Raynaud’s disease is when blood vessels in your fingers and toes temporarily overreact to low temperatures or stress. For most people, it isn’t a serious health problem. But for some, the reduced blood flow can cause damage.
Raynaud’s symptoms affect your skin and may include –
• Color changes. As blood flow stops and then returns, your skin color may change from white to blue to red. Some people don’t experience all three changes in skin color.
• Feeling cold or numb. This happens when your finger or other affected body part isn’t receiving oxygen-rich blood. It feels like that part of your body has “fallen asleep.”
• Feeling warmth, tingling or throbbing: This happens as blood flow returns to your affected body part.
• Skin ulcers and gangrene: Longer or more frequent attacks may lead to painful sores on your fingertips. These sores can take a while to heal. Rarely, lack of oxygen to your tissues may lead to tissue death (gangrene).
Symptoms of Raynaud’s syndrome are episodic. That means they come and go. A typical episode, or attack, lasts about 15 minutes. But attacks may be shorter or longer. Episodes are often associated with certain triggers such as cold weather. Symptoms are usually mild in people with primary Raynaud’s syndrome. People with secondary Raynaud’s syndrome may have more severe symptoms, including skin ulcers.
There are two main types of the condition.
• Primary Raynaud’s. Also called Raynaud’s disease, it is most common form isn’t the result of another medical condition. It can be so mild that many people with primary Raynaud’s don’t seek treatment. And it can go away on its own.
• Secondary Raynaud’s. Also called Raynaud’s phenomenon, this form develops because of another health condition. Although secondary Raynaud’s is less common than the primary form, it tends to be more serious.
Symptoms of secondary Raynaud’s usually appear around age 40. That’s later than symptoms appear for primary Raynaud’s.
What is the difference between Raynaud’s disease, Raynaud’s phenomenon and Raynaud’s syndrome?
Most people use these terms interchangeably. But scientists use them to distinguish between primary and secondary forms of the condition.
• Raynaud’s disease: Occurs on its own and isn’t connected with another disease or condition. Raynaud’s disease is also called primary Raynaud’s syndrome.
• Raynaud’s phenomenon: Occurs due to an underlying condition, medication or lifestyle factor. This is also called secondary Raynaud’s syndrome.
• Raynaud’s syndrome: Refers to either the primary or secondary form of the condition.
Cause of primary Raynaud’s –
When it’s cold, your body tries to conserve heat. One way it does that is to slow down blood flow to the areas farthest from your heart — your hands and feet. To do that, the network of small arteries that carry blood to those points gets narrower, moving them away from your skin. This is called the vasomotor response.
If you have Raynaud’s, your response is off. Those arteries shrink more than normal, and faster than normal. That can make your fingers and toes feel numb and change color to white or blue. This usually lasts about 15 minutes. When the arteries relax and your body warms back up, your fingers feel tingly and turn red before returning to normal.
Causes of secondary Raynaud’s –
• Connective tissue diseases. Most people who have a rare disease that leads to hardening and scarring of the skin, known as scleroderma, have Raynaud’s. Other diseases that increase the risk of Raynaud’s include lupus, rheumatoid arthritis and Sjogren’s syndrome.
• Diseases of the arteries. These include a buildup of fatty deposits in blood vessels that feed the heart and a disorder in which the blood vessels of the hands and feet become inflamed. A type of high blood pressure that affects the arteries of the lungs also may cause secondary Raynaud’s.
• Carpal tunnel syndrome. This condition involves pressure on a major nerve to the hand. The pressure causes numbness and pain in the hand that can make the hand react more to cold temperatures.
• Repeated actions or vibration. Typing, playing piano or doing movements like that for long periods can cause overuse injuries. So can using vibrating tools, such as jackhammers.
• Smoking. Smoking narrows blood vessels.
• Injuries to the hands or feet. Examples include a wrist fracture, surgery or frostbite.
• Certain medicines. These include beta blockers for high blood pressure, some migraine medicines, attention-deficit/hyperactivity disorder medicines, certain cancer medicines and some cold medicines.
Risk Factors –
As many as one in 10 people may have some form of Raynaud’s. Most have primary Raynaud’s. About one person in 100, or fewer, will have secondary Raynaud’s.
• Women are up to nine times more likely to get it than men.
• People of all ages can get primary Raynaud’s, but it usually shows up between ages 15 and 25.
• People with secondary Raynaud’s tend to get it after 35.
• People with illnesses like rheumatoid arthritis, scleroderma, and lupus are more likely to get secondary Raynaud’s.
• People who use some medicines to treat cancer, migraines, or high blood pressure may be more likely to get Raynaud’s.
• Also, people who have carpal tunnel syndrome or use vibrating tools like jackhammers may be more likely to get Raynaud’s.
If secondary Raynaud’s is severe, reduced blood flow to fingers or toes could cause tissue damage. But that’s rare.
A completely blocked artery can lead to skin sores or dead tissue. This can be difficult to treat. Rarely, very bad untreated instances might require removing the affected part of the body.
When you visit your doctor, they will first perform a physical exam, take your medical history, and review any test results.
The doctor will want to inspect your fingers and toes while also looking at your skin and nailbeds. For example, they may apply some mild pressure to your nailbeds. Measuring your capillary refill time offers a visual assessment of your circulation, and it’s a good indicator of your blood vessel health.
There are different tests your doctor may offer to make their definitive diagnosis and includes-
• cold stimulation test: a small device measures your finger’s temperature when exposed to cold and then removed from cold
• nail fold
• capillaroscopy: a drop of oil on your nail is examined via microscope in order to detect abnormalities
• antinuclear antibody (ANA): checks for autoimmune proteins in the blood
• erythrocyte sedimentation rate (ESR): measures inflammation levels in the body
• C-reactive protein (CRP): assesses the liver’s response to inflammation
There is no cure for primary or secondary Raynaud’s. However, different treatments and lifestyle changes may help manage your symptoms and reduce the number of attacks experienced. Treatment options for symptoms are the same for both.
▪︎ Lifestyle changes
Lifestyle changes are a large part of the treatment process for Raynaud’s phenomenon. Avoiding substances that cause your blood vessels to constrict is the first line of treatment, such as caffeine and nicotine products.
Staying warm and exercising can also prevent or reduce the intensity of some attacks. In addition, exercise is perfect for promoting circulation and managing stress.
If you are experiencing vasospasms, it’s essential to keep yourself warm. To help cope with an attack, you can:
• Cover your hands or feet with socks or gloves.
• Get out of the cold and wind and rewarm your entire body.
• Run your hands or feet under lukewarm (not hot) water.
• Massage your extremities.
Staying calm can help reduce the severity of your attack. Try to remain as relaxed and stress-free as possible. It may help to remove yourself from stressful situations physically. Concentrating on your breathing can also help you calm down.
Medications used to treat Raynaud’s work to dilate or widen your blood vessels. These drugsinclude:
• calcium channel blockers: first line of defense and includes amlodipine and nifedipine
• phosphodiesterase (PDE) inhibitor: treats other circulation ailments, such as erectile dysfunction, and includes sildenafil
• topical nitrates: absorbed in the skin and includes nitroglycerin
• other blood pressure medications: such as losartan and prazosin
• low-dose aspirin: 81-milligram aspirin daily is recommended
Your doctor may recommend prostaglandin infusions when the lack of oxygen supply to the affected tissues is severe. Intravenous therapy of the drug works to dilate your blood vessels and prevent blood clots.
Severe cases of Raynaud’s can be distressing, though it may not last long. If severe Raynaud’s phenomenon is impacting your life, your doctor could recommend a sympathectomy in rare cases. The surgery blocks the nerves causing the blood vessels to constrict. After a few years, you may need a repeat procedure.
To help prevent Raynaud’s attacks:
• Bundle up outdoors. When it’s cold, wear a hat, scarf, socks and boots, and two sets of mittens or gloves. Thermal underwear might help. A coat with cuffs that close around mittens or gloves helps protect the hands from cold air. Wear earmuffs and a face mask if the tip of your nose and your earlobes get too cold.
• Warm your car. Run your car heater for a few minutes before driving in cold weather.
• Take care indoors. Wear socks. To take food out of the refrigerator or freezer, wear gloves, mittens or oven mitts. Some people find it helpful to wear mittens and socks to bed during winter
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