Raynaud's phenomenon
Encyclopedia
In medicine
, Raynaud's phenomenon (icon) is a vasospastic
disorder causing discoloration of the fingers, toes, and occasionally other areas. This condition can also cause nails to become brittle with longitudinal ridges. Named for French physician Maurice Raynaud
(1814–1881), the phenomenon is believed to be the result of vasospasms that decrease blood supply to the respective regions. Emotional stress and cold are classic triggers of the phenomenon.
It comprises both Raynaud's disease (also known as "Primary Raynaud's phenomenon") where the phenomenon is idiopathic
, and Raynaud's syndrome (secondary Raynaud's), where it is caused by some other instigating factor. Measurement of hand-temperature gradients is one tool used to distinguish between the primary and secondary forms.
It is possible for the primary form to progress to the secondary form.
In extreme cases, the secondary form can progress to necrosis
or gangrene
of the fingertips.
Raynaud's phenomenon is an exaggeration of vasomotor
responses to cold or emotional stress. More specifically, it is a hyperactivation of the sympathetic system causing extreme vasoconstriction
of the peripheral blood vessels, leading to tissue hypoxia
. Chronic, recurrent cases of Raynaud phenomenon can result in atrophy of the skin, subcutaneous tissue
s, and muscle. In rare cases it can cause ulceration and ischemic gangrene.
The symptoms include several cyclic color changes:
All three colour changes are observed in classic Raynaud's. However, not all patients see all of the aforementioned colour changes in all episodes, especially in milder cases of the condition. Symptoms are thought to be due to reactive hyperemias of the areas deprived of blood flow.
In pregnancy
, this sign normally disappears due to increased surface blood flow.
Raynaud's has also occurred in breastfeeding mothers, causing nipples to turn white and become extremely painful. Nifedipine
, a calcium channel blocker
and vasodilator was recommended to increase blood flow to the extremities and noticeably relieved pain to the breast, in an extremely small study group.
finding that 5% of men and 8% of women suffer from Raynaud Phenomenon.
Raynaud phenomenon results from an exaggerated vasoconstriction of digital arteries and arterioles. These vascular changes induce paroxysmal pallor or cyanosis of the digits of the hands or feet; infrequently, the nose, earlobes, or lips can also be involved. Characteristically, the involved digits show red, white, and blue color changes from most proximal to most distal, correlating with proximal vasodilation, central vasoconstriction, and more distal cyanosis. Raynaud phenomenon may be a primary disease entity or be secondary to a variety of conditions.[82]
Primary Raynaud phenomenon (previously called Raynaud disease) reflects an exaggeration of central and local vasomotor responses to cold or emotional stresses. It affects 3% to 5% of the general population and shows a predilection for young women. Structural changes in the arterial walls are absent except late in the course, when intimal thickening can appear. The course of Raynaud phenomenon is usually benign, but when long-standing can result in atrophy of the skin, subcutaneous tissues, and muscles. Ulceration and ischemic gangrene are rare.[83]
In contrast, secondary Raynaud phenomenon refers to vascular insufficiency of the extremities secondary to arterial disease caused by other entities including SLE, Scleroderma
, Buerger disease, or even Atherosclerosis
. Since Raynaud phenomenon may be the first manifestation of such conditions, any patient with new symptoms should be evaluated. Of these individuals, some 10% will eventually manifest an underlying disease.
or vasculitis
, and may conduct a number of laboratory tests.
, although specific genes have not yet been identified.
Smoking
worsens frequency and intensity of attacks, and there is a hormonal component. Caffeine
also worsens the attacks. Sufferers are more likely to have migraine
and angina than controls.
Secondary Raynaud's has a number of associations:
It is important to realize that Raynaud's can herald these diseases by periods of more than 20 years in some cases, making it effectively their first presenting symptom. This can be the case in the CREST syndrome
, of which Raynaud's is a part.
Patients with Secondary Raynaud's can also have symptoms related to their underlying diseases. Raynaud's phenomenon is the initial symptom that presents for 70% of patients with scleroderma
, a skin and joint disease.
When Raynaud's phenomenon is limited to one hand or one foot, it is referred to as Unilateral Raynaud's. This is an uncommon form, and it is always secondary to local or regional vascular disease. It commonly progresses within several years to affect other limbs as the vascular disease progresses.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, Raynaud's phenomenon (icon) is a vasospastic
Vasospasm
Vasospasm refers to a condition in which blood vessels spasm, leading to vasoconstriction. This can lead to tissue ischemia and death . Cerebral vasospasm may arise in the context of subarachnoid hemorrhage. Symptomatic vasospasm or delayed cerebral ischemia is a major contributor to...
disorder causing discoloration of the fingers, toes, and occasionally other areas. This condition can also cause nails to become brittle with longitudinal ridges. Named for French physician Maurice Raynaud
Maurice Raynaud
A. G. Maurice Raynaud , is the French doctor who discovered Raynaud's Disease, a rare vasopastic disorder which contracts blood vessels in extremities and is the "R" in the CREST syndrome acronym, in the late 19th century.-Life and career :...
(1814–1881), the phenomenon is believed to be the result of vasospasms that decrease blood supply to the respective regions. Emotional stress and cold are classic triggers of the phenomenon.
It comprises both Raynaud's disease (also known as "Primary Raynaud's phenomenon") where the phenomenon is idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
, and Raynaud's syndrome (secondary Raynaud's), where it is caused by some other instigating factor. Measurement of hand-temperature gradients is one tool used to distinguish between the primary and secondary forms.
It is possible for the primary form to progress to the secondary form.
In extreme cases, the secondary form can progress to necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
or gangrene
Gangrene
Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
of the fingertips.
Raynaud's phenomenon is an exaggeration of vasomotor
Vasomotor
Vasomotor refers to actions upon a blood vessel which alter its diameter. More specifically, it can refer to vasodilator action and vasoconstrictor action....
responses to cold or emotional stress. More specifically, it is a hyperactivation of the sympathetic system causing extreme vasoconstriction
Vasoconstriction
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in...
of the peripheral blood vessels, leading to tissue hypoxia
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...
. Chronic, recurrent cases of Raynaud phenomenon can result in atrophy of the skin, subcutaneous tissue
Subcutaneous tissue
The hypodermis, also called the hypoderm, subcutaneous tissue, or superficial fascia is the lowermost layer of the integumentary system in vertebrates. Types of cells that are found in the hypodermis are fibroblasts, adipose cells, and macrophages...
s, and muscle. In rare cases it can cause ulceration and ischemic gangrene.
Symptoms
The condition can cause pain within the affected extremities, discoloration (paleness) and sensations of cold and/or numbness. This can often be distressing to those who are not diagnosed, and sometimes it can be obstructive. If someone with Raynaud's is placed in too cold a climate, it could potentially become dangerous.The symptoms include several cyclic color changes:
- When exposed to cold temperatures, the blood supply to the fingers or toes, and in some cases the nose or earlobes, is markedly reduced; the skin turns pale or white (called pallorPallorPallor is a reduced amount of oxyhaemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, stimulant use, lack of exposure to sunlight, anaemia or genetics....
), and becomes cold and numb. - When the oxygenOxygenOxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...
supply is depleted, the skin colour turns blue (called cyanosisCyanosisCyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...
). - These events are episodic, and when the episode subsides or the area is warmed, the blood flow returns and the skin colour first turns red (rubor), and then back to normal, often accompanied by swellingSwelling (medical)In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
, tingling, and a painful "pins and needles" sensation.
All three colour changes are observed in classic Raynaud's. However, not all patients see all of the aforementioned colour changes in all episodes, especially in milder cases of the condition. Symptoms are thought to be due to reactive hyperemias of the areas deprived of blood flow.
In pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
, this sign normally disappears due to increased surface blood flow.
Raynaud's has also occurred in breastfeeding mothers, causing nipples to turn white and become extremely painful. Nifedipine
Nifedipine
Nifedipine is a dihydropyridine calcium channel blocker...
, a calcium channel blocker
Calcium channel blocker
A calcium channel blocker is a chemical that disrupts the movement of calcium through calcium channels.CCB drugs devised to target neurons are used as antiepileptics. However, the most widespread clinical usage of calcium channel blockers is to decrease blood pressure in patients with...
and vasodilator was recommended to increase blood flow to the extremities and noticeably relieved pain to the breast, in an extremely small study group.
Prevalence
The phenomenon is more common in women than men, with the Framingham StudyFramingham Heart Study
The Framingham Heart Study is a long-term, ongoing cardiovascular study on residents of the town of Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants...
finding that 5% of men and 8% of women suffer from Raynaud Phenomenon.
Raynaud phenomenon results from an exaggerated vasoconstriction of digital arteries and arterioles. These vascular changes induce paroxysmal pallor or cyanosis of the digits of the hands or feet; infrequently, the nose, earlobes, or lips can also be involved. Characteristically, the involved digits show red, white, and blue color changes from most proximal to most distal, correlating with proximal vasodilation, central vasoconstriction, and more distal cyanosis. Raynaud phenomenon may be a primary disease entity or be secondary to a variety of conditions.[82]
Primary Raynaud phenomenon (previously called Raynaud disease) reflects an exaggeration of central and local vasomotor responses to cold or emotional stresses. It affects 3% to 5% of the general population and shows a predilection for young women. Structural changes in the arterial walls are absent except late in the course, when intimal thickening can appear. The course of Raynaud phenomenon is usually benign, but when long-standing can result in atrophy of the skin, subcutaneous tissues, and muscles. Ulceration and ischemic gangrene are rare.[83]
In contrast, secondary Raynaud phenomenon refers to vascular insufficiency of the extremities secondary to arterial disease caused by other entities including SLE, Scleroderma
Scleroderma
Systemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
, Buerger disease, or even Atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
. Since Raynaud phenomenon may be the first manifestation of such conditions, any patient with new symptoms should be evaluated. Of these individuals, some 10% will eventually manifest an underlying disease.
Epidemiology
It is important to distinguish Raynaud's disease from syndrome. In order to diagnose these two forms of Raynaud's, a doctor may look for signs of arthritisArthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
or vasculitis
Vasculitis
Vasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis...
, and may conduct a number of laboratory tests.
Primary Raynaud's (disease)
Raynaud's disease, or "Primary Raynaud's", is diagnosed if the symptoms are idiopathic, that is, if they occur by themselves and not in association with other diseases. Some refer to Primary Raynaud's disease as "being allergic to coldness". It often develops in young women in their teens and early adulthood. Primary Raynaud's is thought to be at least partly hereditaryHeredity
Heredity is the passing of traits to offspring . This is the process by which an offspring cell or organism acquires or becomes predisposed to the characteristics of its parent cell or organism. Through heredity, variations exhibited by individuals can accumulate and cause some species to evolve...
, although specific genes have not yet been identified.
Smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
worsens frequency and intensity of attacks, and there is a hormonal component. Caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
also worsens the attacks. Sufferers are more likely to have migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
and angina than controls.
Secondary Raynaud's (syndrome)
Raynaud's syndrome, or "Secondary Raynaud's", occurs secondary to a wide variety of other conditions.Secondary Raynaud's has a number of associations:
- Connective tissue disorders:
- sclerodermaSclerodermaSystemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
- systemic lupus erythematosusSystemic lupus erythematosusSystemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
- rheumatoid arthritisRheumatoid arthritisRheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
- Sjögren's syndromeSjögren's syndromeSjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
- dermatomyositisDermatomyositisDermatomyositis is a connective-tissue disease related to polymyositis and Bramaticosis that is characterized by inflammation of the muscles and the skin.- Causes :...
- polymyositisPolymyositisPolymyositis is a type of chronic inflammation of the muscles related to dermatomyositis and inclusion body myositis.-Signs and symptoms:...
- mixed connective tissue diseaseMixed connective tissue diseaseIn medicine, mixed connective tissue disease , commonly abbreviated as MCTD, is an autoimmune disease, in which the body's defense system attacks itself. It was characterized in 1972....
- cold agglutinin disease
- Ehlers-Danlos SyndromeEhlers-Danlos syndromeEhlers–Danlos syndrome is a group of inherited connective tissue disorders, caused by a defect in the synthesis of collagen . The collagen in connective tissue helps tissues to resist deformation...
- scleroderma
- Eating disorders
- anorexia nervosaAnorexia nervosaAnorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
- anorexia nervosa
- Obstructive disorders
- atherosclerosisAtherosclerosisAtherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
- Buerger's diseaseBuerger's diseaseThromboangiitis obliterans is a recurring progressive inflammation and thrombosis of small and medium arteries and veins of the hands and feet...
- Takayasu's arteritisTakayasu's arteritisTakayasu's arteritis is a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing affecting often young or middle-aged women of Asian descent...
- subclavian aneurysmAneurysmAn aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...
s - thoracic outlet syndromeThoracic outlet syndromeThoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
- atherosclerosis
- Drugs
- Beta-blockers
- cytotoxic drugs - particularly chemotherapeuticsChemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
and most especially bleomycinBleomycinBleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anticancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. It works by causing breaks in DNA... - ciclosporinCiclosporinCiclosporin , cyclosporine , cyclosporin , or cyclosporin A is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the immune system, and therefore the risk of organ rejection...
- ergotamine
- sulfasalazine
- anthrax vaccines whose primary ingredient is the Anthrax Protective Antigen
- Occupation
- jobs involving vibration, particularly drilling, suffer from vibration white fingerVibration white fingerVibration white finger is a secondary form of Raynaud's syndrome, an industrial injury triggered by continuous use of vibrating hand-held machinery. Use of the term Vibration White Finger has generally been superseded by Hand-Arm Vibration Syndrome or HAVS...
- exposure to vinyl chlorideVinyl chlorideVinyl chloride is the organochloride with the formula H2C:CHCl. It is also called vinyl chloride monomer, VCM or chloroethene. This colorless compound is an important industrial chemical chiefly used to produce the polymer polyvinyl chloride . At ambient pressure and temperature, vinyl chloride...
, mercuryMercury (element)Mercury is a chemical element with the symbol Hg and atomic number 80. It is also known as quicksilver or hydrargyrum... - exposure to the cold (e.g. by working as a frozen food packer)
- jobs involving vibration, particularly drilling, suffer from vibration white finger
- Others
- Physical Trauma, such as that sustained in auto accident or other traumatic events
- Lyme Disease
- hypothyroidismHypothyroidismHypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
- cryoglobulinemiaCryoglobulinemiaCryoglobulinemia is a medical condition in which the blood contains large amounts of cryoglobulins - proteins that become insoluble at reduced temperatures. Cryoglobulins typically precipitate at temperatures below normal body temperature and will dissolve again if the blood is heated...
- malignancyCancerCancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
- reflex sympathetic dystrophyComplex regional pain syndromeComplex regional pain syndrome is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. It often affects an arm or a leg and may spread to another part of the body.Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic...
- carpal tunnel syndromeCarpal tunnel syndromeCarpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...
- Magnesium Deficiency
- ErythromelalgiaErythromelalgiaErythromelalgia, also known as Mitchell's disease , acromelalgia, red neuralgia, or erythermalgia, is a rare neurovascular peripheral pain disorder in which blood vessels, usually in the lower extremities , are episodically blocked , then become hyperemic and inflamed...
, (the opposite of Raynaud's, with hot and warm extremities) often co-exists in patients with Raynaud's)
It is important to realize that Raynaud's can herald these diseases by periods of more than 20 years in some cases, making it effectively their first presenting symptom. This can be the case in the CREST syndrome
CREST syndrome
The limited cutaneous form of systemic scleroderma is often referred to as CREST syndrome. "CREST" is an acronym for the five main features:* Calcinosis* Raynaud's syndrome* Esophageal dysmotility* Sclerodactyly* Telangiectasia...
, of which Raynaud's is a part.
Patients with Secondary Raynaud's can also have symptoms related to their underlying diseases. Raynaud's phenomenon is the initial symptom that presents for 70% of patients with scleroderma
Scleroderma
Systemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
, a skin and joint disease.
When Raynaud's phenomenon is limited to one hand or one foot, it is referred to as Unilateral Raynaud's. This is an uncommon form, and it is always secondary to local or regional vascular disease. It commonly progresses within several years to affect other limbs as the vascular disease progresses.
Examination
A careful medical history will often reveal whether the condition is primary or secondary. Once this has been established, an examination is largely to identify or exclude possible secondary causes.- Digital artery pressure: pressures are measured in the arteries of the fingers before and after the hands have been cooled. A decrease of at least 15 mmHg is diagnostic (positive).
- Doppler ultrasound: to assess blood flow.
- Full blood count: this can reveal a normocytic anaemia suggesting the anaemia of chronic disease or renal failureRenal failureRenal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. - Blood testBlood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
for ureaUreaUrea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....
and electrolyteElectrolyteIn chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s: this can reveal renal impairment. - Thyroid function testsThyroid function testsThyroid function tests is a collective term for blood tests used to check the function of the thyroid.TFTs may be requested if a patient is thought to suffer from hyperthyroidism or hypothyroidism , or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy...
: this can reveal hypothyroidismHypothyroidismHypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
. - An autoantibodyAutoantibodyAn autoantibody is an antibody manufactured by the immune system that is directed against one or more of the individual's own proteins. It is derived from the Greek "auto" which means "self", "anti" which means "against" and "body"...
screen, tests for rheumatoid factorRheumatoid factorRheumatoid factor is an autoantibody most relevant in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG. RF and IgG join to form immune complexes that contribute to the disease process...
, Erythrocyte sedimentation rateErythrocyte sedimentation rateThe erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
and C-reactive proteinC-reactive proteinC-reactive protein is a protein found in the blood, the levels of which rise in response to inflammation...
, which may reveal specific causative illnesses or a generalised inflammatory process. - Nail fold vasculature: this can be examined under the microscopeMicroscopeA microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
.
Treatment
Treatment options are dependent on the type of Raynaud's present. Raynaud's syndrome is treated primarily by addressing the underlying cause, but includes all options for Raynaud's disease as well. Treatment of primary Raynaud's focuses on avoiding triggers.General care
- Environmental triggers should be avoided, e.g. cold, vibration, etc.
- Emotional stress is another recognized trigger.
- Extremities should be kept warm
- Smoking to be avoided.
- Consumption of caffeineCaffeineCaffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
and other stimulants and vasoconstrictors must be prevented. - Raynaud's may be aggravated by hormones and hormone regulators, such as hormonal contraceptionHormonal contraceptionHormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
. Contraception which is low in estrogenEstrogenEstrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
is preferable, and the progesterone only pillProgesterone only pillProgestogen-Only Pills or Progestin-Only Pills are contraceptive pills that contain only synthetic progestogens and do not contain estrogen...
is often prescribed for women with Raynaud's.
Emergency measures
- If white finger (Raynaud's) occurs unexpectedly and a source of warm water is available, allow tepid to slightly warm water to run over the affected digits while you gently massage the area. Continue this process until the white area returns to its normal, healthy color.
- If triggered by exposure in a cold environment, and no warm water is available, place the affected digits in a warm body cavity - arm pit, crotch, or even in the mouth. Keep the affected area warm at least until the whiteness returns to its normal, healthy color. Get out of the cold as soon as possible.
- A useful method exists to take measures ensuring circulation is restored quickly, though this should not be attempted if other circulatory issues are present that disallow fast or vigorous movement. This method is achieved by "windmilling" the arms (swinging them in large circles) reasonably fast to force the blood to the hands and fingers. This can cause dizziness, so it should be attempted only for a short time before stopping for a minute and subsequently continuing. A less effective (but less conspicuous) variation is to swing the arms back and forth in a part of a circle to achieve the same results. This variation does take longer, though, and requires swifter movement of the arms, so it is advised to use the first variation if possible.
Drug therapy
- Treatment for Raynaud's phenomenon may include prescription medicines that dilate blood vesselsVasodilationVasodilation refers to the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, smaller arterioles and large veins. The process is essentially the opposite of vasoconstriction, or the narrowing of blood vessels. When...
, such as calcium channel blockerCalcium channel blockerA calcium channel blocker is a chemical that disrupts the movement of calcium through calcium channels.CCB drugs devised to target neurons are used as antiepileptics. However, the most widespread clinical usage of calcium channel blockers is to decrease blood pressure in patients with...
s (nifedipineNifedipineNifedipine is a dihydropyridine calcium channel blocker...
) or diltiazem. It has the usual common side effects of headache, flushing, and ankle edemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
; but these are not typically of sufficient severity to require cessation of treatment. - Calcium channel blockers can be helpful for the treatment of Raynaud's phenomenon.
- There is some evidence that Angiotensin II receptor antagonistAngiotensin II receptor antagonistAngiotensin II receptor antagonists, also known as angiotensin receptor blockers , AT1-receptor antagonists or sartans, are a group of pharmaceuticals which modulate the renin-angiotensin-aldosterone system...
s (often LosartanLosartanLosartan is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure . Losartan was the first angiotensin II receptor antagonist to be marketed. Losartan potassium is marketed by Merck & Co. Inc. under the trade name Cozaar...
) reduce frequency and severity of attacks, and possibly better than nifedipine. - Alpha-1 adrenergic blockers such as prazosin can be used to control Raynaud's vasospasms under supervision of a health care provider.
- In a study published in the November 8, 2005 issue of Circulation, sildenafilSildenafilSildenafil citrate, sold as Viagra, Revatio and under various other trade names, is a drug used to treat erectile dysfunction and pulmonary arterial hypertension . It was originally developed by British scientists and then brought to market by the US-based pharmaceutical company Pfizer...
(Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilatory therapy. The authors, led by Dr Roland Fries (Gotthard-Schettler-Klinik, Bad Schönborn, Germany), report: "In the present study, capillary blood flow was severely impaired and sometimes hardly detectable in patients with Raynaud's phenomenon. Sildenafil led to a more than 400% increase of flow velocity." - FluoxetineFluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
, a selective serotonin reuptake inhibitor, and other antidepressantAntidepressantAn antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
medications may reduce the frequency and severity of episodes if caused mainly by psychological stress. - RayVa is a topical cream for the treatment of Raynaud's phenomenon. It contains prostaglandin E1Prostaglandin E1Prostaglandin E1 , known pharmaceutically as alprostadil, is a prostaglandin. It is a drug used in the treatment of erectile dysfunction and has vasodilatory properties.-Sexual dysfunction:...
as the active ingredient and a permeation enhancer DDAIPDDAIPDDAIP is a pharmaceutical ingredient added to topical products to increase penetration through the skin. Chemically, DDAIP is an ester of N,N-dimethylalanine and dodecanol. DDAIP is typically formulated as its hydrochloride salt...
which facilitates the delivery of the drug into the blood stream.
Surgical Intervention
- In severe cases, a sympathectomySympathectomyA Sympathectomy is a procedure during which at least one sympathetic ganglion is removed.An example is endoscopic thoracic sympathectomy....
procedure can be performed. Here, the nerves that signal the blood vessels of the fingertips to constrict are surgically cut. Microvascular surgery of the affected areas is another possible therapy. Infusions of prostaglandinProstaglandinA prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
s, e.g. prostacyclinProstacyclinProstacyclin is a member of the family of lipid molecules known as eicosanoids.As a drug, it is also known as "epoprostenol". The terms are sometimes used interchangeably.-History:...
, may be tried, with amputationAmputationAmputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
in exceptionally severe cases. - A more recent treatment for severe Raynaud's is the use of Botox. The 2009 article studied 19 patients ranging in age from 15 to 72 years with severe Raynaud's phenomenon of which 16 patients (84%) reported pain reduction at rest. 13 patients reported immediate pain relief, 3 more had gradual pain reduction over 1–2 months. All 13 patients with chronic finger ulcers healed within 60 days. Only 21% of the patients required repeated injections. A 2007 article describes similar improvement in a series of 11 patients. All patients had significant relief of pain.
Alternative and Experimental (Research) Approaches
- The Ayurvedic oil preparation Mahanarayan Oil has been used very successfully in many cases as a vasodilater when applied daily to affected areas.
- The extract of the Ginkgo biloba leaves (Egb 761, 80 mg) may reduce frequency of attacks.
- Two separate gels combined on the fingertip (somewhat like two-part epoxyEpoxyEpoxy, also known as polyepoxide, is a thermosetting polymer formed from reaction of an epoxide "resin" with polyamine "hardener". Epoxy has a wide range of applications, including fiber-reinforced plastic materials and general purpose adhesives....
, they cannot be combined before use because they will react) increased blood flow in the fingertips by about three times. One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid. The milliliter of combined gel covered an area of ~3 cm². The gel was wiped off after a few seconds. - PiracetamPiracetamPiracetam is a nootropic drug. Piracetam's chemical name is 2-oxo-1-pyrrolidine acetamide; it shares the same 2-oxo-pyrrolidone base structure with 2-oxo-pyrrolidine carboxylic acid . Piracetam is a cyclic derivative of GABA. It is one of the group of racetams...
, a nootropicNootropicNootropics , also referred to as smart drugs, brain steroids, memory enhancers, cognitive enhancers, and intelligence enhancers, are drugs, supplements, nutraceuticals, and functional foods that improve mental functions such as cognition, memory, intelligence, motivation, attention, and concentration...
drug, can be useful as a long-term treatment for vasospastic disorders. - Arginine, which increase nitric oxide acts as a vasodilator.
- Milder cases of Raynaud's can often be addressed by biofeedbackBiofeedbackBiofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...
or other techniques to help control involuntary body functionsAutonomic nervous systemThe autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...
like skin temperature. - Fish oilFish oilFish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty acids eicosapentaenoic acid , and docosahexaenoic acid , precursors of certain eicosanoids that are known to reduce inflammation throughout the body, and are thought to have many health benefits.Fish do not...
supplements which contain long-chain omega-3 fatty acids may help to control symptoms of primary Raynaud's. There are few studies in the medical literature dealing with this subject. However, in one 1989 controlled, double-blinded study of 32 patients, consumption of roughly 6.5 grams of long chain omega-3 fatty acids in the form of fish oil significantly increased the time to onset or entirely prevented symptoms in response to cold in patients with primary Raynaud's. Lower doses of fish oil such as may be commonly available from commercial vendors have not been studied and may not be as effective.
External links
- Overview at National Institutes of HealthNational Institutes of HealthThe National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
- Overview at Medical College of WisconsinMedical College of WisconsinMedical College of Wisconsin is a private, freestanding medical school and graduate school located in Milwaukee, Wisconsin, United States. It was formerly affiliated with Marquette University....
- Raynaud's Disease at healthatoz.com
- What Is Raynaud's Disease at National Heart, Lung, and Blood InstituteNational Heart, Lung, and Blood InstituteThe National Heart, Lung, and Blood Institute is a division of the National Institutes of Health, located in Bethesda, Maryland...
- Testimonial of cure for Raynaud's phenomenon
- Raynaud's Disease at Mayo ClinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
- Raynaud's & Scleroderma Association, a national charity and self help organisation, committed to supporting patients and carers who have these conditions