Despite being a relatively common condition, not everyone is familiar with Raynaud’s (or Raynaud’s phenomenon). It’s a condition where blood flow to the fingers and toes becomes restricted, causing them to turn blue or white. Sometimes, the fingers might become difficult to move or feel painful.
While in the majority of cases it doesn’t lead to serious problems, Raynaud’s can be uncomfortable to experience.
To find out more about the condition, we spoke to Lynn Wunderman, Chairman of US-based charity the Raynaud’s Association.
Why does Raynaud’s occur?
According to the Raynaud’s Association, Raynaud’s is thought to affect between 5 and 10 percent of the population. The condition can occur in anyone of any age, but seems to affect younger women and girls more frequently.
The appearance of symptoms (extremities changing colour) can look quite striking and as though something is significantly amiss. However, the physiological changes that occur are in fact ‘normal’; it is the point at which they are experienced which is not.
Lynn explains that: ‘for most sufferers, the process of a Raynaud’s attack is a normal body reaction to cold temperatures or stress, but patients with Raynaud’s have a much lower threshold. With a non-sufferer, this might occur at -5°c or -10°c; but for a Raynaud’s sufferer it can happen at 10°c or 15°c.’
‘It can be helpful to think of it in terms of the body’s ‘fight or flight’ response. When the body feels it is in danger from extreme cold or stress, the blood vessels in the extremities shut down to send the blood supply to the body’s vital organs for protection. That’s why it is important not to just warm the extremities, but the full body, especially the core, to help deter this reaction.’
Primary and Secondary Raynaud’s: What’s the difference?
Like many other conditions, Raynaud’s can be ‘primary’ (which means that it occurs on it’s own) or ‘secondary’ (the result of another underlying condition).
It is not fully understood why primary Raynaud’s reactions occurs in some people and not others, although it has been theorised that genetics may be a factor.
Secondary Raynaud’s, which is much less common, can be the result of several health conditions, including some autoimmune diseases.
‘In a minority of patients (less than 10 percent),’ Lynn explains, ‘Raynaud’s is caused by another medical condition that can constrict or damage the blood vessels and is known as Secondary Raynaud’s. This form can be a by-product of a more serious autoimmune disease, such as lupus, scleroderma or rheumatoid arthritis.’
It’s incredibly important then to have Raynaud’s symptoms checked out by a doctor, so that these conditions can be identified or ruled out.
‘Raynaud’s can be the first sign that one of these conditions is present and requires medical attention.’ Lynn tells us. ‘Patients with the secondary form are more likely to experience intense and frequent attacks. Their symptoms can even result in dangerous digital ulcers and potentially long-term damage to their blood vessels.’
It is also possible for Raynaud’s to occur as a result of external factors.
‘In addition to autoimmune diseases, Raynaud’s may signal damage to the blood vessels caused by occupational triggers.’ Lynn explains. ‘This form of Raynaud’s is called Vibration White Finger and can be caused by repeated pressure to the extremities from use of vibrating tools and equipment (as might be used by construction workers, woodworkers, dentists, stenographers, or pianists).’
‘Additional causes can include trauma, excessive smoking, vascular issues, or exposure to certain drugs (chemo), chemicals or toxins.’
It is possible for Raynaud’s to be confused with other conditions also triggered by cold weather.
‘If a patient describes their fingers or toes turning white or blue; becoming painful; swollen; tingling or numb, following exposure to cold temperatures or stressful events, then Raynaud’s is a potential explanation. However, Raynaud’s is sometimes confused with other medical conditions that are linked to cold exposure, including:
- Cold Urticaria. This condition is caused by an allergic reaction to cold temperatures, water or mild trauma. Sufferers develop red skin lesions with rash-like symptoms and severe itching.
- Chilblains. Are a result from defective blood circulation when a sufferer is exposed to the cold. The symptoms are inflammation, severe itching, swelling and a burning sensation. The skin can then become itchy, red, swollen and tender to the touch.’
But it is possible, Lynn explains, for symptoms to be caused by a combination of one or more of these factors: ‘The above conditions are not necessarily mutually-exclusive. For example, a Raynaud’s sufferer can also experience chilblains symptoms.’
Talking to a doctor
Some people who experience Raynaud’s attacks may not require medical treatment to keep their symptoms in check. However, when symptoms occur, having them checked by a doctor is, for reasons explained above, crucial.
‘The Raynaud’s Association and its Medical Advisory Board recommend consulting with a physician as soon as an individual exhibits symptoms.’ Lynn explains. ‘A physician will seek to determine whether the condition is Raynaud’s and, if so, whether it is primary or secondary.’
‘If Raynaud’s is diagnosed as secondary, then the patient may be treated for both Raynaud’s and the underlying condition.’
‘Various medications and lifestyle changes might help to prevent or at least lessen spasms that can cause hard-to-heal and potentially dangerous digital ulcers.’
Treating Raynaud’s at home
As Lynn explains, there are certain things someone with Raynaud’s can do to limit the likelihood of a recurring flare-up.
‘Raynaud’s attacks are triggered by cold or stress. Patients are sometimes advised to ‘avoid the cold or stress trigger’ but this is easier said than done. Raynaud’s is a year-round issue and it applies to all climates.’
‘Nonetheless, Raynaud’s sufferers should be diligent in keeping as warm and stress-free as possible. Ice fishing or downhill skiing may no longer be at the top of the activity list, but virtually no activity is automatically labeled taboo, as sufferers have different threshold levels of tolerance. The key is to take precautions to protect yourself from the cold as much as possible.’
In cases where the condition is not particularly severe, Lynn advises that it may be possible to manage Raynaud’s symptoms at home by making small lifestyle changes:
- ‘Dress in layers, including a hat when outdoors in cold weather. Try to stay indoors during frigid conditions.
- Wear gloves when exposed to cold weather, air conditioning or cold temperatures (in the refrigerated section of a supermarket). Mittens can sometimes provide better protection. Remember to use these when handling frozen or refrigerated foods.
- Carry hand and foot warmers (like those found in many sporting goods and ski shops).
- Drink from insulated glasses or mugs. Wrap a napkin around them to help prevent your fingers from becoming cold.
- Place hands under warm (not hot) water when you need to warm them up.
- Avoid smoking. It can narrow blood vessels and make symptoms worse.
- Move arms around in a windmill motion to help increase circulation.
- Self-help, relaxation techniques such as biofeedback and tai chi may help some people minimize the severity of Raynaud’s attacks. These methods have not been clinically proven and may require a great deal of practice and commitment to achieve real results.’
Medicines to treat Raynaud’s
How the condition is approached is largely dependant on whether it is primary or secondary, as Lynn illustrates:
‘For those with secondary Raynaud’s, the treatment plan can depend on the primary ailment, as some can be fatal and affect other organs of the body and the joints. While primary Raynaud’s can be uncomfortable, inconvenient and sometimes painful, it’s generally not life-threatening.’
Severe cases of primary Raynaud’s can be managed with prescription medication, but there is not currently a cure for the condition.
‘To date, there is no medication that eliminates Raynaud’s attacks, but there are some drugs that decrease their severity and frequency.’ Lynn explains. Calcium-channel blockers are a common choice. ‘These drugs work to dilate the blood vessels so the blood circulates more freely. They are the same medications given to people with high blood pressure.’
It can take some time to pinpoint an effective treatment plan for Raynaud’s, especially if the patient has other health conditions or contraindications, but there are several options a doctor may suggest.
‘Topical antibiotics or nitroglycerin paste or patches may be prescribed to protect against infected skin ulcers.’ Lynn goes on to say.
‘If a patient’s blood pressure is already low, they may not be a candidate for some of these treatments, and there is the potential they can cause side effects such as ankle swelling, lightheadedness and headaches. As different brands and generic forms of these drugs are available, sufferers should work closely with their doctor to determine what works best for their body and be aware that it does take time to see results.’
Surgical intervention can be used to treat some patients where medication has failed to provide relief.
‘For the most severe cases where digital ulcers are involved that won’t heal, and the patient is unresponsive to the first-line medications and is at risk of losing a digit, then additional options involve surgical procedures (digital sympathectomy) and higher-level drugs (Iloprost) given intravenously in a hospital environment.’
Research into the condition and how to combat symptoms is ongoing. But as Lynn explains, much of this has been concentrated on the effects of Raynaud’s and not the cause:
‘Unfortunately, most research to date has focused on treatment, as opposed to cause and cure. More recent studies have involved the use of erectile dysfunction drugs (for example Viagra and Cialis) – which are powerful vasodilators – and they are proving to be effective in treating more severe sufferers.’
‘Another treatment option that is showing promise is the use of Botox injections. While still in the trial phase, results in small test samples are suggesting it has potential. The theory behind the research is that Botox may block the action of noradrenaline, a chemical that triggers the constriction of blood vessels in Raynaud’s attacks.’
For more helpful information on Raynaud’s, head over to the Raynaud’s Association website.
If you think you may have Raynaud’s or are experiencing symptoms, make an appointment with your doctor.
Portions of information provided are available in the 35-page guide: The Cold Facts on Raynaud's. Copyright © 2018 Raynaud's Association, Inc. All Rights Reserved.