Raynaud's disease

2021-08-08 03:28 PM

In Raynaud's disease, the small arteries that supply blood to the skin narrow, restricting blood flow to the affected areas.

Define

Raynaud's disease is a problem that's caused by certain areas of the body - such as the fingers, toes, the tips of the nose, and ears - feeling numb and paresthetic in response to cold temperatures or stress. In Raynaud's disease, the small arteries that supply blood to the skin narrow, restricting blood flow to the affected areas.

Women are more likely to have Raynaud's disease. It is also more common in people living in colder climates.
 
Treatment of Raynaud's disease depends on its severity and the presence of related problems. For most people, Raynaud's disease is more of a nuisance than a disability.

Symptoms

Many people with Raynaud's disease simply have cold hands and feet, and it's not the same as frostbite. The signs and symptoms of Raynaud's disease depend on the duration, frequency, and severity of the vasospasm that underlies the disorder. Symptoms of Raynaud's disease include:

Cold fingers and toes.

Changes in skin color in response to stress or cold are sequenced.

Numbness, prickling, or soreness when warming up or relieving stress.
 
In acute Raynaud's, the first affected areas of skin usually turn white. Then, the affected areas often turn blue, feel cold, numb, and feel poorly. As circulation improves, the affected areas may turn red or swell. The order of color changes is not the same for everyone, and not everyone experiences all three colors.

Occasionally, only one or two fingers or toes are affected. Episodes don't always have the same effect. Although Raynaud's most commonly affects the fingers and toes, the problem can also affect other areas of the body, such as the nose, lips, ears, and even the nipples. About can last less than a minute to several hours.

People who have Raynaud's with another disease will likely still have signs and symptoms related to their underlying problem.

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

Causes

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

Cold temperature. When the body is exposed to cold temperatures, the extremities lose heat. The body's blood supply to the toes and fingers slows down to protect the body's internal temperature. The body specifically reduces blood flow by narrowing the small arteries under the skin in the extremities. In people with Raynaud's, this response is often excessive.

Stress. Stress triggers a cold-like response in the body, and the same bodily response can be overdone in people with Raynaud's.

Blood vessel constriction. With Raynaud's, the arteries of the fingers and toes are vasoconstrictive. Significantly narrows blood vessels and temporarily restricts blood supply. Over time, the small arteries can also thicken slightly, restricting blood flow even more. As a result, the affected skin turns pale and dark brown due to the lack of blood flow to the area. As the spasm recedes and blood returns to the area it supplied, the tissue may turn red before returning to its normal color.

Cold temperatures are more likely to trigger an attack. Exposure to cold can be as simple as putting your hand under cold running water, taking something out of the freezer, or exposing it to cold air. For some people, exposure to cold temperatures is unnecessary. Emotional stress can cause Raynaud's onset.

Raynaud's may be part of a genetic disorder.

Raynaud's occurs in two main types

Primary Raynaud's. This is Raynaud's with no underlying disease or related medical problem that could cause vasospasm. Also known as Raynaud's disease, it's the most common form of this disorder.

Secondary Raynaud's. Also known as Raynaud's phenomenon, is caused by an underlying problem. Although secondary Raynaud's is not as common as primary, it tends to be a more serious disorder. Signs and symptoms of secondary Raynaud's usually first appear at a later age - around 40 - older than the person with primary Raynaud's.

Secondary Raynaud's causes include

Scleroderma phenomenon. Raynaud's occurs in most people with scleroderma - a rare disease that leads to hardening and scarring of the skin. Scleroderma, a type of connective tissue disease, Raynaud's occurs because the disease reduces blood flow to the extremities.

Lupus. Raynaud's is also a common problem in people with lupus erythematosus - an autoimmune disease that can affect many parts of the body, including the joints, skin, organs, and blood vessels. An autoimmune disease in which the immune system attacks healthy tissue.

Rheumatoid arthritis. Raynaud's can be an early sign of rheumatoid arthritis - an inflammatory condition that causes pain and stiffness in joints, often including the hands and feet.

Sjogren's syndrome. Raynaud's phenomenon can also occur in people with Sjogren's syndrome - an autoimmune disorder that can be accompanied by scleroderma, lupus, or rheumatoid arthritis.

Diseases of the arteries. Raynaud's phenomenon may be associated with other diseases that affect the arteries, such as atherosclerosis, which is a gradual buildup of plaque in the blood vessels that feed the heart (coronary arteries), or with heart disease. Buerger, a disorder in which the blood vessels of the hands and feet become inflamed. Pulmonary hypertension, a type of hypertension that affects the arteries of the lungs, may be associated with Raynaud's.

Carpal tunnel syndrome. The carpal tunnel is a narrow passage at the wrist that protects the large nerve for the hand. Carpal tunnel syndrome is a condition in which pressure is placed on this nerve, numbness, and pain in the affected hand. The affected hand may become sensitive to cold temperatures and Raynaud's appear.

Repetitive trauma. Raynaud's can also be caused by repetitive nerve injury, damage to blood vessels in the hands and feet. Some people who play the piano hard or for a long time may be prone to Raynaud's. Workers operating vibrating tools can develop Raynaud's phenomenon known as white-handed vibration.

Smoke. Smoking constricts blood vessels and is a potential cause of Raynaud's.

Hurt. Previous trauma to the hand or foot, such as surgery for a broken bone or wrist, can lead to Raynaud's phenomenon.

Some drugs. Certain medicines - including beta-blockers, used to treat high blood pressure, migraine medicines that contain ergotamine, medicines that contain estrogen, certain chemotherapy agents, and medicines that narrow blood vessels, such as some cold medicines - have been linked to Raynaud's.

Chemistry. People exposed to vinyl chloride, such as those who work in the plastics industry, can develop a disease similar to scleroderma. Raynaud's could be part of that illness.

Other causes. Raynaud's has also been linked to thyroid disorders.

Risk factors

Risk factors for primary Raynaud's include

Sex. Primary Raynaud's affects more women than men.

Age. Although anyone can develop this problem, Raynaud's usually begins between the ages of 15 and 30.

Habitat. This disorder is also more common in people living in colder climates.

Family history. In addition, family history seems to increase the risk of Raynaud's. About one-third of people with primary Raynaud's have a parent, sibling, or child with the disorder.

Secondary Raynaud's risk factors include

Related disease. These include conditions like scleroderma and lupus.

Some professions. People in occupations that cause repetitive trauma, such as workers operating vibrating tools, may also be susceptible to Raynaud's.

Exposure to certain substances. Smoking, drugs that affect blood vessels, and exposure to chemicals such as vinyl chloride are associated with an increased risk of Raynaud's.

Complications

If Raynaud's is severe - rare - blood flow to the fingers or toes can often decrease, causing deformities of the fingers or toes.

If an artery to the affected area is completely blocked, sores (skin ulcers) or dead tissue (necrosis) may develop. Ulcers and gangrene can be difficult to treat.

Tests and diagnostics

To diagnose Raynaud's, your doctor will ask detailed questions about your symptoms and medical history and conduct a physical exam. Your doctor may also order tests to rule out other medical problems that can cause similar signs and symptoms, such as a pinched nerve.

Your doctor may perform a simple test called a cold stimulation test. This test may involve placing your hands in cold water or exposing them to cold air to trigger Raynaud's.

Raynaud's classification

To distinguish between primary or secondary Raynaud's, your doctor may perform a nail capillary test. During the test, the doctor examines the nail skin at the base of the nail under a microscope. Enlarged or deformed capillaries near the nail may indicate an underlying disease. However, some diseases may not be detected by this test.

If your doctor suspects a problem, such as an autoimmune or connective tissue disease, is the underlying cause of Raynaud's, he or she may order blood tests, such as:

Antinuclear antibody test. A positive test result for the presence of these antibodies - produced by the immune system - indicates an overactive immune system and is common in people with connective tissue disease or other autoimmune disorders.

erythrocyte sedimentation rate. Red blood cells that settle faster than normal may signal an autoimmune or inflammatory disease. Autoimmune diseases are often associated with secondary Raynaud's.

There is no single blood test to diagnose Raynaud's disease. Your doctor may order other tests, such as ruling out the disease of the arteries, to help identify a disease or problem that may be associated with Raynaud's.

Treatments and drugs

Self-care and prevention, these common-sense steps are effective in dealing with mild symptoms of Raynaud's. If these are not adequate, however, medications are available to treat many severe forms of the condition. The goals of treatment are:

Reduce number and severity.

Prevent tissue damage.

Treat any underlying disease or condition.

Medicine

Depending on the cause of the symptoms, medication may prove effective in treating Raynaud's. To widen blood vessels (dilate) and promote circulation, your doctor may prescribe:

Calcium channel blockers. These drugs and relax the small blood vessels in the hands and feet. Reduces the frequency and severity of Raynaud's in most people. These medications can also help heal skin sores on the fingers or toes. Examples include nifedipine (Adalat CC, Afeditab CR, Procardia), amlodipine (Norvasc), and felodipine (Plendil).

Alpha-blockers. Some people find relief with alpha-blockers, which counteract the action of norepinephrine, a hormone that causes blood vessel constriction. Examples are prazosin (Minipress) and doxazosin (Cardura).

Vasodilators. Some doctors prescribe vasodilators - a medicine that relaxes blood vessels - like nitroglycerin cream to help heal skin sores. Your doctor may also prescribe vasodilators to treat other conditions, but these can effectively reduce the symptoms of Raynaud's disease. These medications include the blood pressure medication losartan (COZAAR), the erectile dysfunction drug sildenafil (Viagra), the antidepressant fluoxetine (Prozac), and the drug prostaglandin.

It is possible to see a drug that works even better. Some medications used to treat Raynaud's have side effects that may require stopping them. A drug can also lose its effectiveness over time. Work with your doctor to find what's best.

Some medications can actually aggravate Raynaud's by leading to increased blood vessel constriction. Your doctor may recommend avoiding:

Prescription (OTC) cold medicine. Examples include medications that contain pseudoephedrine (Actifed, Chlor-Trimeton, Sudafed).

Beta-blockers. This class of drugs, used to treat high blood pressure and cardiovascular disease, includes metoprolol (Lopressor, Toprol), nadolol (Corgard), and propranolol (Inderal, Innopran XL).

Birth control pills. If you're using oral contraceptives, you can switch to another method of birth control because these drugs affect blood flow and can make you more susceptible to Raynaud's. Talk to your doctor before stopping your medication.

If you have questions about the best way to manage Raynaud's, contact your doctor. Your provider may refer you to a doctor who specializes in treating Raynaud's.

Treatments

Sometimes in severe cases of Raynaud's, an approach other than medication may be a treatment option:

Neurosurgery. Nerves called sympathetic nerves in the limbs control the opening and narrowing of blood vessels in the skin. It is necessary in severe Raynaud's cases to cut the nerves causing the overreaction. Surgery can reduce the frequency and duration of Raynaud's, but it is not always successful.

Chemical injection. Your doctor may inject chemicals to block the sympathetic nerves in the affected hand or leg. Repeated procedures may be necessary if symptoms return or persist.

Amputation. Sometimes, doctors need to remove tissue damaged by lack of blood supply. This may include amputation of a finger or toe affected by Raynaud's, in which the blood supply has been completely blocked and the tissues have necrotic. But this is very rare.

Lifestyle and remedies

A series of steps can reduce Raynaud's episodes and help you feel better overall:

No smoking. Smoking causes vasoconstriction of blood vessels, which lowers skin temperature, which can lead to an episode. Inhaling secondhand smoke can also aggravate Raynaud's.

Do exercise. Your doctor may recommend regular exercise, especially if you have primary Raynaud's. Exercise can increase blood circulation, benefits Raynaud's among other health benefits.

Stress management. Because stress can trigger flare-ups, learning to recognize and avoid stressful situations can help control the number of episodes.

Avoid caffeine. Caffeine narrows blood vessels and may increase the signs and symptoms of Raynaud's disease.

Take care of your hands and feet. If Raynaud is present, protect hands and feet from injury. Don't go barefoot. Take care of your nails to avoid injuring your toes and fingers. Also, avoid wearing anything that compresses the blood vessels in the hands or feet, such as tight wristbands, rings, or shoes.

Avoid places to do certain things. Avoiding handshake tools can reduce the frequency of attacks.

When the Raynaud's appeared. The first and foremost action is to warm the hands or feet or any other affected skin areas. The following steps can help gently warm fingers and toes:

Move to a warmer area.

Place your hands under your armpits.

Warm fingers and toes.

Rotate arms.

The water is warm but not hot - on the fingers and toes.

Hand and foot massage.

If a stressful situation triggers a Raynaud's episode, you can help prevent attacks by stepping out of the stress and relaxing. If you're training biofeedback, this technique can be used along with warming your hands or feet in water to help lessen attacks.

Alternative medicine

Lifestyle changes and supplements that encourage better circulation can be effective alternatives to Raynaud's management. If concerned, talk to your doctor about:

Biofeedback. Using the mind to control body temperature - can help reduce the severity and frequency of Raynaud's attacks. Biofeedback includes guided imagery to increase the temperature of the hands and feet, deep breathing, and other relaxation exercises. Your doctor can recommend a therapy that can help you learn biofeedback techniques. Books and tapes are also available.

Niacin. Niacin, also known as vitamin B-3, dilates blood vessels, increasing blood flow to the skin. Supplemental niacin may be helpful in treating Raynaud's, although supplemental niacin may have side effects.

Dealing with Raynaud's stressors and annoyances can take patience and effort. Work with your doctor to manage this condition and maintain a positive attitude. Most people with Raynaud's response to treatment.

Prevention

Raynaud's is a problem that may need to be managed as it develops. There are ways to help prevent Raynaud's attack:

Dress warmly outdoors. In winter, wear a hat, scarf, socks and boots, gloves or mittens when going outside. Use them before going out. Hats are important because a large amount of body heat is lost through the head. Use a glove that prevents cold air from reaching the hands. Wear ear coverings and a mask if the tip of your nose and earlobes are very sensitive to cold. Warm up the car a few minutes before driving in cold weather.

Take precautions in the house. When handling food in the refrigerator or freezer, wear gloves. Some people find wearing gloves and sleeping socks in the winter helpful. Because air conditioning can cause Raynaud's attacks, setting the air conditioner to a warmer temperature can help prevent Raynaud's attacks.

Consider moving to a location with a milder climate. Moving to a warmer climate can help people with severe Raynaud's. However, Raynaud's can occur even in warmer climates with a drop in temperature.