Raynaud’s Disease Causes and Diagnosis

What Is Raynaud’s Disease? Raynaud’s disease (also known as Raynaud’s phenomenon and sometimes just called Raynaud’s) is a condition that causes some areas of the body to feel numb and cool in response to cold temperatures or stress.

It mostly affects the extremities such as the fingers, toes, tip of the nose and the ears. It is a common condition of the blood vessels that supply blood to the skin. Smaller arteries narrow and limit blood circulation to affected areas. This causes the area to become cold and white, with a feeling of pins and needles and numbness, eventually turning blue then red. It is sometimes painful.

According to Medilexicon’s medical dictionary:

Raynaud’s phenomenon is an “idiopathic paroxysmal bilateral cyanosis of the digits due to arterial and arteriolar contraction; caused by cold or emotion.”

The disease is named for Maurice Raynaud (1834 – 1881), a French physician who first described it in 1862.

The condition is either:

Primary. This is the most common form, there is no apparent cause.

Secondary. It is associated with an underlying disease, such as rheumatoid arthritis.

It is difficult to measure how many people are affected because many are unaware that their condition has a name or that it can be treated. It is much more common in women than in men. The condition can affect people of all ages, though it usually develops before the age of 40. It is also more common in people who live in colder climates.

Treatment of Raynaud’s disease depends on its severity and the presence of associated conditions. The symptoms of Raynaud’s are usually mild and do not affect day-to-day life. In more severe cases it can be successfully controlled with medicine. The condition sometimes goes away on its own.

What are the signs and symptoms of Raynaud´s disease?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Raynaud’s disease is different than having cold hands and cold feet or frostbite. Signs and symptoms of Raynaud’s depend on the frequency, duration and severity of the blood vessel spasms. They can include:

Cold fingers and toes

Sequence of color changes in the skin in response to cold or stress

Numb, tickling, throbbing or stinging pain upon warming or relief of stress

Usually, the affected areas of the skin turn white at first. Then, the affected areas often turn blue, feel cold and numb, and the sensory perception is dulled. As circulation improves, the affected areas may turn red, throb, tingle or swell. The order of the changes of color is not identical for all people, and not everyone experiences all three colors.

Primary Raynaud’s tends to be fairly mild, whereas secondary Raynaud’s, caused by another condition, is often more severe.

Occasionally, an attack of Raynaud´s disease affects just one or two fingers or toes. Attacks do not necessarily always affect the same digits. Raynaud’s most commonly affects the fingers and toes. However, the condition can also affect other areas of the body, such as the nose, lips, ears and even nipples. An attack may last less than a minute to several hours.

People who have Raynaud’s accompanied by another disease will likely also have signs and symptoms related to their basic underlying condition.

Seek medical advice if there is a history of severe Raynaud’s or if an ulcer or infection develops in one of the affected fingers or toes.

What are the risk factors?

Risk factors for primary Raynaud’s include:

Gender. Primary Raynaud’s affects women more than men.

Age. Anyone can develop the condition. Primary Raynaud’s often begins between the ages of 15 and 30.

Location. The disorder is also more common in people who live in colder climates.

Family history. It appears to increase the 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 workers who operate tools that vibrate, also may be more vulnerable to secondary Raynaud’s.
Exposure to certain substances. Smoking, medications that affect the blood vessels and exposure to chemicals such as vinyl chloride are associated with an increased risk of Raynaud’s.

Raynaud’s disease causes

Doctors do not completely understand the cause of Raynaud’s attacks, but blood vessels in the hands and feet appear to overreact to cold temperatures or stress.

When the body is exposed to cold temperatures, the fingers and toes lose heat. The small blood vessels under the skin of the fingers and toes become narrower. This slows down the blood supply to these areas, which helps to preserve the body’s general temperature.

In people with Raynaud’s, the small blood vessels in the fingers and toes are more sensitive than usual and overreact to cold temperatures. This makes them narrow more than usual and allows a very limited amount of blood to flow through them.

Symptoms can be triggered by even mildly cool weather, getting something out of the freezer or running hands under water.

Strong emotion or anxiety may also trigger symptoms. Stress causes a similar reaction to cold in the body. Likewise, the body’s response may be exaggerated in people with Raynaud’s.

Health conditions

Various conditions of blood vessels, joints or skin can cause secondary Raynaud’s, including:
Lupus. Raynaud’s is a common problem for people with lupus erythematosus. It is an autoimmune disease that can affect many parts of the body, including the skin, joints, organs and blood vessels.
Rheumatoid arthritis. Raynaud’s may be an initial sign of rheumatoid arthritis. It is an inflammatory condition causing pain and stiffness in the joints, often including the hands and feet.
Scleroderma. Raynaud’s phenomenon occurs in the majority of people who have scleroderma. It is a rare disease that leads to hardening and scarring of the skin. The disease reduces blood flow to the extremities.
Sjogren’s syndrome. Raynaud’s phenomenon can also occur in people who have Sjogren’s syndrome. It is an autoimmune disorder that may accompany scleroderma, lupus or rheumatoid arthritis.
Diseases of the arteries. Raynaud’s phenomenon can be associated with various diseases that affect arteries, such as atherosclerosis, Buerger’s disease, primary pulmonary hypertension.
Carpal tunnel syndrome. The carpal tunnel is a narrow passageway in the wrist that protects a major nerve to the hand. Carpal tunnel syndrome is a condition in which pressure is put on this nerve, producing numbness and pain in the affected hand.
Medications

Secondary Raynaud’s can be a side effect of taking certain medicines, including:

anti-migraine medications that contain ergotamine
beta-blockers (used to treat raised blood pressure or heart disease)
decongestants, such as some over-the-counter cold medications
in some cases, the contraceptive pill and HRT, medications containing estrogen
some cancer drugs (certain chemotherapy agents)
Injury and overuse

Raynaud’s sometimes results from a physical injury to the affected area. Prior injuries to the hands or feet, such as wrist fracture, surgery or frostbite, can lead to the condition. It can also affect musicians, typists or other people who use their fingers and hands more than usual. Raynaud’s can also be caused by repetitive trauma that damages nerves serving blood vessels in the hands and feet. Some people who type or play the piano vigorously or for long periods of time may be susceptible to Raynaud’s.

Vibration

Workers who operate vibrating tools can develop a type of Raynaud’s phenomenon called vibration-induced white finger. This typically happens to people who regularly use certain types of vibrating tools, such as chainsaws, hedge trimmers and power mowers, chipping hammers, concrete breakers and pokers, hammer drills, sanders, grinders and disc cutters, scabblers and needle guns.

The employer has a responsibility to protect workers from vibration white finger. Workers should ask to use suitable low-vibration tools, use the right tool for the job, check tools to make sure they are properly maintained, make sure cutting tools are kept sharp, reduce the amount of time you use the tool in one go by doing other jobs in between, keep warm at work, wear anti-vibration gloves and warm clothing if working in the cold, store tools correctly so they do not have cold handles when next used, and encourage blood circulation by keeping warm, massage and exercise fingers during breaks.

If vibration white finger has been diagnosed stop exposure to vibration as soon as possible. This may help full recovery.

Smoking

Smoking constricts blood vessels and is a potential cause of Raynaud’s.

Chemical exposure

People exposed to vinyl chloride, such as those who work in the plastics industry, may develop an illness similar to scleroderma. Raynaud’s can be a part of that illness.

Other causes

Raynaud’s has also been linked to thyroid gland disorders.

What are the complications of Raynaud´s disease?

If the rare cases where Raynaud’s disease is severe, blood circulation to the fingers or toes could permanently diminish, causing deformities of the fingers or toes.

If an artery to an affected area becomes blocked completely (thrombosis), sores (skin ulcers) or dead tissue (gangrene) may develop. This can be difficult to treat.

A small number of people who have Raynaud’s also develop scleroderma. The disease affects the connective tissue (the supporting tissues of the body, such as tendons and ligaments). Symptoms of scleroderma include:
diarrhea, bloating or constipation
puffy and itchy skin
small calcium spots and red spots under the skin
tight and uncomfortable joints
trouble swallowing
There is no cure for scleroderma, but medication can control it.

It is essential to include plenty of vitamins A, C, and E in your diet. These antioxidants help reduce inflammation. A healthy diet, not smoking and doing regular exercise are important to protect your heart.

How is Raynaud´s disease diagnosed?

A physical examination is conducted as well as a review of the symptoms and medical history to rule out other causes, such as arthritis or scleroderma.

Raynaud’s can often be diagnosed directly from a description of the symptoms, but it may be more difficult to identify if another condition is causing the symptoms (secondary Raynaud’s).

Additional tests are sometimes necessary:

Cold-simulation test

It involves placing hands in cool water or exposing the patient to cold air to bring on an episode of Raynaud’s. This allows the specialist to witness the symptoms.

Nail fold capillaroscopy

In order to find out if Raynaud’s is primary or secondary, an examination of the tiny blood vessels (capillaries) near the nail fold (the skin at the base of the fingernail) is performed under a microscope.

Enlarged or deformed capillaries may indicate an underlying disease. However, some secondary conditions cannot be spotted by this test.

Blood tests

A blood test may be recommended if an underlying condition is suspected. However, there is no single blood test to diagnose Raynaud’s.

Antinuclear antibodies (ANA) test: If these antibodies are present, it indicates an overactive immune system, which is common in people with connective tissue diseases or other autoimmune disorders, such as rheumatoid arthritis and lupus (commonly associated with Raynaud’s).

Erythrocyte sedimentation rate: It measures how fast the red blood cells settle to the bottom of a test tube. A faster-than-normal fall rate suggests swelling of the tissues, which can indicate an autoimmune disorder.

What is the treatment for Raynaud´s disease?

Usually, self-care and prevention steps are effective in dealing with mild symptoms of Raynaud’s. However, 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 and treat any underlying disease or condition.

Medications

Depending on the cause of the symptoms, medications may prove helpful in treating Raynaud’s. This can effectively dilate blood vessels and promote circulation.

Calcium channel blockers. These drugs relax and open up small blood vessels in the hands and feet. They decrease the frequency and severity of attacks in most people with Raynaud’s. Some people only use it during the winter or cold weather spells. These drugs can also help heal skin ulcers on the fingers or toes. Examples include nifedipine (Adalat CC, Afeditab CR, Procardia), amlodipine (Norvasc) and felodipine (Plendil). Do not drink grapefruit juice when taking nifedipine. The juice can increase the amount of nifedipine absorbed by the body, which could cause changes in blood pressure.
Alpha blockers. Some people find relief with drugs called alpha blockers, which counteract the actions of norepinephrine (angiotensin), a hormone that constricts blood vessels. Examples include prazosin (Minipress) and doxazosin (Cardura).
Vasodilators. Those are drugs that relax blood vessels, such as nitroglycerin cream to help heal skin ulcers. Vasodilator drugs are commonly used to treat other conditions, but may effectively relieve the symptoms of Raynaud’s. These drugs include the high blood pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra), the antidepressant medication fluoxetine (Prozac), and a class of medication called prostaglandins.

Some drugs work better for some people than others. In addition, some drugs used to treat Raynaud’s have side effects that may require stopping the medication. A drug may also lose effectiveness over time.

Some medications actually can aggravate Raynaud’s by leading to increased blood vessel spasm. Some of these drugs should be avoided:

Certain over-the-counter (OTC) cold drugs. Examples include drugs that contain pseudoephedrine (Actifed, Chlor-Trimeton, Sudafed).
Beta blockers. They are used to treat high blood pressure and heart disease. They include metoprolol (Lopressor, Toprol), nadolol (Corgard) and propranolol (Inderal, Innopran XL).
Birth control pills. It might be recommended to switch to another method of contraception because these drugs affect circulation and may trigger attacks. Talk to your doctor before stopping the pill.
Other treatments

In cases of severe Raynaud’s disease, other approaches may be a treatment option:

Nerve surgery. Sympathectomy or ‘nerve blocks’. The sympathetic nerves in the hands and feet control the opening and narrowing of blood vessels in the skin. In cases of severe Raynaud’s it can be necessary to cut these nerves to interrupt their exaggerated response. The surgery, called sympathectomy, may reduce the frequency and duration of attacks. It is not always successful.
Chemical injection. Chemicals can be injected to block sympathetic nerves in affected hands or feet. The procedure may need to be repeated if symptoms return or persist.
Intravenous infusion therapy. If there is no response to the other treatments, intravenous infusion therapy may be performed. This is the injection of drugs into the bloodstream through a vein. This is usually given for three to five days using a drug called iloprost, which aims to open up the blood vessels to help them carry more blood to all areas of the body.
Amputation. In rare cases, damaged tissue from a lack of blood supply needs to be removed. This may include amputating a finger or toe affected by Raynaud’s in which the blood supply has been completely blocked. The tissue has developed gangrene.
Stress counseling. Counseling may be useful for primary Raynaud’s and if symptoms are triggered by stress or anxiety.

Prevention and control

A variety of steps can decrease Raynaud’s attacks and symptoms:

No smoking. Smoking causes skin temperature to drop by constricting blood vessels, which may lead to an attack. The chemicals in tobacco can cause the small blood vessels to narrow. Quitting may ease or cure the problem. Inhaling secondhand smoke also may aggravate Raynaud’s.
Exercise. Exercise regularly, particularly in the case of primary Raynaud’s. Exercise can increase circulation, among other health benefits.
Control stress. Because stress may trigger an attack, learning to recognize and avoid stressful situations may help control the number of attacks.
Avoid caffeine. Tea, coffee and cola can also worsen symptoms in some people. Caffeine causes your blood vessels to narrow and may increase the signs and symptoms of Raynaud’s.
Care of hands and feet. Guard hands and feet from injury. Do not walk barefoot. Take care of nails to avoid injuring sensitive toes and fingertips. Avoid wearing anything that compresses blood vessels in hands or feet (tight wristbands, jewelry, and footwear).
Workplace tools. Avoiding tools that vibrate the hand may reduce the frequency of attacks.
Keep warm. Wear warm gloves, socks and shoes when going out in the cold weather. It is best to put on the gloves when you are warm, before going out into the cold. Portable heat packs and battery-heated gloves and socks can be useful. Also, symptoms are less likely to occur if the entire body is warm. Wrap up in warm clothes, a hat and scarf when out in cold weather. Keep natural fibers (cotton, wool and silk) next to the skin. Man-made fibers tend to make skin sweat. Layers of clothes are a good insulator.
Check medication. Some medicines used to treat other conditions can trigger symptoms of Raynaud’s or make them worse. However, do not stop a prescribed medicine. See your doctor first to discuss the options.
Avoid touching cold objects. Sometimes, just touching something cold can bring on an attack. Try not to do the things that cause an attack.

What to do during an attack?

Firstly, the most important action is to warm hands or feet or any other affected areas of skin. Gently warm fingers and toes with the following steps:
Make wide circles, or windmills, with arms.

Massage hands and feet.

Move to a warmer area.

Place hands under armpits.
Run warm (but not hot) water over fingers and toes.
Wiggle fingers and toes.

If a stressful situation triggers an attack, a way to help stop the attack is getting out of the stressful situation and relaxing. Biofeedback is a technique along with warming the hands or feet in water that can help lessen the attack.

Lifestyle changes

Lifestyle changes and supplements help encourage better circulation. They may be effective alternatives for managing Raynaud’s disease:
Biofeedback. It is a technique that uses the mind to control body temperature. It 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.
Niacin. Niacin, also known as vitamin B-3, causes blood vessels to dilate, increasing blood flow to skin. Niacin supplements may be useful in treating Raynaud’s disease. However, niacin supplements may have side effects.

It takes patience and effort to cope with the stress and nuisance of Raynaud’s disease. Medical advice and a positive attitude can help manage the condition. The majority of people with Raynaud’s respond to treatment.

Tips to keep warm. In winter, wear a hat, scarf, socks and boots. Put them on before you go outside. A hat is essential because a great deal of body heat is lost through the head. Wear a coat with fairly snug cuffs to prevent cold air from reaching the hands. Wear earmuffs and a face mask if the tip of your nose and your earlobes are sensitive to cold.

Run your car heater for a few minutes before driving in cold weather.

Precautions indoors. Wear socks. Some people find it helpful to wear mittens and socks to bed during winter. When taking food out of the refrigerator or freezer, protect your hands by wearing gloves, mittens or oven mitts.

Because air conditioning can trigger attacks, setting your air conditioner to a warmer temperature may help prevent attacks. You may also find it helpful to use insulated drinking glasses.

Consider moving to a location with a milder climate. Moving to a warmer climate may help people with severe Raynaud’s disease.

However, the condition can occur even in warmer climates when the temperature decreases.