Raynaud’s disease is a rare disorder that involves the arteries, the blood vessels that carry blood from your heart to other parts of the body.
During an episode of Raynaud’s, the arteries constrict (become narrow). Blood does not flow well to the skin’s surface and causes the skin to change from its normal color to blue (because of the lack of oxygen-rich blood). The skin may also feel numb and cold. A Raynaud’s episode can last from several minutes to an hour or more.
Once an episode is over, the skin turns red as the blood rushes back through the arteries. The skin begins to tingle or throb as it warms up again. It can take up to 15 minutes for blood flow to return to normal.
Raynaud’s disease usually affects the fingers and toes. In rare instances, it also may affect the nose, ears, nipples and lips.
While most people have no long-term tissue damage or disability from the disease, those with severe Raynaud's can develop skin sores or infections from long or repeated attacks.
Raynaud's Disease
What is Raynaud’s disease?
What causes Raynaud’s?
There are two types of Raynaud’s disease: primary and secondary.
Primary Raynaud’s disease is the most common type, making up about 80% of the cases. Primary Raynaud’s occurs when the blood vessels in the hands or feet overreact to stress or cold temperatures. Often, people who have primary Raynaud’s have mild symptoms that can be treated with lifestyle changes.
Secondary Raynaud's syndrome occurs in people who have some other health problem that leads to or triggers Raynaud’s syndrome. Secondary Raynaud’s is a more serious disease that can require both medicine and lifestyle changes to manage. Secondary Raynaud’s may be related to:
Primary Raynaud’s disease is the most common type, making up about 80% of the cases. Primary Raynaud’s occurs when the blood vessels in the hands or feet overreact to stress or cold temperatures. Often, people who have primary Raynaud’s have mild symptoms that can be treated with lifestyle changes.
Secondary Raynaud's syndrome occurs in people who have some other health problem that leads to or triggers Raynaud’s syndrome. Secondary Raynaud’s is a more serious disease that can require both medicine and lifestyle changes to manage. Secondary Raynaud’s may be related to:
- Connective tissue disorders, such as polymyositis/dermatomyositis, rheumatoid arthritis, scleroderma, Sjögren's syndrome, lupus
- Endocrine (gland) disorders, such as hypothyroidism
- Blood disorders, such as cold agglutinin disease, Polycythemia vera
- Neoplastic (cell growth) disorders, such as carcinoid syndrome, paraneoplastic syndrome
- Problems that affect the nervous system, such as carpal tunnel syndrome
- Vascular disorders, such as thoracic outlet syndrome
- Artery diseases, such as atherosclerosis (hardening of the arteries), Buerger's disease, pulmonary hypertension
Some medicines also can trigger Raynaud’s:
- Certain high blood pressure medicines called beta blockers
- Migraine medicines that contain ergotamine
- Estrogen-containing medicines, such as birth control pills
- Chemotherapy medicine, such as cisplatin and vinblastine
- Certain cold medicines that cause blood vessels to narrow, such as those containing pseudoephedrine
Who is at risk for Raynaud’s?
Raynaud’s disease affects about 3% to 5% of people. It is most common in women and occurs more often in colder climates.
Primary Raynaud’s usually occurs between the ages of 15 and 25. People who have a family history of the disease are at a greater risk.
Secondary Raynaud’s occurs later in life, usually after age 30. Certain diseases (see above), medicines (see above), smoking, injuries to the hands or feet, frostbite, chemical exposure, and occupations that involve repetitive motion or vibration have also been linked to Raynaud’s disease.
Primary Raynaud’s usually occurs between the ages of 15 and 25. People who have a family history of the disease are at a greater risk.
Secondary Raynaud’s occurs later in life, usually after age 30. Certain diseases (see above), medicines (see above), smoking, injuries to the hands or feet, frostbite, chemical exposure, and occupations that involve repetitive motion or vibration have also been linked to Raynaud’s disease.
How is Raynaud’s diagnosed?
Your doctor will likely check your medical history to find out if you have relatives with Raynaud’s or health conditions that are linked to Raynaud’s. Your doctor may ask about your symptoms, especially when you are cold or stressed.
A physical exam will help determine if you have Raynaud’s or some other problem that can cause similar symptoms. Your doctor may examine your fingernails to check the blood vessels there. He or she may trigger a Raynaud’s episode using cold water or air to see your response. Blood tests also may be used to identify the form of the disease or if other diseases are causing your symptoms.
A physical exam will help determine if you have Raynaud’s or some other problem that can cause similar symptoms. Your doctor may examine your fingernails to check the blood vessels there. He or she may trigger a Raynaud’s episode using cold water or air to see your response. Blood tests also may be used to identify the form of the disease or if other diseases are causing your symptoms.
Tips on How to Manage a Raynaud’s Episode
- Get warm: Move inside if it’s cold outside or move to warmer place. Use warm water to soak your hands and feet.
- Move around: Wiggle your fingers and toes. Move your arms in wide circles.
- Encourage circulation. Massage your fingers and toes.
- De-stress. Get away from a stressful situation if that is part of what is causing your symptoms.
How is Raynaud’s treated?
Both types of Raynaud’s are lifelong conditions. To date, no cure has been found. But research is under way to improve diagnosis and treatment. And lifestyle changes can help with the symptoms.
- Reduce exposure to cold or temperature extremes, such as going outdoors in winter or removing items from a freezer.
- Quit smoking.
- Learn stress-relief techniques.
- Warm your hands or feet during an episode with warm water or chemical warmers, which are small packets that you can put in your pockets or shoes.
- Exercise to increase blood flow (especially for primary Raynaud’s disease).
- Avoid wearing clothes with tight cuffs, or tight jewelry such as rings or bracelets.
- Limit caffeine and alcohol.
Medicines that help Reynaud’s symptoms include:
- Many different calcium channel blockers (brand names: Adalat, Dynacirc, Norvasc, Plendil, Procardia) can be used to reduce how often you have episodes and how long the episodes last. These medicines relax the small blood vessels so they can open up again.
- Alpha blockers (brand names: Cardura, Minipress) can be helpful. They block a hormone called epinephrine that constricts blood vessels.
- Medicine that helps blood cells flow through small channels better, such as pentoxifylline (brand names: Pentoxil, Trental).
- ACE inhibitors, such as captopril (brand name: Capoten).
- Intravenous (IV) prostaglandins (brand names: Caverject, Edex, Flolan, Muse).
New medicines for people whose Raynaud’s symptoms don’t seem to be controlled by other methods include fluoxetine (brand name: Prozac), phosphodiesterase inhibitors such as cilostazol (brand name: Pletal), sildenafil (brand name: Viagra) and an angiotensin II receptor antagonist losartan (brand name: Cozaar).
Sometimes the affected area can be injected with a medicine that helps block the nerves that are triggering the blood vessel changes. This treatment may be needed more than once.
If your Raynaud’s is especially serious—for example, if lack of blood flow is so extreme you could lose a finger or toe—you may need surgery to improve the blood flow to your fingers and toes, or surgery or shots to block the nerves that control the arteries. In rare cases, damaged or destroyed tissue may need to be treated or removed.
If another condition is causing Secondary Raynaud’s disease, you may need treatment for that condition. Talk to your doctor about your options.
See your doctor often for ongoing care. Contact your doctor right away if symptoms occur on only one side of your body, or if you get sores or ulcers on your fingers or toes.
Sometimes the affected area can be injected with a medicine that helps block the nerves that are triggering the blood vessel changes. This treatment may be needed more than once.
If your Raynaud’s is especially serious—for example, if lack of blood flow is so extreme you could lose a finger or toe—you may need surgery to improve the blood flow to your fingers and toes, or surgery or shots to block the nerves that control the arteries. In rare cases, damaged or destroyed tissue may need to be treated or removed.
If another condition is causing Secondary Raynaud’s disease, you may need treatment for that condition. Talk to your doctor about your options.
See your doctor often for ongoing care. Contact your doctor right away if symptoms occur on only one side of your body, or if you get sores or ulcers on your fingers or toes.
Other Organizations
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National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov
Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Created: 08/09