What is Raynaud’s phenomenon?
Raynaud’s phenomenon or simply Raynaud’s occurs when the extremities (fingers, toes, and sometimes the nose) become very pale, then bluish (cyanosed) when exposed to the cold. When the digits are returned to the warmth they can become reddish, tingling, and uncomfortable. It can also occur if a person experiences a stressful situation.
In 90% of cases it occurs on its own. This is called primary Raynaud’s phenomenon. More rarely it is associated with autoimmune conditions such as systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, or Sjögren’s syndrome. This is called secondary Raynaud’s phenomenon.
Causes of Raynaud’s phenomenon
Raynaud’s phenomenon is common, and as many as 10 million people in the UK are living with the condition. Around 1 in 10 women in Scotland have Raynaud’s phenomenon.
Raynaud’s occurs because the blood vessels supplying the area are very sensitive to changes in temperature and temporarily constrict (close down) too much in the cold. Constriction of blood vessels is a normal response to the cold by the nerves in the fingers and toes to conserve heat. However, in Raynaud’s this response is exaggerated.
Emotional changes can also trigger the response.
Primary Raynaud’s phenomenon is more common in young women and teenage girls. Often this can be seen to run in families.
Secondary Raynaud’s phenomenon can occur at any age and can precede the associated rheumatic condition by many years.
Less commonly, Raynaud’s can occur as a side effect of medications, these are often medications to treat heart diseases.
Symptoms of Raynaud’s phenomenon
- At first the fingers go white and cool. This happens because the small blood vessels in the fingers become narrow (constrict).
- The fingers then turn a bluish colour. This occurs because the oxygen is used up quickly from the blood in the narrowed blood vessels.
- When the person warms their hands they can turn reddish. This happens because blood vessels open up again (dilate) and the blood flow returns. This may cause tingling, throbbing, numbness and pain.
- In severe secondary Raynaud’s, ulcers can develop in the fingers and toes due to the blood vessels remaining constricted and cutting off the blood supply to small areas of the skin. This can happen if the fingers remain white for longer than 20 minutes.
How do we diagnose Raynaud’s?
A diagnosis can be made based on your symptoms. Typically, white, blue and red colour changes are observed in the fingers in response to cold exposure. The doctor may order other tests if they suspect it is secondary Raynaud’s. These tests include investigations to look for other autoimmune diseases such as SLE.
In some hospitals a microscope camera can be used to look at the nailbed, this is called capillaroscopy. These can tell if there are abnormal blood vessels suggesting a secondary cause. This is not currently carried out in Edinburgh. We do have a magnifying device known as a Dermalite that can help us to see dilated capillaries.
Things you can do to help:
- Keep warm – keep your ‘core’ warm. Wear thermal base layers, gloves, hat and warm socks. Wear silk inner lining gloves under your mittens. Use hand warmers or heated gloves e.g. Snowdeer battery heated gloves. Consider wearing “Ugg” boots or similar.
- Stop smoking – smoking can damage your circulation and make your Raynaud’s symptoms worse
- Regular exercise can help improve circulation.
- No special food or diet has been proven to help Raynaud’s, but it is important to eat a balanced diet.
Medications for Raynaud’s
These act to widen the blood vessels, so that blood flow can be increased to the fingers and/or toes. Medications have limited benefit and will not work unless you have got your clothing layering right for the conditions.
- Calcium channel blocking drugs such as Nifedipine or Amlodipine. These can have side effects such as dizziness, headaches and facial flushing.
- Angiotensin receptor blocker – Losartan.
- Selective serotonin receptor inhibitor – Fluoxetine (also used in higher doses for depression).
- Phosphodiesterase inhibitors such as Sildenafil (trade name Viagra) are also used although they require to be started by the hospital.
- If your Raynaud’s is severe and causing ulcers, you may benefit from an Iloprost infusion directly into a vein.
Symptoms are monitored on medications to ensure that things are improving. Should severe attacks occur with ulcers or black areas on the fingers or toes occur, these should be highlighted urgently to your doctor.
Versus Arthritis: http://www.versusarthritis.org
Scleroderma and Raynaud’s UK charity: https://www.sruk.co.uk/raynauds/