Raynaud Disease

Overview

Raynaud’s sometimes is called a disease, syndrome, or phenomenon.  Often the cause of Raynaud’s is not known.  When the cause is unknown, this is considered to be primary Raynaud’s.  Sometimes a disease, condition or other factor causes Raynaud’s and when this occurs it is considered to be secondary.  Primary Raynaud’s is generally less severe than secondary.  The most common type of Raynaud’s is primary but the symptoms are the same.  Whether you have primary or secondary Raynaud’s, an attack can be triggered by cold temperatures or stress at which time little or no blood flows to the affected extremities resulting in color changes of the skin.

What are causes and risk factors?

Raynaud’s is a rare disorder that affects the arteries.  Arteries are blood vessels that carry blood from your heart to different parts of your body.  The disorder is marked by brief episodes of vasospasm, which is a narrowing of the blood vessels.

Vasospasm of the arteries reduces blood flow to the fingers and toes.  In people who have Raynaud’s, the disorder usually affects the fingers; but in a fewer number of people who have Raynaud’s, it can affect the toes and rarely Raynaud’s can affect the nose, ears, nipples, and lips.

As a result, the skin may turn white and then blue for a short time.  As blood flow returns, the affected areas may turn red and throb, tingle, burn, or feel numb.

 Primary vs. Secondary Raynaud’s

  • Primary Raynaud’s.  This is Raynaud’s disease without an underlying disease or associated medical problem that could provoke vasospasm. Also called Raynaud’s disease, it is the most common form of the disorder.
  • Secondary Raynaud’s.  Also called Raynaud’s phenomenon, this form is caused by an underlying problem. Although secondary Raynaud’s is less common than the primary form, it tends to be a more serious disorder. Signs and symptoms of secondary Raynaud’s usually first appear at later ages — around 40 — than they do for people with the primary form of Raynaud’s.

Causes of secondary Raynaud’s include:

  • Scleroderma Raynaud’s phenomenon occurs in the majority of people who have scleroderma—a rare disease that leads to hardening and scarring of the skin.
  • Lupus.  Raynaud’s is also a common problem for people with lupus erythematosus—an autoimmune disease that can affect many parts of your body, including your skin, joints, organs and blood vessels.
  • Rheumatoid arthritis.  Raynaud’s may be an initial sign of rheumatoid arthritis—an inflammatory condition causing pain and stiffness in the joints, often including the hands and feet.
  • Sjögren syndrome.  Raynaud’s phenomenon can also occur in people who have Sjögren syndrome—an autoimmune disorder that may accompany scleroderma, lupus or rheumatoid arthritis.
  • Diseases of the arteries.  Raynaud’s phenomenon can be associated with various diseases that affect arteries, such as atherosclerosis, which is the gradual buildup of plaques in blood vessels that feed the heart (coronary arteries), or Bürger disease, a disorder in which the blood vessels of the hands and feet become inflamed.  Primary pulmonary hypertension, a type of high blood pressure that affects the arteries of the lungs, can be linked to Raynaud’s.
  • Carpal tunnel syndrome.  The carpal tunnel is a narrow passageway in your wrist that protects a major nerve to your hand.  Carpal tunnel syndrome is a condition in which pressure is put on this nerve, producing numbness and pain in the affected hand.  The affected hand may become more susceptible to cold temperatures and episodes of Raynaud’s.
  • Injury due to overuse.  Raynaud’s can also be caused by repetitive injuries that damage nerves serving blood vessels in the hands and feet.  Some people who type or play the piano vigorously or for long periods of time may be susceptible to Raynaud’s.  Workers who operate vibrating tools can develop a type of Raynaud’s phenomenon called vibration white finger.
  • Smoking.  Smoking constricts blood vessels and is a potential cause of Raynaud’s.
  • Injuries.  Prior injuries to the hands or feet, such as wrist fracture, surgery or frostbite, can lead to Raynaud’s phenomenon.
  • Certain medications.  Some drugs—including beta blockers, which are used to treat high blood pressure; migraine medications that contain ergotamine; medications containing estrogen; certain chemotherapy agents; and drugs that cause blood vessels to narrow, such as some over-the-counter (OTC) cold medications—have been linked to Raynaud’s.
  • Chemical exposure.  People exposed to vinyl chloride, such as those who work in the plastics industry, may develop an illness similar to scleroderma. Raynaud’s can be a part of that illness.
  • Other causes.  Raynaud’s has also been linked to thyroid gland disorders.

In both types of Raynaud’s, even mild or brief changes in temperature can cause Raynaud’s attacks.  For example, taking something out of the freezer or being exposed to temperatures below 60 degrees Fahrenheit can cause your fingers to turn blue.

What are signs and symptoms?

Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues.  Initially, the digit(s) involved turn white because of the diminished blood supply.  The digit(s) then turn blue because of prolonged lack of oxygen.  Finally, the blood vessels reopen causing a local “flushing” phenomenon, which turns the digit(s) red.  This three-phase color sequence (white to blue to red) that occurs most often upon exposure to cold temperature is characteristic of Raynaud’s phenomenon.

Symptoms of Raynaud’s phenomena depend on the severity, frequency, and duration of the blood vessel spasm.  Most patients with mild disease only notice skin discoloration upon cold exposure.  They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal.  When the blood vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen and can cause pain in the involved digit(s).  Only rarely can poor oxygen supply to the tissue cause the tips of the digits to ulcerate.  Ulcerated digits can become infected and with continued lack of oxygen gangrene (cell and tissue death) of the digits can occur.

People who have secondary Raynaud’s (accompanied by another disease) will likely also have signs and symptoms related to their basic underlying condition and it is important to seek medical attention to control that underlying cause.  Raynaud’s phenomena is the initial symptom of patients with scleroderma which is a skin and joint disease. Other rheumatic diseases frequently associated with Raynaud’s phenomena include systemic lupus erythematosus, rheumatoid arthritis and Sjögren syndrome.

People who have primary Raynaud’s (Raynaud’s disease) or secondary Raynaud’s (Raynaud’s phenomenon) can have attacks in response to cold temperatures or emotional stress.

Raynaud’s attacks usually affect the fingers and toes.  Rarely, the attacks affect the nose, ears, nipples or lips.

During a Raynaud’s attack, the arteries become very narrow for a brief period.  As a result, little or no blood flows to affected body parts.  This may cause these areas to:

  • Turn pale or white and then blue
  • Feel numb, cold, or painful
  • Turn red, throb, tingle, burn, or feel numb as blood flow returns to the affected areas

Raynaud’s attacks can last less than a minute or as long as several hours.  Attacks can occur daily or weekly.

Attacks often begin in one finger or toe and move to other fingers or toes.  Sometimes only one or two fingers or toes are affected and at other times different areas may be affected at different times.

Severe secondary Raynaud’s can cause skin sores or gangrene. Gangrene refers to the death or decay of body tissues.  Fortunately, severe Raynaud’s is rare.

How is Raynaud’s diagnosed?

Your doctor will diagnose primary Raynaud’s (Raynaud’s disease) or secondary Raynaud’s (Raynaud’s phenomenon) based on your medical history, a physical exam, and test results.   Your doctor may also run tests to rule out other medical problems that may cause similar signs and symptoms, such as a pinched nerve.

Since there is no single blood test to diagnose Raynaud’s, your doctor may order other tests, such as those that rule out diseases of the arteries, to help pinpoint a disease or condition that may be associated with Raynaud’s.

In patients with the characteristic sequence of skin-color changes of the digits upon cold exposure, diagnosing Raynaud’s phenomena is not difficult.  Sometimes, certain patterns in the tiny blood vessels (capillaries) adjacent to the fingernails of patients with Raynaud’s phenomena can be seen using a magnifying viewing instrument.  Abnormal nail-fold capillary patterns can suggest the possibility of an associated rheumatic condition.  There is, however, no single blood test to help the doctor to confirm the diagnosis. The doctor can order certain blood tests (for example:

  • Sedimentation rate
  • Antinuclear antibody (ANA)
  • Thyroid hormone levels, and protein levels) to exclude associated rheumatic diseases and thyroid disorders
  • Chemistry Profile
  • The doctor can also perform certain maneuvers with the patient’s extremities to exclude pinched blood vessels that can produce symptoms that mimic Raynaud’s phenomena, such as in thoracic outlet syndrome.
  • Cold pressor testing which involves placing your affected areas to cold, such as placing your hands in cold water, to invoke an episode of Raynaud’s while being monitored.

How is Raynaud’s treated and managed?

Primary Raynaud’s (Raynaud’s disease) and secondary Raynaud’s (Raynaud’s phenomenon) have no cure.  However, treatments can reduce the number and severity of Raynaud’s attacks.  Treatments include lifestyle changes, medicines and, rarely, surgery.

Most people who have primary Raynaud’s can manage the condition with lifestyle changes.  People who have secondary Raynaud’s may need medicines in addition to lifestyle changes.  Rarely, they may need surgery or shots.  If you have Raynaud’s and develop sores on your fingers, toes, or other parts of your body, see your doctor right away.  Timely treatment can help prevent permanent damage to the areas.

Lifestyle changes

Lifestyle changes can help you avoid things that may trigger a Raynaud’s attack.  Examples of such triggers include cold temperatures, emotional stress, workplace or recreational factors, and contact with certain chemicals or medicines.

Protect yourself from cold temperatures with the following measures:

  • Wear a hat, mittens (rather than gloves), scarf, coat with snug cuffs, and warm socks and shoes during cold weather. Layer your clothing for extra warmth.
  • Put hand and foot warmers in your mittens, boots, socks, or pockets. Some warmers are small heat packs, and others are battery-operated. These warmers often are available at sporting goods stores.
  • Turn up air conditioning or dress warmly while in an air-conditioned space.
  • Warm up your car before driving in cold weather.
  • Wear gloves or mittens when taking food out of the refrigerator or freezer (if cold temperatures severely affect you).

Avoid other triggers

Try to avoid things that make you upset or stressed. Learn ways to handle stress that you cannot avoid.

Try to avoid workplace and recreational triggers.  For example, limit the use of vibrating tools such as drills.  Wear proper protective gear if you work with industrial chemicals.  Also, try to limit repetitive hand actions.

Be aware that some medicines can trigger Raynaud’s attacks.  Examples include:

  • Over-the-counter cold or allergy medicines or diet aids. Some of these medicines can narrow your arteries.
  • Beta blockers. These medicines slow your heart rate and lower your blood pressure.
  • Birth control pills. These medicines can affect blood flow.
  • Migraine headache medicines that contain ergotamine. This substance causes your arteries to narrow.
  • Certain cancer medicines, such as cisplatin and vinblastine.

Talk with your doctor about your medicines and what they may do to your Raynaud’s.

Other lifestyle changes

Other lifestyle changes also can help you avoid Raynaud’s attacks.  For example, include physical activity as part of your healthy lifestyle.  Physical activity can increase your blood flow and help keep you warm.

Limit your use of caffeine and alcohol.  These substances can trigger Raynaud’s attacks. If you smoke, quit.  Smoking makes Raynaud’s worse.  Ask your doctor about programs and products that can help you quit.  Also, try to avoid secondhand smoke.

You also can take steps to help stop Raynaud’s attacks when they occur.  For example:

  • Move to a warmer spot, such as indoors, during cold weather.
  • Warm your hands or feet.  Place your hands under your armpit or soak your feet or hands in warm (not hot) water.
  • Wiggle or massage your fingers and toes.
  • Move your arms in circles or shake your arms or feet.
  • Get out of stressful situations and try relaxation techniques.

If you have Raynaud’s, be sure to take care of your hands and feet.  Protect them from cold and especially in the wintertime by wearing warm gloves.  Be aware that Raynaud’s will make you more susceptible to frostbite.  Protect you hands and feet from cuts, bruises, and other injuries.  For example, wear properly fitting shoes and do not walk barefoot.  Use lotion to prevent your skin from drying and cracking and avoid tight wristbands and rings.

Medicines and surgery

If lifestyle changes do not control Raynaud’s, you may need medicines or surgery.  Medicines are used to improve blood flow to the fingers and toes.

Examples of medicines used to treat Raynaud’s include:

  • Calcium channel blockers
  • Alpha blockers rarely
  • Prescription skin creams
  • And less often ACE inhibitors

Rarely, people who have severe Raynaud’s may develop skin sores or gangrene. Gangrene refers to the death or decay of body tissues.  If this happens, antibiotics or surgery to cut out the damaged tissue may be needed.  In very serious cases, the affected toe or finger may need to be removed.

Most people who have primary Raynaud’s can manage the disorder with lifestyle changes.  People who have secondary Raynaud’s may need medicines in addition to lifestyle changes.  Rarely, they may need surgery.

__________________________________________________

We hope the information on these pages is both informative and helpful, but it is intended for education only.  Please do note that no web site, no matter how much information is shared, can replace a consultation with your doctor and a vascular specialist.  Medical technology and treatment are continually improving and evolving so before making any decision on treatment, it is always advisable to see your doctor first for a comprehensive evaluation of your vascular disease and other medical conditions.

At the Vascular Center of Wichita Falls, we work closely with your other physicians.  If you have concerns about your arteries or veins, contact us.  A referral is not necessary to make an appointment.At the Vascular Center of Wichita Falls, we work closely with your other physicians to achieve the best outcome for the best quality of life.  If you have concerns about your arteries or veins, contact us for an appointment.