cold or stress. It can be associated with discomfort or “pins and needles” sensation. It is due to the small blood vessels in the fingers that “spasm”, thus decreasing blood flow to the fingertips. Individuals should seek the care of a rheumatologist if they have frequent or severe symptoms, or if they develop sores on their fingertips.

A person with Raynaud’s disease experiences pain in the extremities, for example, the fingers, when temperatures drop. Blood vessels narrow and almost completely shut down. Fingers or toes turn from white to blue and, then, as the blood returns, they flush red. Also known as Raynaud’s syndrome or Raynaud’s phenomenon, Raynaud’s disease affects 5 to 10 percent of Americans, but only 1 in 10 seek treatment. Females are an estimated nine times more likely to be affected than males.

It is important to know there are two types of Raynaud’s Phenomenon – these are referred to as “primary” and “secondary”. Primary Raynaud’s typically affects women under the age of 30 (usually in the teenage years or early twenties). While symptoms can be uncomfortable, there is no danger of damage to the body. Primary Raynaud’s occurs in patients who do not have another rheumatic disease. Secondary Raynaud’s is “secondary” to another condition. These conditions are numerous and can include several autoimmune conditions. The most common rheumatic diseases associated with Raynaud’s include scleroderma and lupus, but can include others such as rheumatoid arthritis, inflammatory myositis, and Sjögren’s syndrome. Often, the onset of secondary RP is later in life – usually after the age of 30.

Patients with either primary or secondary RP will typically report colour changes of the fingers or toes that occur in response to several triggers – cold weather and stress are most commonly reported. Symptoms can also occur in the frozen food aisle at the grocery store or due to air conditioning. Rheumatologists are typically needed to differentiate whether Raynaud’s is primary or secondary. 

What causes Raynaud’s Phenomenon?

Raynaud’s Phenomenon is caused by overly-sensitive blood vessels within the fingers and toes. They are more affected by cold and stress. The blood vessels narrow substantially, causing a decrease in blood flow and associated colour change. The lack of blood flow often results in a pale, or white, discolouration. Subsequently, the digits can turn blue and eventually red as there is a sudden influx of blood into the digits after the episode is over.

How is Raynaud’s phenomenon diagnosed?

RP is diagnosed based on history and physical examination. Patients with primary Raynaud’s typically have a normal examination and blood work. Often, an exam technique that involves looking at the blood vessels below the fingernails (called nail fold capillaroscopy) is used to help differentiate primary from secondary Raynaud’s. Patients with secondary Raynaud’s typically have an abnormal exam and/or blood work.

How is Raynaud’s phenomenon treated?

There is no cure for Raynaud’s disease, but there are ways to manage symptoms. For mild forms of Raynaud’s disease, covering exposed skin before leaving the house can help. If an attack occurs, soaking the affected parts in warm, not hot, water can alleviate symptoms and prevent them from worsening. If stress is a factor, learning to manage stress can help.

For moderate to severe cases, medication may be necessary.

Alpha-1 blockers can counter the effect of norepinephrine, which constricts blood vessels. Examples include doxazosin and prazosin. Dihydropyridine calcium channel blockers relax the smaller blood vessels of the hands and feet. Examples include amlodipine, nifedipine, and felodipine. Topical nitro-glycerine ointment applied to the affected area appears to relieve the symptoms by improving blood flow and cardiac output and decreasing blood pressure. Other vasodilators dilate the veins, easing symptoms. Examples include losartan, sildenafil (Viagra), fluoxetine (Prozac), and prostaglandin. 

In very severe cases, more invasive procedures are an option:

Nerve surgery: Sympathectomy – The vasoconstriction that causes Raynaud’s is controlled by sympathetic nerves in the affected areas. A surgeon can make small incisions and strip the nerves away from the blood vessels, to decrease the frequency or severity of attacks. This is not always successful.

Chemical injections: Injecting certain chemicals that block sympathetic nerve fibres from carrying out vasoconstriction can be effective. Local anaesthetics or onabotulinum toxin type A, or Botox, work well for some people. However, the effect will wear off, and treatment will need repeating.

Living with Raynaud’s

People who are prone to Raynaud’s can take measures to avoid some triggers.

  • Wapping up and keeping the house warm when temperatures are cold
  • As far as possible, avoiding emotional stress
  • Exercise to promote a healthy lifestyle and reduce stress
  • Avoiding medicines and substances that trigger the symptoms
  • Limiting the consumption of caffeine and alcohol
  •  Not smoking

They also suggest following up with a physician, especially if sores develop on the extremities. Getting medical help may prevent a worsening of symptoms and serious complications.

Possible pathways of Raynaud’s disease

The exact pathways of Raynaud’s disease are not known, but it probably results from a combination of factors, and the combination of factors probably differs between individuals. 

Vascular mediators

Nitric oxide is a strong vasodilator. It has been found in people with secondary Raynaud’s but less so in those with primary Raynaud’s disease. Endothelin-1 is a potent vasoconstrictor. People with primary Raynaud’s have been found to have high levels of this protein. Serotonin, a neurotransmitter, has been found in high concentrations in people with Raynaud’s

Raynaud’s feet

Raynaud’s syndrome can affect either the hands or feet or both. To reduce the risk of an attack, it can help to keep the feet and hands warm, avoid smoking, and get enough exercise. If an attack starts, it may be reduced or prevented by warming the hands and feet at once, for example, by massaging them. The feet and hands should be protected from cuts, bruises, and other injuries as far as possible because the lack of circulation can make it harder for them to heal. Use lotion to prevent the skin from cracking, and make sure you have comfortable, well-fitting shoes.

Can Raynaud’s Kill You?

No, but serious cases can cut off the blood flow to your skin and lead to tissue damage. A completely blocked blood artery can lead to skin sores (ulcers) or dead tissue (gangrene). It’s rare, but if this happens, the doctor might have to remove a finger or toe.

Outlook

If you have Raynaud’s phenomenon, your outlook depends on your overall health. Over the long term, secondary Raynaud’s pose larger concerns than the primary form. People who have secondary Raynaud’s are more likely to get an infection, skin ulcers, and gangrene.

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