Raynaud’s

Raynaud’s Phenomenon (RP) results when there is a decrease in blood flow to the fingers and toes when someone is exposed to cold weather or stress. The fingers or toes typically change colors including white, blue and red. This can be associated with a “pins and needles” sensation (numbness) or discomfort. These symptoms occur intermittently, and are known as “episodes” or “attacks”, and tend to resolve on their own.

It is important to know there are two types of Raynaud’s Phenomenon – these are referred to as “primary” and “secondary”. Primary Raynaud’s typically affects women typically under the age of 30 (usually in the teenage years or early twenties). While symptoms can be uncomfortable, there is no danger of damage to the body. Primary Raynaud’s occurs in patients who do not have another rheumatic disease. Secondary Raynaud’s is “secondary” to another condition. These conditions are numerous and can include several autoimmune conditions. The most common rheumatic diseases associated with Raynaud’s include scleroderma and lupus, but can include others such as rheumatoid arthritis, inflammatory myositis, and Sjögren’s syndrome. Often, the onset of secondary RP is later in life – usually after the age of 30.

Patients with either primary or secondary RP will typically report color changes of the fingers or toes that occur in response to a number of triggers – cold weather and stress are most commonly reported. Symptoms can also occur in the frozen food aisle at the grocery store or due to air conditioning. Rheumatologists are typically needed to differentiate whether Raynaud’s is primary or secondary.

Raynaud’s Phenomenon is caused by overly-sensitive blood vessels within the fingers and toes. They are more affected by cold and stress. The blood vessels narrow substantially, causing a decrease in blood flow and associated color change. The lack of blood flow often results in a pale, or white, discoloration. Subsequently, the digits can turn blue and eventually red as there is a sudden influx of blood into the digits after the episode is over.

RP is diagnosed based on a history and physical examination. Patients with primary Raynaud’s typically have a normal examination and blood work. Often, an exam technique that involves looking at the blood vessels below the fingernails (called nailfold capillaroscopy) is used to help differentiate primary from secondary Raynaud’s.

Patients with secondary Raynaud’s typically have an abnormal exam and/or blood work.

Raynaud’s can be managed with lifestyle modifications and medications.

Lifestyle modifications include keeping the body warm, specifically, keeping the core of the body warm. Often times patients will use hand warmers and mittens/gloves to help keep the fingers warm. Stress reduction and smoking cessation are also recommended to help decrease Raynaud’s attacks.

Many patients can control their symptoms with lifestyle modification alone. However, sometimes medications are needed, and many options are available. These include blood pressure medications such as calcium channel blockers (amlodipine, nifedipine, felodipine, and others) and angiotensin-receptor blockers. These medications act by increasing blood flow to the fingers and toes. For patients with more severe symptoms or who have developed complications such as ulcers on the fingertips, other medications can be used including sildenafil or prostacyclins.

Sometimes, patients will also be prescribed other medications that can help improve symptoms, including topical creams, selective-serotonin-reuptake inhibitors (SSRIs), or cholesterol-lowering (statin) medications.

RP is often diagnosed by a rheumatologist, who further can decide whether the Raynaud’s is primary or secondary. Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. Thus, they are best qualified to make a proper diagnosis of Raynaud’s Phenomenon. They can also advise patients about the best treatment options.