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Definition
Raynaud's phenomenon is a disorder of small blood vessels that respond excessively to stimuli which causes poor blood flow, usually in the fingers.
When this condition occurs by itself, it is called Raynaud's disease, or Primary Raynaud's phenomenon.
When it occurs along with other diseases, such as scleroderma, rheumatoid arthritis, systemic lupus erythematosus, polymyositis, dermatomyositis, Sjogren's syndrome, or mixed connective tissue disease, it is called Secondary Raynaud's phenomenon.
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Description
During an attack of Raynaud's, the arteries contract briefly, limiting blood flow. This is called vasospasm. Deprived of the blood's oxygen, the skin first turns white, then blue. The skin turns red as the arteries relax and blood flows again.
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Causes and Risk Factors
The cause is unknown, but some abnormality of the sympathetic nervous system seems to be present. The attacks are precipitated by cold or occasionally by emotional upsets. Smoking exacerbates the condition.
Raynaud's disease appears first between ages 15 and 45, almost always in women. It tends to be progressive, and unlike Raynaud's phenomenon, symmetric involvement of the fingers of both hands is typical. Spasm becomes more frequent and prolonged.
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Symptoms
There are intermittent attacks of pallor (white) or cyanosis (blue) in the fingers (and rarely the toes). In early attacks, only 1 or 2 fingertips may be affected. As it progresses, all the fingers may become involved. The thumbs are rarely affected.
During recovery there may be intense redness, throbbing, numbness, tingling, and slight swelling. Attacks usually terminate spontaneously or upon returning to a warm room or putting the hand in warm water. Between attacks there are no symptoms. The fingertips may develop ulcers that may heal during warm weather.
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Diagnosis
The diagnosis is clinically-based on the history and physical exam.
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Treatment
The goal of treatment is to prevent attacks and prevent tissue damage if an attack does occur. This is done mainly by protecting the skin from cold and by avoiding emotional stress.
People suffering from Raynaud's should protect themselves from cold and keep all parts of their body warm - not just the extremities. Outdoors in winter, they should wear scarves, warm socks and boots, and mittens or gloves under mittens because gloves alone allow heat to escape.
People with Raynaud's also should wear wristlets to close the space between the sleeve and mitten. Indoors, they should wear socks and comfortable shoes. When taking food out of the refrigerator or freezer, they should wear mittens, oven mitts, or use pot holders.
Patients with Raynaud's should guard against cuts, bruises, and other injuries to the affected areas. Activities such as sewing may have to be limited. Patients who smoke should quit. Moisturizing lotion should be applied to the hands daily.
Doctors also may adjust medications if the drugs appear to be responsible for the symptoms. In patients with secondary Raynaud's, doctors first treat the underlying cause. Vasodilators - drugs that help relax artery walls to improve blood flow - may be prescribed for patients with secondary Raynaud's or primary Raynaud's that resists other forms of therapy. Medications include nifedipine or a long-acting oral nitrate. Surgical measures including sympathectomy may be indicated when attacks become frequent and severe.
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Questions to Ask Your Doctor
Do any tests need to be done to help diagnose or to determine the cause?
What is the cause of the condition?
What treatment will you be recommending to prevent attacks?
If the cause is eliminated, will Raynaud's be eliminated?
What is the prognosis?
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