Raynaud's disease

Raynaud's (ray-NOSE) disease causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud's disease, smaller arteries that supply blood to your skin become narrow, limiting blood flow to affected areas (vasospasm).

Women are more likely than men to have Raynaud's disease, also known as Raynaud's or Raynaud's phenomenon or syndrome. It appears to be more common in people who live in colder climates.

Treatment of Raynaud's disease depends on its severity and whether you have other health conditions. For most people, Raynaud's disease isn't disabling, but it can affect your quality of life.

Symptoms

Signs and symptoms of Raynaud's disease include:

• Cold fingers or toes
• Color changes in your skin in response to cold or stress
• Numb, prickly feeling or stinging pain upon warming or stress relief

During an attack of Raynaud's, affected areas of your skin usually first turn white. Then, they often turn blue and feel cold and numb. As you warm and your circulation improves, the affected areas may turn red, throb, tingle or swell.

Although Raynaud's most commonly affects your fingers and toes, it can also affect other areas of your body, such as your nose, lips, ears and even nipples. After you warm up, the return of normal blood flow to the area can take 15 minutes.

When to see a doctor

See your doctor right away if you have a history of severe Raynaud's and develop a sore or infection in one of your affected fingers or toes.

Causes

Doctors don't completely understand the cause of Raynaud's attacks, but blood vessels in the hands and feet appear to overreact to cold temperatures or stress.

Blood vessels in spasm

With Raynaud's, arteries to your fingers and toes become narrow and briefly limit blood supply when exposed to cold or stress. Over time, these small arteries can thicken slightly, further limiting blood flow.

Cold temperatures are most likely to trigger an attack. Exposure to cold, such as putting your hands in cold water, taking something from a freezer or being in cold air, is the most likely trigger. For some people, emotional stress can trigger an episode.

Primary vs. secondary Raynaud's

There are two main types of the condition.

• Primary Raynaud's. Also called Raynaud's disease, this most common form isn't the result of an associated medical condition. It can be so mild that many people with primary Raynaud's don't seek treatment. And it can resolve on its own.

• Secondary Raynaud's. Also called Raynaud's phenomenon, this form is caused by an underlying problem. Although secondary Raynaud's is less common than the primary form, it tends to be more serious.

  Signs and symptoms of secondary Raynaud's usually appear around age 40, later than they do for primary Raynaud's.

Causes of secondary Raynaud's include:

• Connective tissue diseases. Most people who have a rare disease that leads to hardening and scarring of the skin (scleroderma) have Raynaud's. Other diseases that increase the risk of Raynaud's include lupus, rheumatoid arthritis and Sjogren's syndrome.
• Diseases of the arteries. These include a buildup of plaques in blood vessels that feed the heart, a disorder in which the blood vessels of the hands and feet become inflamed, and a type of high blood pressure that affects the arteries of the lungs.
• Carpal tunnel syndrome. This condition involves pressure on a major nerve to your hand, producing numbness and pain in the hand that can make the hand more susceptible to cold temperatures.
• Repetitive action or vibration. Typing, playing piano or doing similar movements for long periods and operating vibrating tools, such as jackhammers, can lead to overuse injuries.
• Smoking. Smoking constricts blood vessels.
• Injuries to the hands or feet. Examples include a wrist fracture, surgery or frostbite.
• Certain medications. These include beta blockers for high blood pressure, migraine medications that contain ergotamine and sumatriptan, attention-deficit/hyperactivity disorder medications, certain chemotherapy agents, and drugs that cause blood vessels to narrow, such as some over-the-counter cold medications.

Risk factors

Risk factors for primary Raynaud's include:

• Sex. More women than men are affected.
• Age. Although anyone can develop the condition, primary Raynaud's often begins between the ages of 15 and 30.
• Climate. The disorder is also more common in people who live in colder climates.
• Family history. A first-degree relative — a parent, sibling or child — having the disease appears to increase your risk of primary Raynaud's.

Risk factors for secondary Raynaud's include:

• Associated diseases. These include conditions such as scleroderma and lupus.
• Certain occupations. These include jobs that cause repetitive trauma, such as operating tools that vibrate.
• Exposure to certain substances. This includes smoking, taking medications that affect the blood vessels and being exposed to certain chemicals, such as vinyl chloride.

Complications

If secondary Raynaud's is severe — which is rare — reduced blood flow to your fingers or toes could cause tissue damage.

A completely blocked artery can lead to sores (skin ulcers) or dead tissue, both of which can be difficult to treat. Rarely, extreme untreated cases might require removing the affected part of your body.

Prevention

To help prevent Raynaud's attacks:

• Bundle up outdoors. When it's cold, don a hat, scarf, socks and boots, and two layers of mittens or gloves before you go outside. Wear a coat with snug cuffs to go around your mittens or gloves, to prevent cold air from reaching your hands.

  Also use chemical hand warmers. Wear earmuffs and a face mask if the tip of your nose and your earlobes are sensitive to cold.

• Warm your car. Run your car heater for a few minutes before driving in cold weather.

• Take precautions indoors. Wear socks. When taking food out of the refrigerator or freezer, wear gloves, mittens or oven mitts. Some people find it helpful to wear mittens and socks to bed during winter.

  Because air conditioning can trigger attacks, set your air conditioner to a warmer temperature. Use insulated drinking glasses.

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical examination. Your doctor might also order tests to rule out other medical problems that can cause similar signs and symptoms.

Sorting out primary vs. secondary Raynaud's

To tell the difference between primary and secondary Raynaud's, your doctor might do a test called nailfold capillaroscopy. During the test, the doctor looks at the skin at the base of your fingernail under a microscope or magnifier to look for deformities or swelling of the tiny blood vessels.

If your doctor thinks that another condition, such as an autoimmune disorder or a connective tissue disease, may be causing Raynaud's, he or she will likely order blood tests, such as:

• Antinuclear antibodies test. Testing positive for these antibodies might be a sign of a stimulated immune system, common in people who have connective tissue diseases or other autoimmune disorders.
• Erythrocyte sedimentation rate. This test determines the rate at which red blood cells settle to the bottom of a tube. A faster than normal rate might signal an underlying inflammatory or autoimmune disease.

No one blood test can diagnose Raynaud's. Your doctor might order other tests, such as those that rule out diseases of the arteries, to help pinpoint a condition that can be associated with Raynaud's.

Treatment

Dressing for the cold in layers and wearing gloves or heavy socks usually are effective in dealing with mild symptoms of Raynaud's. Medications are available to treat more-severe forms of the condition. The goals of treatment are to:

• Reduce the number and severity of attacks
• Prevent tissue damage
• Treat the underlying disease or condition

Medications

Depending on the cause of your symptoms, medications might help. To widen blood vessels and increase blood flow, your doctor might prescribe:

• Calcium channel blockers. These drugs relax and open small blood vessels in your hands and feet, reducing the severity and number of attacks in most people with Raynaud's. These drugs can also help heal skin ulcers on your fingers or toes. Examples include nifedipine (Adalat CC, Procardia), amlodipine (Norvasc), felodipine and isradipine.
• Vasodilators. These drugs, which relax blood vessels, include nitroglycerin cream (Nitro-Dur) applied to the base of your fingers to help heal skin ulcers. Other vasodilators include the high blood pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra, Revatio), the antidepressant fluoxetine (Prozac, Sarafem) and a class of medications called prostaglandins.

Surgeries and medical procedures

If you have severe Raynaud's, your doctor may recommend surgery or injections.

• Nerve surgery. Sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Cutting these nerves interrupts their exaggerated responses.

  Through small incisions in the affected hands or feet, a doctor strips these tiny nerves around the blood vessels. This surgery, if successful, might lead to fewer and shorter attacks.

• Chemical injection. Doctors can inject chemicals such as local anesthetics or onabotulinumtoxinA (Botox) to block sympathetic nerves in affected hands or feet. You might need to have the procedure repeated if symptoms return or persist.

Lifestyle and home remedies

A variety of steps can decrease Raynaud's attacks and help you feel better.

• Avoid smoke. Smoking or inhaling secondhand smoke causes skin temperature to drop by tightening blood vessels, which can lead to an attack.
• Exercise. Exercise can increase circulation, among other health benefits. If you have secondary Raynaud's, talk to your doctor before exercising outdoors in the cold.
• Control stress. Learning to recognize and avoid stressful situations might help control the number of attacks.
• Avoid rapidly changing temperatures. Try not to move from a hot environment to an air-conditioned room. If possible, avoid frozen-food sections of grocery stores.

What to do during an attack

Warm your hands, feet or other affected areas. To gently warm your fingers and toes:

• Get indoors or to a warmer area
• Wiggle your fingers and toes
• Place hands under armpits
• Make wide circles (windmills) with your arms
• Run warm — not hot — water over your fingers and toes
• Massage your hands and feet

If stress triggers an attack, get out of the stressful situation and relax. Practice a stress-relieving technique that works for you, and warm your hands or feet in water to help lessen the attack.

Alternative medicine

Lifestyle changes and supplements that encourage better blood flow might help you manage Raynaud's. However, it's unclear how well these measures may work for Raynaud's. More study is needed. If you're interested, talk to your doctor about:

• Fish oil. Taking fish oil supplements could help improve your tolerance to cold.
• Ginkgo. Ginkgo supplements could help decrease the number of Raynaud's attacks.
• Acupuncture. This practice appears to improve blood flow, so it may be helpful in relieving Raynaud's attacks.

• Biofeedback. Using your mind to control body temperature might help decrease the severity and number of attacks you experience. Biofeedback includes guided imagery to increase the temperature of hands and feet, deep breathing, and other relaxation exercises.

  Your doctor may be able to suggest a therapist who can help you learn biofeedback techniques. There are books and videos on the subject.

Talk to your doctor before taking supplements. Your doctor can warn you if there are potential drug interactions or side effects of alternative treatments.

Preparing for an appointment

Your primary doctor will likely be able to diagnose Raynaud's based on your signs and symptoms. In some cases, however, you may be referred to a doctor who specializes in disorders of the joints, bones and muscles (rheumatologist).

Here's information to help you get ready for your appointment.

Make a list of:

• Your symptoms, when they began and what seems to trigger them
• Other medical conditions you and your family have, particularly connective tissue or autoimmune disorders
• All medications, vitamins and other supplements you take, including doses
• Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you receive.

Questions to ask your doctor include:

• What is likely causing my signs and symptoms?
• If I have Raynaud's, is it primary or secondary?
• What treatment do you recommend, if any?
• How can I reduce the risk of a Raynaud's attack?
• I have other health conditions. How can I manage them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• During a Raynaud's attack, do your fingers or toes change color or feel numb or painful?
• Has anyone else in your family been diagnosed with Raynaud's?
• Do you smoke?
• How much caffeine, if any, do you consume daily?
• What do you do for a living and for recreation?

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