Raynaud's Phenomenon

This is a condition in which the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or from an emotional upset. Smoking cigarettes or working with vibrating machinery also can cause these episodes. The small veins are usually open, so the blood drains out of the capillaries (Kap'ih-lair"eez). The result is that the fingers or toes become pale, cold and numb. If there's a spasm in the small veins and blood is trapped in the capillaries, the fingers or toes turn blue as the blood loses its oxygen. Raynaud's (ra-noz') phenomenon is also sometimes called Raynaud's syndrome or Raynaud's disease.

 

What is Raynaud's Phenomenon?

Raynaud's Phenomenon is a disorder of the small blood vessels that feed the skin. During an attack of Raynaud's, these arteries contract briefly, limiting blood flow. This is called a vasospasm. Deprived of the blood's oxygen, the skin first turns white then blue. The skin turns red as the arteries relax and blood flows again. Extremities--hands and feet--are most commonly affected, but Raynaud's can attack other areas such as the nose and ears.

 

What are the symptoms?

Symptoms include changes in skin color (white to blue to red) and skin temperature (the affected area feels cooler). Usually there is no pain, but it is common for the affected area to feel numb or prickly, as if it has fallen asleep.

 

What causes Raynaud's?

Doctors do not completely understand the cause of Raynaud's, but they believe the body's blood vessels overreact to cold.

 

When the body is exposed to cold, the hands and feet lose heat rapidly. To conserve heat, the body reduces the amount of blood flowing to these areas by narrowing the small arteries that supply them with blood. In persons with Raynaud's, these small blood vessels overrespond to cold. For example, reaching into a refrigerator may trigger an attack.

 

Cold temperatures are more likely to provoke an attack when the individual is physically or emotionally stressed. For some persons, exposure to cold is not even necessary; stress alone causes vessels to narrow.

 

Who is affected?

Women between the ages of 15 and 50 are most often affected, but anyone can have the problem. It is not known for sure how many people suffer from these symptoms, but Raynaud's is a common problem.

How is Raynaud's diagnosed?

An attack is usually temporary, so the doctor relies on the patient's description to diagnose the problem. The doctor will also determine whether the patient has Raynaud's alone (called primary Raynaud's phenomenon) or if another disease or some aspect of the patient's lifestyle is causing the symptoms. If the problem is caused by another disease or risk factor, the patient is said to have secondary Raynaud's phenomenon.

 

Is primary Raynaud's different from secondary Raynaud's?

Yes. Primary Raynaud's usually affects both hands and both feet, and the cause is not known for certain. Secondary Raynaud's usually affects either both hands or both feet. Causes of secondary Raynaud's can be identified. Smoking is one cause. Some drugs may also cause this form of Raynaud's phenomenon. These include:

Some heart and blood medications.

Migraine headache medications.

 

Other medical conditions that may cause secondary Raynaud's phenomenon include:

 

*           Scleroderma--a thickening and hardening of the skin and other body tissues.

*           Systemic lupus erythematosus--a chronic inflammation of the skin and organ systems.

*           Rheumatoid arthritis--a chronic inflammation and swelling of tissue in the joints.

*           Blood flow reduction--problems that slow or stop blood flow in a vessel. These include inflammation and hardening of the arteries (arteriosclerosis).

*           Nerve problems--problems that affect the nerves supplying the muscles.

*           Pulmonary hypertension--a condition in which the blood pressure rises in the blood vessels of the lungs.

 

Injuries may also cause Raynaud's phenomenon. They can result from frostbite, surgery, or other causes. For example, regular use of machinery such as chain saws and vibrating drills can hurt blood vessels. Other activities that may aggravate the phenomenon are regular typing and piano playing.

 

What are the treatments for Raynaud's?

Patients with primary Raynaud's are taught how to prevent attacks (see below). In patients with secondary Raynaud's, doctors first treat the underlying cause. Vasodilators--drugs that help relax artery walls to improve blood flow--may be prescribed for patients with secondary Raynaud's or primary Raynaud's that resists other forms of therapy.

 

Are there ways to prevent attacks?

Yes. People suffering from Raynaud's should protect themselves from cold and keep all parts of their body warm--not just their extremities. Outdoors in winter, they should wear scarves, warm socks and boots, and mittens or gloves under mittens because gloves alone allow heat to escape. People with Raynaud's should also wear wristlets to close the space between the sleeve and mitten. Indoors, people should wear socks and comfortable shoes. When taking food out of the refrigerator or freezer, they should wear mittens, oven mitts, or pot holders.

 

Patients with Raynaud's should guard against cuts, bruises, and other injuries to the affected areas. Activities such as sewing may have to be limited.

 

Patients who smoke should quit. Doctors may also adjust medications if the drugs appear to be responsible for the symptoms.

 

After several sessions of training, patients can often prevent or stop attacks using biofeedback, a technique in which patients are taught to "think" their fingers or toes warm.

 

It is important for persons who suspect they have Raynaud's to talk with their personal physicians. The doctor can give advice on the best ways to manage and treat the problem.

 

What is the prognosis?

Between 40 to 60 percent of patients with primary Raynaud's respond to management techniques. A rare but serious complication of primary Raynaud's is dry gangrene, or dead flesh. This may occur if the arteries stay contracted so that blood cannot bring oxygen to the area.

 

In most people with secondary Raynaud's, the problem does not get worse. All patients with Raynaud's should discuss any questions about their prognosis with their doctor.

 

Is more information available on Raynaud's phenomenon?

Yes. For more information, you may wish to contact:

 

United Scleroderma Foundation, Inc.

P.O. Box 350

Watsonville, CA 95077-0350

(408) 728-2202

 

American Lupus Society

23751 Madison Street

Torrance, CA 90505

(213) 373-1335