Raynaud (RAY-node) syndrome is a reversible condition in which the fingers or toes start throbbing and turning a whitish or blue color because a contraction (vasospasm) of the small arteries has interfered with blood flow. It typically occurs when the body parts are exposed to cold temperatures or stress.
There are two types of Raynaud syndrome:
Primary Raynaud syndrome is by far the more common type and has no known cause, but contributing factors include cold weather and emotional stress. It is estimated to occur in about 5 to 10 percent of nonsmokers and is much more common in women than men.
Secondary Raynaud syndrome is the result of a known underlying condition, such as connective tissue disorders (e.g., scleroderma or lupus), nervous system diseases or certain occupationally related disabilities.
It is important to understand that merely cold hands and feet are not Raynaud syndrome. It also should not be confused with frostbite. The symptoms of the condition vary with the duration and severity of the blood vessel spasms. In most cases, the skin changes color and there is a feeling of numbness. As blood flow returns, the skin tone changes back to normal and there is often a tingling sensation. These symptoms are caused by the rapid constriction of small arteries in the extremities, especially the fingers, although Raynaud can also occur in the nose and ears. Attacks can be triggered by cold, stress or brought on for no apparent reason.
People who have experienced what appears to be Raynaud syndrome are encouraged to see their physician to confirm the diagnosis and, if necessary, to get treatment. Most people need only to make minor lifestyle changes. In some cases, however, vasodilators may be prescribed to keep the blood vessels from constricting.
About Raynaud syndrome
Raynaud (RAY-nodes) syndrome is a reversible condition in which the extremities, usually the fingers or toes, start throbbing and turning a whitish or blue color (cyanosis) because a contraction (vasospasm) of the small arteries has interfered with blood flow. Raynaud syndrome can also occur in the ears, nose and, rarely, tongue.
Raynaud syndrome is a type of peripheral vascular disease that is functional, meaning there is no permanent change in the makeup of the blood vessels, although there is evidence that blood flow is altered even in the absence of attacks. During a typical Raynaud syndrome attack, the constricted blood vessel will obstruct blood flow temporarily, and the fingers will slowly turn from white to blue due to the lack of oxygen. An attack will usually begin in one finger and spread slowly to other digits, often avoiding the thumb completely. It will occasionally be accompanied by mottling of the skin of the arms and legs (livedo reticularis). A typical Raynaud attack lasts less that half an hour if warming measures are taken.
After the attack is over, the vessels will re-open, and the fingers or toes will slowly return to their healthy color as blood flow is restored. Individuals with Raynaud syndrome may also experience pain, throbbing or a prickly feeling in the extremities and, in extremely serious cases, damaged tissue and the possibility of permanent tissue death (gangrene).
Cold and stress are common triggers for primary Raynaud syndrome. These conditions appear to trigger constriction of the blood vessels, which limit the blood supply to the extremities.
Types of Raynaud syndrome
Raynaud syndrome takes two common forms. Primary Raynaud (also called Raynaud disease) is by far the most common form, occurring in 90 percent of cases. It is not associated with any underlying medical problem. In some cases, primary Raynaud syndrome will go into spontaneous remission.
Secondary Raynaud or Raynaud phenomenon, occurs in the presence of other conditions, such as certain types of autoimmune disorders (e.g., lupus erythematosus). These conditions affect many different parts of the body as a result of the immune system attacking itself. Secondary Raynaud is the more serious form of the disease. It can be accompanied by painful ulcers and gangrene.
Secondary Raynaud may be caused by conditions such as:
Connective tissue disorders. Raynaud phenomenon occurs in most people who have scleroderma, a type of connective tissue disease. The disease reduces blood flow to extremities and makes the patient more susceptible to Raynaud.
Autoimmune diseases (e.g. lupus)
Rheumatoid arthritis. Raynaud may be one of the first signs of rheumatoid arthritis, a condition that causes pain and stiffening of the joints. However, this association is somewhat controversial, with studies showing conflicting results.
Nervous system diseases
Diseases of the arteries (e.g., atherosclerosis, pulmonary hypertension)
Occupationally related disabilities associated with the use of chain saws, pneumatic drills and other vibrating machinery (occupational Raynaud). Also, repetitive trauma, such as vigorous piano playing, may contribute to the condition.
Injuries, such as prior wrist fractures or frostbite, can lead to Raynaud phenomenon. Carpal tunnel syndrome, which places pressure on nerves in the wrist and hand, may increase the chances of developing the condition.
Smoking.
Certain medications (e.g. beta blockers, estrogen drugs)
Other causes, including hypothyroidism and in rare cases, certain cancers.
Other factors also place individuals at risk for Raynaud syndrome. Women between the ages of 15 and 40 most often develop the Primary Raynaud. It is often more common in people who live in colder climates.
Diagnosis and treatment of Raynaud syndrome
Although cold hands and feet are common complaints, they do not confirm a diagnosis of Raynaud syndrome. Physicians often rely on a complete medical history and description from the patient for a diagnosis. In addition, some patients may need a simple noninvasive test that measures blood flow, blood pressure and temperature in the fingers or toes before and after exposure to ice-cold water. However, this test is used less frequently today than in the past because its results are often unreliable.
There is no single blood test to diagnose Raynaud syndrome. However, blood tests and other laboratory tests might be used to diagnosis conditions associated with Raynaud phenomenon. These tests may include an antinuclear antibodies (ANA) test or an erythrocyte sedimentation rate (ESR) test if the physician suspects an underlying autoimmune disorder.
Raynaud syndrome is not directly treatable, but it can be managed through prevention and medications, if necessary. Patients diagnosed with Raynaud syndrome are encouraged to take the following precautions:
Dress warmly, and avoid sudden exposure to cold and damp, cold conditions. Raynaud attacks can sometimes be stimulated by exposure to cold in freezers and refrigerated sections of grocery stores.
Exercise.
Briskly rub the hands and feet to stimulate circulation if symptoms develop. Hands can also be placed under warm water if an attack develops. Consult with a physician about methods to end an attack.
Refrain from using tools such as jackhammers that cause repeated vibrations in the hands. Take breaks if participating in repetitive actions (e.g. piano playing).
Minimize exposure to stress situations, and learn stress management techniques.
Quit smoking and avoid from second-hand smoke.
Avoid or change medications that may increase vasospasms, including medications that contain pseudoephedrine and herbs containing ephedra.
Avoid tight-fitting clothing, jewelry or shoes.
Other strategies include:
Biofeedback. This painless treatment involves a machine that clearly displays how people’s states of either relaxation or stress are affecting the body. As a result, people can learn to gain better control over their physical response to stress.
Vasodilators. These medications keep the blood vessels open (dilated) and may be prescribed if general preventive measures are not successful. Calcium channel blockers are effective, particularly for Raynaud syndrome secondary to scleroderma and are also used with primary Raynaud syndrome. Some studies have examined the use of ACE inhibitors and other medications. Medication may be limited to the colder months.
Treatment of secondary Raynaud syndrome focuses on the underlying condition. For all patients diagnosed with Raynaud, especially men and those people over age 40, it is generally a good idea to make sure there are no underlying causes.
In extreme cases, surgery might be necessary to amputate a toe or finger that has permanently blocked blood supply.
Scientists are evaluating new medications that may be successful in treating Raynaud. Some of these drugs include losartan, a drug to treat hypertension, and a class of drugs known as prostaglandins. In addition, some success has been found with applying nitric oxide to the affected area during an attack. The drug appears to improve circulation and blood supply to the area.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about Raynaud syndrome:
How will I know if I have Raynaud syndrome?
How is it different from frostbite?
What tests will be used to diagnose Raynaud syndrome?
Do I have primary or secondary Raynaud?
If it is secondary, what underlying condition could be causing it?
Can I make any lifestyle changes to avoid the attacks?
If I experience the symptoms, what can be to make them less severe?
What are my treatment options?
What are the benefits and risks with these treatments?
