Raynaud’s Phenomenon: Symptoms, Treatment

Overview

Raynaud’s phenomenon is a rare disease of the blood vessels that often presents in fingers and toes. It is also known as Raynaud’s disease or Raynaud’s syndrome. It occurs when the blood vessels that feed the fingers and toes get smaller in reaction to cold or emotional stress, causing affected areas to turn white or blue. When the blood flow returns, the skin turns red accompanying throbs or tingles.

People in colder climates are more likely to develop Raynaud’s phenomenon. Women are more likely to have the disorder than men. People with a family history and those over age 30 are at higher risk of getting affected. Typically, Raynaud’s phenomenon is not disabling but can affect quality of life

Causes

The exact cause of Raynaud’s phenomenon is not clear. Certain use of medications and health conditions may play a role in developing the disease. These risk factors include:

• Sex

Women are nearly nine times more likely to get the condition than men.

• Age

People of all ages can get Raynaud’s phenomenon, but it usually starts showing up between ages of 15 and 25. Individuals over 30 years old are at higher risk of developing it.

• Medications

People who use some medicines to treat cancer, migraines or high blood pressure may be more likely to get Raynaud’s disease.

• Health problems

People with diseases like rheumatoid arthritis, scleroderma and lupus are more likely to get a severe Reynaud’s phenomenon. Also, people who have carpal tunnel syndrome may be at greater risk of getting the condition.

• Environment

People living in cold regions may at higher risk, because cold temperatures that narrow blood vessels may be the trigger of the disease. Emotional stress may also be the cause of the condition.

• Certain occupations

Typing, playing piano or doing similar movements for long periods and operating vibrating tools, such as jackhammers, can lead to this condition.

Symptoms

There are two forms of Raynaud’s phenomenon: primary and secondary. Approximately 10% of the population has Primary Raynaud’s phenomenon, the mild form of the disease. About 1 in 100 people will have the more serious type, secondary Raynaud’s phenomenon.

The form of Raynaud’s phenomenon affects the symptoms you have. Common signs and symptoms of Raynaud’s phenomenon include:

• Extreme sensitivity to cold
• Skin color changes, first to white or blue, then to red when blood flow returns
• Coldness, pain and numbness in the affected area
• Warmth, tingling and throbbing in the fingers or toes
• Skin ulcers and gangrene in rare cases

If you have primary Raynaud’s phenomenon, you may find that the same fingers or toes on each side of your body are affected at the same time. If you have the secondary form of the condition, you may have symptoms on one or both sides of your body.

Diagnosis

To make a diagnosis, your doctor will first ask about your symptoms and medical history and then conduct a physical examination to check your fingers and toes. He or she may also order tests to rule out other conditions that can cause similar signs and symptoms.

To differentiate primary and secondary Raynaud’s phenomenon, your doctor might perform a test called nail fold capillaroscopy. During the test, the doctor examines the skin at the base of your fingernail under a microscope or magnifier for signs of deformities or enlargement.

Lab tests that can help determine the conditions underlying Raynaud’s phenomenon include:

• Antinuclear antibodies test (ANA test)

A positive test for the presence of these antibodies might indicate a stimulated immune system, which is common in people who have connective tissue diseases or other autoimmune disorders.

• Erythrocyte sedimentation rate (ESR or sed rate)

This test determines the rate at which red blood cells settle to the bottom of a tube. A faster than normal rate might indicate an underlying inflammatory or autoimmune disease.

Treatment

Treatment options for Raynaud’s phenomenon are aimed at keeping attacks from happening or reducing the effects of the appearing attacks. Generally, the disease can be treated with lifestyle changes, medications and surgeries.

Lifestyle management methods include:

• Keep your body warm
• Avoid smoking
• Exercising regularly
• Control mental stress

Medications might help to widen blood vessels and promote circulation. They include:

• Calcium channel blockers

These drugs can relax and open small blood vessels in your hands and feet, decreasing the frequency and severity of attacks in most people with Raynaud’s. Examples include nifedipine (Afeditab CR, Procardia, others) and amlodipine (Norvasc).

• Vasodilators

These drugs, which relax blood vessels, include nitroglycerin cream applied to the base of your fingers to help heal skin ulcers.

For some severe cases, surgical procedures that might be treatment options include:

• Nerve surgery

Sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Cutting these nerves interrupts their exaggerated responses. This surgery, if successful, might reduce the frequency and duration of attacks.

• Chemical injection

Doctors can inject chemicals to block sympathetic nerves in affected hands or feet. You might need to have the procedure repeated if symptoms return or persist.

Keywords: Raynaud’s phenomenon; Raynaud’s disease; Raynaud’s syndrome.

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