Raynaud's (ray-NOHZ) disease causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud's disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm).
Women are more likely than men to have Raynaud's disease, also known as Raynaud or Raynaud's phenomenon or syndrome. It appears to be more common in people who live in colder climates.
Treatment of Raynaud's disease depends on its severity and whether you have other health conditions. For most people, Raynaud's disease isn't disabling, but can affect quality of life.
Signs and symptoms of Raynaud's depend on the frequency, duration and severity of the blood vessel spasms that underlie the disorder. Raynaud's disease signs and symptoms include:
- Cold fingers or toes
- Color changes in your skin in response to cold or stress
- Numb, prickly feeling or stinging pain upon warming or stress relief
During an attack of Raynaud's, affected areas of your skin usually first turn white. Then, the affected areas often turn blue and feel cold and numb. As you warm and circulation improves, the affected areas may turn red, throb, tingle or swell. The order of the color changes isn't the same for everyone, and not everyone experiences all three colors.
Although Raynaud's most commonly affects your fingers and toes, the condition can also affect other areas of your body, such as your nose, lips, ears and even nipples. After warming, it may take 15 minutes for normal blood flow to return to the area.
When to see a doctor
See your doctor right away if you have a history of severe Raynaud's and develop a sore or infection in one of your affected fingers or toes.
Doctors don't completely understand the cause of Raynaud's attacks, but blood vessels in the hands and feet appear to overreact to cold temperatures or stress.
Blood vessels in spasm
With Raynaud's, arteries to your fingers and toes go into vasospasm when exposed to cold or stress, narrowing your vessels and temporarily limiting blood supply. Over time, these small arteries may thicken slightly, further limiting blood flow.
Cold temperatures are most likely to trigger an attack. Exposure to cold, such as putting your hands in cold water, taking something from a freezer or encountering cold air, is the most likely trigger. For some people, emotional stress can cause an episode of Raynaud's.
Primary vs. secondary Raynaud's
There are two main types of the condition.
- Primary Raynaud's. Also called Raynaud's disease, this most common form isn't the result of an underlying associated medical condition that could provoke vasospasm.
- Secondary Raynaud's. Also called Raynaud's phenomenon, this form is caused by an underlying problem. Although secondary Raynaud's is less common than the primary form, it tends to be more serious. Signs and symptoms of secondary Raynaud's usually appear later in life — around age 40 — than they do for primary Raynaud's.
Causes of secondary Raynaud's include:
- Connective tissue diseases. Most people who have a rare disease that leads to hardening and scarring of the skin (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. Raynaud's phenomenon can be associated with various diseases that affect arteries, such as the buildup of plaques in blood vessels that feed the heart (atherosclerosis) or a disorder in which the blood vessels of the hands and feet become inflamed (Buerger's disease). A type of high blood pressure that affects the arteries of the lungs (primary pulmonary hypertension) can be linked to Raynaud's.
- Carpal tunnel syndrome. This condition involves pressure on a major nerve to your hand (median nerve) producing numbness and pain in the affected hand. The hand may become more susceptible to cold temperatures and episodes of Raynaud's.
- Repetitive action or vibration. Typing, playing piano or doing similar movements for long periods and operating vibrating tools, such as jackhammers, can increase your risk of developing Raynaud's.
- Smoking. Smoking constricts blood vessels and is a potential cause of Raynaud's.
- Injuries. Injuries to the hands or feet, such as wrist fracture, surgery or frostbite, can lead to Raynaud's phenomenon.
- Certain medications. Some drugs — including beta blockers, which are used to treat high blood pressure; migraine medications that contain ergotamine or sumatriptan; attention-deficit/hyperactivity disorder medications; certain chemotherapy agents; and drugs that cause blood vessels to narrow, such as some over-the-counter cold medications — have been linked to Raynaud's.
Risk factors for primary Raynaud's include:
- Sex. Primary Raynaud's affects women more than men.
- Age. Although anyone can develop the condition, primary Raynaud's often begins between the ages of 15 and 30.
- Climate. The disorder is also more common in people who live in colder climates.
- Family history. A family history appears to increase your risk of primary Raynaud's. About one-third of people with primary Raynaud's have a first-degree relative — a parent, sibling or child — with the disorder.
Risk factors for secondary Raynaud's include:
- Associated diseases. These include conditions such as scleroderma and lupus.
- Certain occupations. People in occupations that cause repetitive trauma, such as operating tools that vibrate, may be more vulnerable to secondary Raynaud's.
- Exposure to certain substances. Smoking, medications that affect the blood vessels, and exposure to certain chemicals, such as vinyl chloride, are associated with an increased risk of Raynaud's.
If Raynaud's is severe — which is rare — blood circulation to your fingers or toes could permanently diminish, causing deformities of your fingers or toes.
If an artery to an affected area becomes blocked completely, sores (skin ulcers) or dead tissue (gangrene) may develop. Ulcers and gangrene can be difficult to treat. In extreme untreated cases, your doctor may need to remove the affected part of your body (amputation).
Your family doctor or general practitioner will likely be able to diagnose Raynaud's based on your signs and symptoms. In some cases, however, you may be referred to a doctor who specializes in disorders of the joints, bones and muscles (rheumatologist).
Here's some information to help you get ready for your appointment.
Write down the following:
- Signs and symptoms. Your doctor will want to know when you first noticed these and what seems to trigger them.
- Other medical conditions. Your doctor will want to know if you've been diagnosed with a disorder commonly associated with Raynaud's, such as scleroderma, lupus or Sjogren's syndrome.
- Medications. Include in your list all prescription and over-the-counter medications, vitamins, supplements and herbal remedies you take.
- Questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Some questions to ask your doctor include:
- What is likely causing my signs and symptoms?
- If I have Raynaud's, is it primary or secondary?
- Am I at risk of complications from this condition?
- What treatment do you recommend, if any?
- How can I reduce the risk of a Raynaud's attack?
- I have other health conditions. How can I best manage them together?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did you notice your symptoms?
- During a Raynaud's attack, do your fingers or toes change color or feel numb or painful?
- What seems to trigger an attack?
- Have you been diagnosed with other medical conditions?
- Do you take prescription or over-the-counter medications?
- Has anyone else in your family been diagnosed with Raynaud's?
- Do you smoke?
- Do you use caffeine?
- What do you do for a living and for recreation?
Your doctor will ask about your symptoms and medical history and conduct a physical examination. Your doctor may also run tests to rule out other medical problems that may cause similar signs and symptoms, such as a pinched nerve.
Sorting out primary vs. secondary Raynaud's
To distinguish between primary and secondary Raynaud's, your doctor may perform an in-office test called nail fold capillaroscopy. During the test, the doctor examines your nail fold — the skin at the base of your fingernail — under a microscope. Tiny blood vessels (capillaries) near the nail fold that are enlarged or deformed may indicate an underlying disease. However, some secondary diseases can't be detected by this test.
If your doctor suspects that another condition, such as an autoimmune or connective tissue disease, underlies Raynaud's, he or she may order blood tests, such as:
- Antinuclear antibodies test. A positive test for the presence of these antibodies — produced by your immune system — may indicate a stimulated immune system and is common in people who have connective tissue diseases or other autoimmune disorders.
- Erythrocyte sedimentation rate. This test determines the rate at which red blood cells settle to the bottom of a tube. A faster than normal rate may signal an underlying inflammatory or autoimmune disease.
There's no single blood test to diagnose Raynaud's. Your doctor may order other tests, such as those that rule out diseases of the arteries, to help pinpoint a disease or condition that may be associated with Raynaud's.
Dressing for the cold in layers and wearing gloves or heavy socks usually are effective in dealing with mild symptoms of Raynaud's. Medications are available to treat more-severe forms of the condition. The goals of treatment are to:
- Reduce the number and severity of attacks
- Prevent tissue damage
- Treat the underlying disease or condition
Depending on the cause of your symptoms, medications may help treat Raynaud's. To widen (dilate) blood vessels and promote circulation, your doctor may prescribe:
- Calcium channel blockers. These drugs relax and open small blood vessels in your hands and feet, decreasing the frequency and severity of attacks in most people with Raynaud's. These drugs can also help heal skin ulcers on your fingers or toes. Examples include nifedipine (Afeditab CR, Procardia), amlodipine (Norvasc) and felodipine (Plendil).
- Alpha blockers. Some people find relief with drugs called alpha blockers, which counteract the actions of norepinephrine, a hormone that constricts blood vessels. Examples include prazosin (Minipress) and doxazosin (Cardura).
- Vasodilators. Some doctors prescribe a drug that relaxes blood vessels (vasodilator), such as nitroglycerin cream applied to the base of your fingers to help heal skin ulcers. Some vasodilators commonly used to treat other conditions, including the high blood pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra, Revatio), the antidepressant medication fluoxetine (Prozac, Sarafem, others), and a class of medications called prostaglandins, may relieve the symptoms of Raynaud's.
Work with your doctor to find what works best for you. Tell your doctor if a drug loses effectiveness or causes worrisome side effects.
Some medications can aggravate Raynaud's by leading to increased blood vessel spasm. Your doctor may recommend that you avoid taking:
- Certain over-the-counter (OTC) cold drugs. Examples include drugs that contain pseudoephedrine (Chlor-Trimeton, Sudafed, others).
- Beta blockers. This class of drugs, used to treat high blood pressure and heart disease, includes metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and propranolol (Inderal, InnoPran XL).
Surgeries and medical procedures
For some cases of severe Raynaud's, approaches other than medications may be a treatment option:
Nerve surgery. Nerves called sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Cutting these nerves interrupts their exaggerated response.
Through small incisions in the affected hands or feet, a doctor strips away these tiny nerves around the blood vessels. This surgery (sympathectomy) may reduce the frequency and duration of attacks, but it's not always successful.
- Chemical injection. Doctors can inject chemicals such as local anesthetics or onabotulinumtoxin type A (Botox) to block sympathetic nerves in affected hands or feet. You may need to have the procedure repeated if symptoms return or persist.
A variety of steps can decrease Raynaud's attacks and help you feel better.
- Don't smoke. Smoking causes skin temperature to drop by constricting blood vessels, which may lead to an attack. Inhaling secondhand smoke also can aggravate Raynaud's.
- Exercise. Exercise can increase circulation, among other health benefits. If you have secondary Raynaud's, talk to your doctor before exercising outdoors in the cold.
- Control stress. Learning to recognize and avoid stressful situations may help control the number of attacks.
- Avoid rapidly changing temperatures. Try not to move from a hot environment to an air-conditioned room. If possible, avoid frozen-food sections of grocery stores.
During an attack: What should you do?
First, warm your hands, feet or other affected areas. To gently warm your fingers and toes:
- Get indoors or to a warmer area
- Wiggle your fingers and toes
- Place hands under armpits
- Make wide circles (windmills) with your arms
- Run warm — not hot — water over your fingers and toes
- Massage your hands and feet
If stress triggers an attack, get out of the stressful situation and relax. Practice a stress-reduction technique that works for you, and warm your hands or feet in water to help lessen the attack.
Lifestyle changes and supplements that encourage better circulation may help you manage Raynaud's. However, more study is needed. If you're interested, talk to your doctor about:
- Fish oil. Taking fish oil supplements could help improve your tolerance to cold and delay the narrowing of your blood vessels that triggers Raynaud's attacks.
- Ginkgo. Ginkgo supplements could help decrease the number of Raynaud's attacks you have.
- Biofeedback. Using your mind to control body temperature (biofeedback) may help decrease the severity and frequency of attacks. Biofeedback includes guided imagery to increase the temperature of hands and feet, deep breathing, and other relaxation exercises. Your doctor may be able to suggest a therapist who can help you learn biofeedback techniques. There are books and DVDs on the subject.
- Acupuncture. This practice appears to improve blood flow, so it may be helpful in relieving Raynaud's attacks.
Talk to your doctor before taking supplements. Your doctor can warn you if there are potential drug interactions or side effects of alternative treatments.
Coping with Raynaud's takes patience and effort. Work with your doctor to manage your condition and maintain a positive attitude. The majority of people with Raynaud's respond to treatment.
To help prevent Raynaud's attacks:
- Bundle up outdoors. When it's cold, don a hat, scarf, socks and boots, and two layers of mittens or gloves before you go outside. Wear a coat with fairly snug cuffs to go around your mittens or gloves, to prevent cold air from reaching your hands. Use chemical hand warmers. Wear earmuffs and a face mask if the tip of your nose and your earlobes are sensitive to cold.
- Warm your car. Run your car heater for a few minutes before driving in cold weather.
Take precautions indoors. Wear socks. When taking 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.
Because air conditioning can trigger attacks, set your air conditioner to a warmer temperature. Use insulated drinking glasses.
- Consider relocating. Moving to a warmer climate may help people with severe Raynaud's. However, Raynaud's can occur even in warmer climates when temperatures decrease.
March 04, 2015
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