Raynaud’s Phenomenon

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition affecting an estimated 5-10% of Americans in which the blood vessels of the fingers and toes and sometimes those of the earlobes, nose, and lips overreact to cold temperatures, stress, or other stimuli by having spasms and constricting (narrowing) too much and for too long.

What causes Raynaud’s phenomenon?

Two types of the condition exist depending on the cause.  Primary or idiopathic Raynaud’s phenomenon, which doctors call Raynaud’s disease or Raynaud’s syndrome, is not associated with another known condition and has no known cause other than a malfunction of the nerves controlling the muscles responsible for changing blood vessel diameter.  Secondary Raynaud’s phenomenon is a disorder that is associated with another condition, typically an autoimmune disease.  Primary Raynaud’s is more common and generally causes fewer complications than secondary Raynaud’s.  Various diseases can accompany secondary Raynaud’s phenomenon, but two of the most common are scleroderma and mixed connective-tissue disease.  Between 85 to 95% of patients with these conditions also have Raynaud’s phenomenon.  Other possible causes for Raynaud’s include lupus, frostbite, vibration injury, polyvinyl chloride exposure, cryoglobulinemia, rheumatoid arthritis, atherosclerosis, some cancers, hormone imbalance, and smoking. 

What are the risk factors for Raynaud’s phenomenon?

Women are 5 times more likely to be affected with Raynaud’s than men, and they are most likely to begin to have symptoms between age 20 and 40.  People with a condition that is known to be associated with Raynaud’s, for example, scleroderma, mixed connective tissue disease, or lupus, are at an increased risk for developing Raynaud’s.  Smokers, alcohol abusers, and patients who have had prolonged exposure to cold temperatures, experience working with vibrating machinery, or a helicobacter pylori infection are also more likely than others to begin having the symptoms of Raynaud’s phenomenon.

What are the symptoms, dangers, and complications of Raynaud’s phenomenon?

While Raynaud’s phenomenon can cause a digit to need amputation, this condition is usually not threatening and serious complications are rare.  The symptoms of a classic spasm attack include digits that turn white and feel cold and numb as blood vessels narrow to limit blood flow.  As the spasm continues, the digits can turn blue from a prolonged lack of fresh blood with high oxygen content.  Once the spasm ends, the blood vessels may overreact in the opposite direction and dilate to clear wastes and deliver oxygen to the tissue that was deprived during the period of blood vessel constriction.  This dilation turns fingers red and can cause them to tingle or throb painfully once the initial numbness wears off.  The series of colors that a patient experiences is not always the standard white, then blue, then red: some patients can skip a color or the colors can be out of order.  In addition to varying in color sequence, these attacks can also vary in duration from less than a minute to several hours. 

Primary Raynaud’s phenomenon is less likely to cause serious complications than secondary Raynaud’s.  Skin ulcers that can become infected, gangrene, heartburn, and difficulty swallowing are all complications that can be related to Raynaud’s phenomenon. 

How do doctors diagnose Raynaud’s phenomenon?

Diagnosing Raynaud’s phenomenon frequently depends upon a patient’s description of the vasospasm attacks because there are no simple tests to confirm the diagnosis.  However, most of those affected have characteristic symptoms with a uniform series of color changes, so doctors usually have little difficulty determining that a patient is affected by Raynaud’s phenomenon.  The challenging portion of the diagnosis is determining whether or not the vasospasms are related to another condition and then identifying the underlying condition if present.  Viewing an altered structure of the capillaries (tiny blood vessels connecting arteries to veins) in a patient’s digits under a microscope can alert a physician of a rheumatic condition that may be causing the spasms.  Blood tests can also help doctors investigate causes like rheumatic conditions or a thyroid gland disorder.  Antinuclear antibodies (ANAs) are proteins that patients produce when they have autoimmune disorders like connective tissue diseases; testing for their presence in patients with Raynaud symptoms can help a doctor determine whether their disease is associated with another problem.

What are the treatment options for patients with Raynaud’s phenomenon?

Most patients do not need any invasive medical treatment for Raynaud’s phenomenon.  They should try to avoid cold or stressful situations and chemicals that can cause attacks by staying inside during cold weather or dressing warmly, wearing gloves when handling cold objects, wearing wool or synthetic socks rather than cotton, avoiding working with vibrating machinery, not consuming large amounts of caffeine, not taking decongestants containing pseudoephedrine, and quitting smoking because nicotine acts as a vasoconstrictor and can trigger attacks.  Patients should not ignore attacks, but, when they happen, should try to restore circulation to their digits by warming their hands and feet.  They should go indoors in cold weather and run warm water over their fingers and toes or soak them in a bowl of warm water.  Also, they should get out of any stressful situations and relax. 

For primary Raynaud’s, calcium channel blockers like nifedipine at low, slow releasing doses can help prevent spasms by keeping blood vessels dilated.  Angiotensin-converting enzyme (ACE) inhibitors, prostaglandin, and fluoxetine may also help patients prevent their vasospasm attacks. 

When doctors treat patients with secondary Raynaud’s, they focus on treating the underlying disorder, but, there is unfortunately no effective therapy for the autoimmune disorders that are usually associated with Raynaud’s phenomenon.  Doctors might prescribe nitroglycerin paste for a patient to apply to ulcers in order to dilate blood vessels and increase local circulation.

Sympathectomy is an invasive, surgical treatment option for severe cases of either primary or secondary Raynaud’s.  This surgery involves disconnecting the arteries from the sympathetic, autonomic nerves that control their dilation (widening) and constriction (narrowing).