Raynaud’s phenomenon is where the fingers turn white and become numb and painful. It is due to a narrowing (constriction) of the small blood vessels on exposure to the cold, or to a change in temperature, or to emotional stress. The fingers can then go a bluish colour (or even purple or black in severe cases). This happens because the oxygen is used up quickly from the blood in the narrowed blood vessels. The fingers then go bright red. This happens because blood vessels open up again (dilate) and the blood flow returns. This may cause tingling, throbbing, numbness and pain (which can be severe in some cases).
Many people with Raynaud’s do not have the full classic colour changes, but develop infrequent, mild bouts of uncomfortable, pale, cold fingers where symptoms only last a few minutes. Sometimes it is moderate with more frequent bouts of symptoms that last longer. Rarely, it is severe with repeated frequent bouts, with each bout lasting for longer periods of time.
Only the fingers are affected in most cases. Less commonly areas of the body such as the toes, earlobes, nose, nipples or tongue can be affected.
Raynaud’s is divided into two types:
Primary Raynaud’s – when the condition develops by itself and in most cases there is no known cause
Even mildly cool weather, or getting something out of the freezer, or being in windy conditions can trigger symptoms in some people. Strong emotion may also trigger symptoms in some cases. The small blood vessels in the fingers, toes, etc, just appear to be more sensitive than normal to cool temperatures. Usually, all fingers on both hands are affected in primary Raynaud’s. It also tends to run in some families; women are affected more often than men and it usually first develops before the age of 30.
The outlook for people with primary Raynaud’s is usually good. Most people have mild symptoms that do not interfere much with daily life. People with more severe symptoms often respond well to treatment with nifedipine. In some cases the condition remits (goes away) in time. In one study that followed up people with primary Raynaud’s over seven years, the condition had gone away in nearly 2 in 3 cases at some point over the study period.
Sometimes, someone who is thought to have primary Raynaud’s develops other symptoms several months or years later and the diagnosis is changed to secondary Raynaud’s. This is thought to occur in about 1 in 10 people who are initially diagnosed with primary Raynaud’s.
Secondary Raynaud’s – when it develops in association with another health condition.
Secondary Raynaud’s is less common and is usually associated with an underlying autoimmune condition affecting the blood vessels, joints, muscles, nerves or skin such as scleroderma, systemic lupus erythematosus and rheumatoid arthritis. Symptoms are often more severe and tend to respond less well to treatment.
If you have secondary Raynaud’s you will normally have other symptoms in addition to the symptoms of Raynaud’s. The Raynaud’s is just one feature of the condition. For example, you may also have joint pains, rashes, joint swelling, etc.
Often the underlying condition is already present, and you may develop Raynaud’s as a complication. Sometimes the symptoms of Raynaud’s occur first, and other symptoms of the underlying condition develop weeks, months or even years later.
In secondary Raynaud’s, symptoms may first begin in just one or two fingers on one hand. This is in contrast to primary Raynaud’s when all fingers on both hands are typically affected.
Hand-arm vibration syndrome (vibration white finger) is one common cause of secondary Raynaud’s. This is caused by using vibrating tools regularly over a long period of time. For example, it occurs in some shipyard workers, mine workers, road diggers, etc. It is thought that repeated vibrations over time may damage the small blood vessels or their nerve supply.
Medicines
Secondary Raynaud’s can also be a side effect of taking certain medicines, including:
Injury and overuse
Raynaud’s sometimes results from a physical injury to the affected area. It can also affect musicians, people who type a lot or other people who use their fingers and hands more than usual.
Are tests needed to confirm Raynaud’s?
Not in most cases. There is no test that confirms primary Raynaud’s. The diagnosis of primary Raynaud’s is made on the basis of the symptoms described above and there is no abnormality found that may suggest a secondary cause when a doctor examines you. Blood tests and other tests may be done if secondary Raynaud’s is suspected.
What are the complications of Raynaud’s?
In very severe cases of Raynaud’s the blood supply to an affected body part can become severely diminished, which normally only occurs in secondary, not primary, Raynaud’s. Without a constant supply of blood, the tissue in the body part will begin to die.
How is Raynaud’s phenomenon treated?
For the majority of us with mild Raynaud’s it’s about self-care:
However, sometimes medications are needed, and many options are available. These include blood pressure medications such as calcium channel blockers (amlodipine, nifedipine, felodipine, and others) and angiotensin-receptor blockers. These medications act by increasing blood flow to the fingers and toes. For patients with more severe symptoms or who have developed complications such as ulcers on the fingertips, other medications can be used including sildenafil or prostacyclins.
Sometimes, patients will also be prescribed other medications that can help improve symptoms, including topical creams, selective-serotonin-reuptake inhibitors (SSRIs), or cholesterol-lowering (statin) medications.
For more information about Raynaud’s phenomenon you can visit the Scleroderma & Raynaud’s UK website or download their factsheet HERE
Only the fingers are affected in most cases. Less commonly areas of the body such as the toes, earlobes, nose, nipples or tongue can be affected.
Raynaud’s is divided into two types:
Primary Raynaud’s – when the condition develops by itself and in most cases there is no known cause
Even mildly cool weather, or getting something out of the freezer, or being in windy conditions can trigger symptoms in some people. Strong emotion may also trigger symptoms in some cases. The small blood vessels in the fingers, toes, etc, just appear to be more sensitive than normal to cool temperatures. Usually, all fingers on both hands are affected in primary Raynaud’s. It also tends to run in some families; women are affected more often than men and it usually first develops before the age of 30.
The outlook for people with primary Raynaud’s is usually good. Most people have mild symptoms that do not interfere much with daily life. People with more severe symptoms often respond well to treatment with nifedipine. In some cases the condition remits (goes away) in time. In one study that followed up people with primary Raynaud’s over seven years, the condition had gone away in nearly 2 in 3 cases at some point over the study period.
Sometimes, someone who is thought to have primary Raynaud’s develops other symptoms several months or years later and the diagnosis is changed to secondary Raynaud’s. This is thought to occur in about 1 in 10 people who are initially diagnosed with primary Raynaud’s.
Secondary Raynaud’s – when it develops in association with another health condition.
Secondary Raynaud’s is less common and is usually associated with an underlying autoimmune condition affecting the blood vessels, joints, muscles, nerves or skin such as scleroderma, systemic lupus erythematosus and rheumatoid arthritis. Symptoms are often more severe and tend to respond less well to treatment.
If you have secondary Raynaud’s you will normally have other symptoms in addition to the symptoms of Raynaud’s. The Raynaud’s is just one feature of the condition. For example, you may also have joint pains, rashes, joint swelling, etc.
Often the underlying condition is already present, and you may develop Raynaud’s as a complication. Sometimes the symptoms of Raynaud’s occur first, and other symptoms of the underlying condition develop weeks, months or even years later.
In secondary Raynaud’s, symptoms may first begin in just one or two fingers on one hand. This is in contrast to primary Raynaud’s when all fingers on both hands are typically affected.
Hand-arm vibration syndrome (vibration white finger) is one common cause of secondary Raynaud’s. This is caused by using vibrating tools regularly over a long period of time. For example, it occurs in some shipyard workers, mine workers, road diggers, etc. It is thought that repeated vibrations over time may damage the small blood vessels or their nerve supply.
Medicines
Secondary Raynaud’s can also be a side effect of taking certain medicines, including:
- some types of anti-migraine medication, such as sumatriptan and ergotamine
- beta-blockers, which are used to treat high blood pressure and heart disease
- some chemotherapy medications
- decongestants
- the contraceptive pill
- medications used in hormone replacement therapy
- some types of medications used in the treatment of high blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors and clonidine
- The illegal drugs cocaine and amphetamine can also cause secondary Raynaud’s.
Injury and overuse
Raynaud’s sometimes results from a physical injury to the affected area. It can also affect musicians, people who type a lot or other people who use their fingers and hands more than usual.
Are tests needed to confirm Raynaud’s?
Not in most cases. There is no test that confirms primary Raynaud’s. The diagnosis of primary Raynaud’s is made on the basis of the symptoms described above and there is no abnormality found that may suggest a secondary cause when a doctor examines you. Blood tests and other tests may be done if secondary Raynaud’s is suspected.
What are the complications of Raynaud’s?
In very severe cases of Raynaud’s the blood supply to an affected body part can become severely diminished, which normally only occurs in secondary, not primary, Raynaud’s. Without a constant supply of blood, the tissue in the body part will begin to die.
How is Raynaud’s phenomenon treated?
For the majority of us with mild Raynaud’s it’s about self-care:
- Keep the hands and feet warm. Warm gloves, socks and shoes are essential when outside in cool weather.
- Keep the whole body warm, symptoms are less likely to occur if the entire body is warm. For example, wear hats and scarves in addition to warm clothes.
- Buy portable heat packs and battery heated gloves and socks. The Raynaud’s and Scleroderma Association has a list of suppliers.
- Try not to touch cold objects. For example, use a towel or gloves when removing food from the freezer or working with cold food.
- Regular exercise is recommended by many experts. Exercise the hands and feet frequently to improve the circulation.
- Smoking can make symptoms worse, because the chemicals in tobacco can cause the small blood vessels to narrow.
- Avoid caffeine (in tea, coffee, cola and some painkillers) as it can trigger symptoms in some people.
However, sometimes medications are needed, and many options are available. These include blood pressure medications such as calcium channel blockers (amlodipine, nifedipine, felodipine, and others) and angiotensin-receptor blockers. These medications act by increasing blood flow to the fingers and toes. For patients with more severe symptoms or who have developed complications such as ulcers on the fingertips, other medications can be used including sildenafil or prostacyclins.
Sometimes, patients will also be prescribed other medications that can help improve symptoms, including topical creams, selective-serotonin-reuptake inhibitors (SSRIs), or cholesterol-lowering (statin) medications.
For more information about Raynaud’s phenomenon you can visit the Scleroderma & Raynaud’s UK website or download their factsheet HERE
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