Raynaud's Disease

Raynaud’s disease causes some areas of your body especially your toes and fingers will feel cold and numb in response to stress or cold temperature.

This disease will limit your blood circulation to affected areas (vasospasm) because of the smaller arteries that supply blood to your skin narrow.

This is most common in women and to people who live in colder climates.

The treatment of this condition will be based upon the severity or if you have other health conditions.

This can affect the quality of life.

The signs and symptoms of Raynaud’s disease include:

• cold toes and fingers,
• numb, prickly feeling or stinging pain upon warming or stress relief,
• color changes in your skin in response to stress or cold.

Your skin will turn white first then it will turn blue and you will feel numb and cold. The affected areas will

• throb,
• turn red,
• swell
• or tingle as you get warm and the circulation improves.

It may take up to 15 minutes for normal blood flow to return to the area.

This condition can also affect other parts of your body such as:

• lips,
• nose,
• nipples
• and ears.

The cause of Raynaud’s disease is still unclear but blood vessels in the feet and hands tend to overreact to stress and cold temperature.

Your blood vessels will narrow and will temporarily limit the supply of blood and these arteries may even thicken that will further limit the blood flow.

If you put your feet and hands in cold water or taking something out of the freezer will trigger an attack but for some people emotional stress can also trigger an attack.

The two main types of Raynaud’s disease are:

Primary Raynaud’s

Also known as Raynaud’s disease is the result of an underlying medical condition which can lead to vasospasm;

Secondary Raynaud’s

Also known as Raynaud’s phenomenon that can appear around age 40 and is the result of serious underlying condition.

The causes of secondary Raynaud’s disease include:

• diseases of the arteries – if you have a disorder in which the blood vessels of the hands and feet will become inflamed (Buerger’s disease) or a buildup of plaques in blood vessels that feed the heart (atherosclerosis) or even primary pulmonary hypertension which is a type of high blood pressure that affects the arteries of the lungs;

• connective tissue diseases – diseases such as scleroderma which is the hardening and scarring of the skin, rheumatoid arthritis, Sjogren’s syndrome and lupus;

• repetitive action or vibration – if you are playing piano, typing, operating vibrating tools and doing similar movements for long periods will increase your chance to have Raynaud’s disease;  carpal tunnel syndrome – if you have median nerve that produces numbness and pain in the affected hand which may trigger attacks of Raynaud’s disease;

• injuries – injuries to the feet and hands such as frostbite or surgery or wrist fracture;

• smoking – because it constricts blood vessels;

• certain medications – such as migraine medications that have ergotamine or sumatriptan, beta blockers, chemotherapy agents, ADHD medications and drugs that cause blood vessels to narrow.

There is no single test for Raynaud’s disease diagnosis.

Consult your doctor if you have the symptoms of Raynaud’s disease. He may refer you to a rheumatologist who specializes in bones, joints and muscle disorders.

Make a list of all the symptoms that you are having and the medications, supplements and vitamins that you are taking. You can also write the other medical conditions that you had.

Some of the questions that you can ask your doctor include:

• What is causing my symptoms?
• Is this primary or secondary?
• Am I at risk of complications?
• How can I reduce the risk of the attacks?
• What treatments are available?

Your doctor will also ask questions such as:

• When did you notice the symptoms?
• What seems to be the trigger factor?
• Has anyone else in your family been diagnosed with Raynaud’s disease?
• Do you smoke?
• Do you use caffeine?
• What do you do for a living or for recreation?

Your doctor will first conduct a physical exam and may recommend tests to rule out other medical problems with similar signs and symptoms.

Your doctor may perform an in office test called capillaroscopy to distinguish primary and secondary Raynaud’s.

Your doctor will examine you nail fold under a microscope then tiny blood vessels (capillaries) near the nail fold that are enlarged or deformed may indicate an underlying disease. Your doctor may order blood tests if he suspects other medical conditions such as:

• antinuclear antibodies test – this may indicate a stimulated immune system and is common in people who have connective tissue diseases or other autoimmune disorders and this is done by testing the presence of antibodies that is produced by your immune system;

• erythrocyte sedimentation rate – to check the rate at which red blood cells settle at the bottom of a tube.

The treatments for Raynaud’s disease have goals that are to:

• reduce the number and severity of attacks,
• prevent tissue damage,
• treat the underlying condition or cause.

For medication

Calcium channel blockers such as nifedipine (Afeditab CR, Procardia), amlodipine (Norvasc) and felodipine (Plendil) that helps heal skin ulcer and can decrease the severity and frequency of attacks;

Alpha blockers

Such as prazosin (Minipress) and doxazosin (Cardura) that counteract the actions of a hormone that constricts blood vessels;

Vasodilators

Such as nitroglycerin by applying it to the base of your fingers, and this can help the blood vessels to relax and to heal skin ulcers.

The commonly vasodilators that treat other conditions are:

• losartan for high blood pressure,
• sildenadil for erectile dysfunction,
• antidepressant medication fluoxetine and prostaglandins can also relieve the symptoms of Raynaud’s.

Consult your doctor because some of these medications can lead to increase blood vessel spasm;

• OTC cold drugs – such as pseudoephedrine (Sudafed, Chlor-Trimeton);
• beta blockers – such as metoprolol,
• nadolol and propranolol that used to treat heart disease and high blood pressure.

For surgeries and medical procedures:

• nerve surgery – this procedure is called sympathectomy and the nerves in your hands are called sympathetic nerves that control the opening and narrowing of blood vessels will be cut to interrupt their exaggerated response. It may also reduce the duration and frequency of attacks;

• chemical injection – such as onabotulinumtoxin type A will be injected to block the sympathetic nerves in your affected feet or hands.

To prevent Raynaud’s disease:

• warm your car by running the heater for a few minutes before driving in cold weather;

• bundle up outdoors by using scarf, socks, boots or hat when it is cold, you can also wear gloves or mittens to prevent cold from reaching your hands; consider relocating by moving to a warmer climate;

• take precautions indoors by wearing mittens of gloves or socks especially in winter time, you can also use drinking glasses and set your temperature to warm.

There are few alternative remedies and lifestyle changes that may help in managing Raynaud’s disease such as:

• ginkgo to decrease the attacks;
• fish oil to improve your tolerance in cold;
• biofeedback to decrease the frequency and severity of attacks;
• acupuncture to improve the blood flow.

Consult your doctor first before taking any of these supplements so your doctor can warn you if there are side effects with these supplements.

Work with your doctor to maintain a positive attitude and to manage your symptoms.

To help you feel better follow some of these lifestyle tips:

• do not smoke because your skin temperature will drop and may cause attacks,
• exercise regularly to increase circulation,
• control stress by avoiding and learning to recognize stressful situations,
• avoiding rapidly changing temperatures.

During an attack warm your hands, feet or other affected areas. To warm your toes and fingers:

• wiggle your fingers and toes,
• get indoors,
• make wide circles with your arms,
• place hands under armpits,
• massage your feet and hands,
• run warm water over your toes and fingers.

You can also practice a stress-reduction technique.

The risk factors for primary Raynaud’s are:

• sex – most common in women,
• age – it often begins between the ages 15 and 30,
• climate – if you live in a colder climate,
• family history – about one third of people have a first degree relative with the disorder.

Risk factors for secondary Raynaud’s include:

• associated diseases – conditions such as lupus and scleroderma,
• certain occupations – that can cause repetitive trauma,
• exposure to certain substances – such as smoking and medications that can affect the blood vessels or exposure to chemicals such as vinyl chloride.

Your toes and fingers could permanently diminish leading to deformities of fingers and toes if the Raynaud’s is severe.

Skin ulcers and gangrene may also develop if the artery is completely blocked, this are hard to treat.

Your doctor may even recommend amputation to remove the affected part of the body.