Raynaud's Phenomenon

What is Raynaud's phenomenon?

Raynaud's phenomenon or, simply, Raynaud's, is a disorder characterized by decreased blood flow - usually to the fingers, and less frequently to the ears, toes, nipples, knees, or nose. Vascular spasms usually occur as attacks in response to cold exposure, stress, or emotional upset.

Raynaud's can occur alone (primary form) or may occur with other diseases (secondary form). The diseases most frequently associated with Raynaud's are autoimmune or connective tissue diseases, among others, such as the following:

• systemic lupus erythematous (lupus)
• scleroderma
• CREST syndrome (calcium skin deposits, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasis)
• Buerger's disease
• Sjögren's syndrome
• rheumatoid arthritis
• occlusive vascular disease
• polymyositis
• cryoglobulinemia

What causes Raynaud's phenomenon?

The exact cause of Raynaud's is unknown. One theory links blood disorders characterized by increased platelets or red blood cells that may increase the blood thickness. Another theory involves the special receptors in the blood that control the constriction of the blood vessels being more sensitive in individuals with Raynaud's.

What are the risk factors for Raynaud's phenomenon?

There are certain diseases or lifestyle choices that can increase a person's risk for developing Raynaud's. These risk factors include the following:

• existing connective tissue or autoimmune disease
• cigarette smoking (in men)
• alcohol use (in women)

What are the symptoms of Raynaud's phenomenon?

The following are the most common symptoms of Raynaud's phenomenon. However, each individual may experience symptoms differently. Symptoms may include:

• a pattern of color changes in the fingers as follows: pale/white followed by blue then red when the hands are warmed; color changes are usually preceded by exposure to cold or emotional upset
• hands may become swollen and painful when warmed
• ulcerations of the finger pads develop (in severe cases)
• gangrene may develop in the fingers leading to amputation (in about 10 percent of the severe cases)

How is Raynaud's phenomenon diagnosed?

There are no specific laboratory tests that can confirm a diagnosis of Raynaud's phenomenon. Instead, diagnosis is usually based on reported symptoms. Your physician may perform a cold challenge test to bring out color changes in the hands.

Tests to determine which form-primary or secondary-of Raynaud's phenomenon a patient may have include a medical exam, blood tests, a complete medical history, and examination of fingernail tissue with a microscope.

Treatment for Raynaud's phenomenon:

Specific treatment for Raynaud's phenomenon will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your signs and symptoms
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the disease
• your opinion or preference

Although there is no cure for Raynaud's phenomenon, the disorder can often be successfully managed with proper treatment. Treatment may include:

• preventative measures such as wearing gloves or avoiding cold exposure
• smoking cessation
• wearing finger guards over ulcerated fingers
• avoiding trauma or vibration to the hand (such as vibrating tools)
• medications that are usually used to treat high blood pressure (antihypertensive medications) may be given during the winter months (to help reduce constriction of the blood vessels)

Individuals who first experience Raynaud's phenomenon after 35 to 40 years of age may be tested for an underlying disease. The primary form of Raynaud's is the most common type, and usually begins between 15 and 25 years of age. It is less severe, and few people with this form develop another related condition.