What Is Raynaud's Phenomenon?
Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose.
Raynaud's phenomenon can exist as a primary condition or in congruence with an underlying disease, most commonly one of the connective tissue diseases such as:
- scleroderma (systemic sclerosis)
- mixed connective tissue disease (MCTD)
- lupus (systemic lupus erythematosus)
- Sjogren's syndrome
- dermatomyositis
- polymyositis
Approximately 85% to 95% of patients with scleroderma and mixed connective tissue disease, plus one-third of patients with lupus, suffer with Raynaud's phenomenon.
What Happens During An Attack?
The blood vessels in the fingers and toes are most commonly affected by Raynaud's phenomenon. It is possible for the ear lobes, lips, and nose to also be affected. During "vasospastic" attacks of Raynaud's phenomenon, the blood vessels in the affected area constrict. Attacks are often triggered by exposure to cold or by emotional stress. The resulting decreased blood supply caused by the vasospasm can cause skin discoloration and intense pain.
Upon exposure to cold, the body's normal response is to slow the loss of heat and maintain core temperature. Blood vessels which control blood flow to the skin move blood from arteries near the surface to veins deep within. People suffering with Raynaud's phenomenon, however, experience sudden vasospastic attacks instead. An attack can last less than a minute or up to several hours.
How Is Raynaud's Phenomenon Classified?
Raynaud's phenomenon is divided into two classifications: primary and secondary.
How Is Raynaud's Phenomenon Diagnosed?
Diagnostic tests which doctors use to assess Raynaud's phenomenon include the:
- antinuclear antibody (ANA) lab test
- erythrocyte sedimentation rate (ESR) blood test
- nailfold capillaroscopy test
- cold stimulation test
The diagnostic criteria used to diagnose primary Raynaud's phenomenon include:
- Periodic vasospastic attacks of pallor (whiteness) or cyanosis (blueness)(note: some doctors include the additional criterion of the presence of these attacks for at least 2 years)
- Normal nailfold capillary pattern
- Negative antinuclear antibody test (ANA)
- Normal erythrocyte sedimentation rate (ESR)
- Absence of pitting scars or ulcers of the skin, or gangrene (tissue death) in the fingers or toes
The diagnostic criteria used to diagnose secondary Raynaud's phenomenon include:
- Periodic vasospastic attacks of pallor (whiteness) and cyanosis (blueness)
- Abnormal nailfold capillary pattern
- Positive antinuclear antibody test (ANA)
- Abnormal erythrocyte sedimentation rate (ESR)
- Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes
Raynaud's Phenomenon Treatment
Treatment of Raynaud's phenomenon is aimed at reducing the number of attacks and preventing tissue damage in the affected areas. Non-drug treatments and self-help measures are usually the focus early on. These recommendations include:
- Taking action during an attack (an attack should not be ignored)
- Warming the affected areas
- Keeping warm
- Relaxation techniques
- Biofeedback techniques
- Stress control
- Smoking cessation
- Exercise
- Seeing your doctor if questions or concerns develop
People with secondary Raynaud's phenomenon are more likely to be prescribed medications. Calcium-channel blockers which relax smooth muscle and dilate small blood vessels are viewed as safe and effective. These medications generally decrease frequency and severity of attacks in two-thirds of patients. Alpha blockers, which counteract a hormone that constricts blood vessels, are also utilized.
In severe cases, Raynaud's phenomenon can be treated surgically with a sympathectomy, whereby nerves that control the contraction of arteries are cut. Beyond these methods of treatment, most people learn to live with Raynaud's phenomenon. Clearly though, any encounter between cold and the hands or other affected area can provoke an attack. Bare-handed snow ball fights, handling frozen food, and other chilling situations are to be avoided!
Related Resources
Sources: NIH Publication No. 01-4911, AMA Family Medical Guide, Kunz & Finkel
