Raynauds Syndrome

Raynaud’s Syndrome is a disorder affecting the small blood vessels of the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks of the blood vessels in the digits (fingers and toes) to narrow. Raynaud’s Syndrome can occur on its own, or it can be secondary to another condition such as scleroderma or lupus.

Raynaud’s Syndrome may affect 5 to 10 percent of the general population in the United States. It affects women more than men and is more common in people living in colder climates.

Symptoms

Attack is usually triggered by exposure to cold or emotional stress. In general, attacks affect the fingers or toes but may affect the nose, lips, or ear lobes.

 

Classic Raynauds Syndrome involves a three phases of skin color changes (white, blue, and red) in the fingers or toes. The order of the changes of color is not the same for all people, and not everyone has all three colors. Pallor (whiteness) may occur in response to spasm of the blood vessels and the resulting collapse of the digital arteries. Cyanosis (blueness) may appear because the fingers or toes are not getting enough oxygen-rich blood. The fingers or toes may also feel cold and numb. Finally, as the blood vessels dilate (relax) and blood returns to the digits, rubor (redness) may occur. As the attack ends, throbbing and tingling may occur in the fingers and toes. An attack can last from less than a minute to several hours.

 

Raynaud’s Syndrome Classification

Primary Raynaud’s Syndrome

Most people who have Raynaud’s Syndrome have the primary form (the milder version). A person who has primary Raynaud’s Syndrome has no underlying disease or associated medical problems. More women than men are affected, and approximately 75 percent of all cases are diagnosed in women who are between 15 and 40 years old.

People who have only vasospastic attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease (that is, a connective tissue disorder such as scleroderma) later.

 

Secondary Raynaud’s Syndrome

Although secondary Raynaud’s Syndrome is less common than the primary form, it is often a more complex and serious disorder. Connective tissue diseases are the most common cause of secondary Raynaud’s Syndrome. Raynaud’s Syndrome is seen in approximately 85 to 95 percent of patients with scleroderma and mixed connective tissue disease, and it is present in about one-third of patients with systemic lupus erythematosus.

Some drugs, including beta-blockers (used to treat high blood pressure), ergotamine preparations (used for migraine headaches), certain agents used in cancer chemotherapy, and drugs that cause vasoconstriction (such as some over-the-counter cold medications and narcotics), are linked to Raynaud’s Syndrome.

Individuals in certains occupations including those using vibrating tools and exposure to vinyl chloride have a higher risk for Raynaud’s syndrome.

People in certain occupations may be more vulnerable to secondary Raynaud’s Syndrome.

Diagnosis

Diagnosis begins with a thorough medical history and physical examination. Most doctors find it fairly easy to diagnose Raynaud’s phenomenon but more difficult to identify the form of the disorder.

Nailfold capillaroscopy (study of capillaries under a microscope) can help the doctor distinguish between primary and secondary Raynaud’s phenomenon.

The doctor may order laboratory blood testing, an antinuclear antibody test (ANA) and an erythrocyte sedimentation rate (ESR). The ANA test determines whether the body is producing special proteins (antibodies) often found in people who have connective tissue diseases or other autoimmune disorders. The ESR test is a measure of inflammation in the body.

Diagnostic Criteria for Raynaud’s Phenomenon

Primary Raynaud’s Phenomenon

  • Periodic vasospastic attacks of pallor or cyanosis (some doctors include the additional criterion of the presence of these attacks for at least 2 years)
  • Normal nailfold capillary pattern
  • Negative antinuclear antibody test
  • Normal erythrocyte sedimentation rate
  • Absence of pitting scars or ulcers of the skin, or gangrene (tissue death) in the fingers or toes

Secondary Raynaud’s Phenomenon

  • Periodic vasospastic attacks of pallor and cyanosis
  • Abnormal nailfold capillary pattern
  • Positive antinuclear antibody test
  • Abnormal erythrocyte sedimentation rate
  • Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes

Treatment

The aims of treatment are to reduce the number and severity of attacks and to prevent tissue damage in the fingers and toes. Both non-medication and medication measures are often utilized. In addition, patients are treated for any underlying disease or condition that causes secondary Raynaud’s phenomenon.

Non-drug Treatments and Self-Help Measures

  • Avoid precipitating factors – Avoid cold weather or stressful situations which may trigger an attack.
  • Keep the extremities warm – Where appropriate clothing to avoid chilling any part of the body. In cold weather several layers of loose clothing, socks, hats, and gloves or mittens are recommended. Feet should be kept dry and warm. Chemical warmers, such as small heating pouches that can be placed in pockets, mittens, boots, or shoes, can give added protection during long periods outdoors. Turning down the air conditioning or wearing a sweater may help prevent attacks.
  • Control stress – Learning to recognize and avoid stressful situations may help control the number of attacks. Many people have found that relaxation or biofeedback training can help decrease the number and severity of attacks.
  • Avoid tobacco smoking – nicotine in cigarettes causes the skin temperature to drop, which may lead to an attack.
  • Exercise – Many doctors encourage patients with Raynaud’s phenomenon to exercise regularly. Exercise promotes overall well-being, increases energy level, helps control weight, and promotes restful sleep.

Medication-based Treatments

Medications used for Raynaud’s Syndrome are aimed to reduce the frequency and severity of attacks.

The most commonly used class of medications are calcium-channel blockers which act to relax and dilate the small blood vessels. With more severe symptoms or the development of ulcers or gangrene, other more aggressive medications may be indicated. Discuss these options with your treating rheumatologist.