Your doctor will ask about your symptoms and medical history and conduct a physical examination. Your doctor might also run tests to rule out other medical problems that can cause similar signs and symptoms.
Sorting out primary vs. secondary Raynaud's
To distinguish between primary and secondary Raynaud's, your doctor might perform a test called nail fold capillaroscopy. During the test, the doctor examines the skin at the base of your fingernail under a microscope or magnifier for deformities or enlargement of the tiny blood vessels (capillaries).
If your doctor suspects that another condition, such as an autoimmune or connective tissue disease, underlies Raynaud's, he or she will likely order blood tests, such as:
- Antinuclear antibodies test. A positive test for the presence of these antibodies — produced by your immune system — might indicate a stimulated immune system, 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 might signal an underlying inflammatory or autoimmune disease.
No one blood test can diagnose Raynaud's. Your doctor might order other tests, such as those that rule out diseases of the arteries, to help pinpoint a condition that can 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 might help. To widen (dilate) blood vessels and promote circulation, your doctor might 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, others), amlodipine (Norvasc), felodipine and isradipine.
Vasodilators. These drugs, which relax blood vessels, include nitroglycerin cream applied to the base of your fingers to help heal skin ulcers. Other vasodilators include the high blood pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra, Revatio), the antidepressant fluoxetine (Prozac, Sarafem, others) and a class of medications called prostaglandins.
Surgeries and medical procedures
For some cases of severe Raynaud's, procedures that might be treatment options include:
Nerve surgery. Sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Cutting these nerves interrupts their exaggerated responses.
Through small incisions in the affected hands or feet, a doctor strips these tiny nerves around the blood vessels. This surgery (sympathectomy), if successful, might reduce the frequency and duration of attacks.
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 might need to have the procedure repeated if symptoms return or persist.
Lifestyle and home remedies
A variety of steps can decrease Raynaud's attacks and help you feel better.
- Avoid smoke. Smoking or inhaling secondhand smoke causes skin temperature to drop by constricting blood vessels, which can lead to an attack.
- 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 might 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.
What to do during an attack
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 might help you manage Raynaud's. However, the evidence of effectiveness is unclear and 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.
Ginkgo. Ginkgo supplements could help decrease the number of Raynaud's attacks.
Acupuncture. This practice appears to improve blood flow, so it may be helpful in relieving Raynaud's attacks.
Biofeedback. Using your mind to control body temperature might 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.
Talk to your doctor before taking supplements. Your doctor can warn you if there are potential drug interactions or side effects of alternative treatments.
Preparing for your appointment
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 information to help you get ready for your appointment.
Make a list of:
- Your symptoms, when they began and what seems to trigger them
- Other medical conditions you and your family have, particularly connective tissue or autoimmune disorders
- All medications, vitamins and other supplements you take, including doses
- Questions to ask your doctor
Take a family member or friend along, if possible, to help you remember the information you receive.
Questions to ask your doctor include:
- What is likely causing my signs and symptoms?
- If I have Raynaud's, is it primary or secondary?
- 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 manage them together?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, including:
- During a Raynaud's attack, do your fingers or toes change color or feel numb or painful?
- Has anyone else in your family been diagnosed with Raynaud's?
- Do you smoke?
- How much caffeine, if any, do you consume daily?
- What do you do for a living and for recreation?
Oct. 19, 2017