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Raynauds Disease and Phenomenon

Definition

Raynauds disease and phenomenon are problems with the blood vessels. It causes blood flow problems to the fingers ears, nose, and lips.
Constriction of Blood Vessels
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Raynauds Disease (primary Raynauds) is the most common form. It does not requires the presence of any other medical conditions.
Raynauds Phenomenon (secondary Raynauds) is the more severe form. It occurs along with other medical conditions such as:

Causes

Blood vessels normally narrow in response to cold temperatures or emotional stress. Raynauds is an exaggerated response to these triggers. The narrow blood vessels make it difficult to get enough blood flow to certain areas of the body. Fingers are affected most often.
It is not known what causes this abnormal reaction, but it is probably related to a problem of the nervous system. Secondary Raynauds is believed to be caused by the associated disease.

Risk Factors

Raynauds is more common in females and those aged 15-40 years old. Factors that increased your risk of Raynauds include:
  • Activities that involve repeated stress to hands such as:
    • Typing
    • Playing piano
    • Regular operation of vibrating tools, as in construction
    • Exposure to certain chemicals
  • A connective tissue disease (such as scleroderma)
  • Diseases of the arteries, including atherosclerosis
  • Injuries to the hands or feet, such as wrist fractures or frostbite
  • Smoking
  • Certain medications, such as:
    • Beta-blockers
    • Cancer chemotherapy
    • Cold remedies
    • Migraine medications containing ergotamine
    • Estrogen-containing medications

Symptoms

An attack of Raynauds may last a few minutes to a few hours. It usually comes on in response to the cold or during emotional distress. 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 and may become swollen when the attack subsides and blood returns.
  • Throbbing and tingling sensations, stinging, pain, and swelling of the affected area. This may occur at the end of the attack as blood flow returns to the area.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
  • Nailfold capillaroscopy—study of the capillaries under a microscope
  • Blood tests—to help distinguish between Primary and Secondary Raynauds, and help identify underlying autoimmune conditions:
    • Complete blood count
    • Antinuclear antibody test
    • Erythrocyte sedimentation rate

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. Make wide circles with your arms.

Medications

When the above measures fail, medications may help relieve symptoms. Medications that can affect blood vessel size include:
  • Calcium channel blockers
  • Alpha-blockers
  • Vasodilators

Surgery

Rarely, surgery may be done when symptoms are persistent and debilitating. This involves cutting the sympathetic nerves that supply the affected fingers. These nerves control the expansion and narrowing of blood vessels.

Chemical Injection

Chemicals may be injected into the nerve that is responsible for the narrowed blood vessel. The chemical stops the nerve.

Treating Underlying Medical Condition

Treating the underlying disorder will help manage the symptoms of Secondary Raynauds.

Prevention

There are no guidelines for preventing Primary or Secondary Raynauds. To prevent symptoms of Raynauds:
  • Stay warm. Avoid cold temperatures when possible.
  • Dress in layers.
  • Wear clothing that covers extremities such as hats, gloves, or socks.
  • Learn to adapt to stressful situations.
  • Don't smoke. If you smoke, quit.
  • Exercise regularly.
  • Consider using biofeedback training to control body temperature.
  • Avoid the use of medications known to exacerbate Raynaud’s.
To minimize the risk of complications from Raynauds:
  • Keep skin on fingers and toes protected.
  • Avoid injuries.

RESOURCES

Arthritis Foundation http://www.arthritis.org

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

The Arthritis Society http://www.arthritis.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

References

Goundry B, et al. Diagnosis and management of Raynaud’s phenomenon. BMJ. 2012;344:e289.

Raynaud phenomenon. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 27, 2012. Accessed April 3, 2013.

Raynauds phenomenom. Cedars Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Health-Conditions/Raynauds-Phenomenon.aspx. Accessed April 3, 2013.

Raynauds phenomenom. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Raynauds%5FPhenomenon/raynauds%5Fphenomenon%5Fff.pdf. Accessed April 3, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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