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Raynaud's Phenomenon

What is Raynaud's phenomenon?

Raynaud's phenomenon or, simply, Raynaud's, is a disorder characterized by decreased blood flow to the fingers, and less frequently to the ears, toes, nipples, knees, or nose. Vascular spasms usually occur as attacks in response to cold exposure, stress, or emotional upset.

Raynaud's can occur alone (primary form) or may occur with other diseases (secondary form). The diseases most frequently associated with Raynaud's are autoimmune or connective tissue diseases, among others, such as:

  • Systemic lupus erythematous (lupus)

  • Scleroderma

  • CREST syndrome (a form of scleroderma involving calcium skin deposits, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias)

  • Buerger's disease

  • Sjögren's syndrome

  • Rheumatoid arthritis

  • Occlusive vascular disease, such as atherosclerosis 

  • Polymyositis

  • Blood disorders, such as Cryoglobulinemia

  • Thyroid disorders

  • Pulmonary hypertension

What causes Raynaud's phenomenon?

The exact cause of Raynaud's is unknown. One theory links blood disorders characterized by increased platelets or red blood cells that may increase the blood thickness. Another theory involves the special receptors in the blood that control the constriction of the blood vessels that are shown to be more sensitive in individuals with Raynaud's.

What are the risk factors for Raynaud's phenomenon?

There are certain diseases or lifestyle choices that can increase a person's risk for developing Raynaud's. These risk factors include:

  • Existing connective tissue or autoimmune disease

  • Cigarette smoking 

  • Repetitive actions, such as typing or use of tools that vibrate (like a jack hammer) 

  • Injury or trauma  

  • Chemical exposure 

  • Side effects from certain medications 

What are the symptoms of Raynaud's phenomenon?

The following are the most common symptoms of Raynaud's phenomenon. However, each individual may experience symptoms differently. Symptoms may include:

  • A pattern of color changes in the fingers as follows: pale or white followed by blue then red when the hands are warmed; color changes are usually preceded by exposure to cold or emotional upset

  • Hands may become swollen and painful when warmed

  • Ulcerations of the finger pads develop (in severe cases)

  • Gangrene may develop in the fingers and, in rare cases, lead to infection or amputation.

How is Raynaud's phenomenon diagnosed?

There are no specific laboratory tests that can confirm a diagnosis of Raynaud's phenomenon. Instead, diagnosis is usually based on reported symptoms. Your doctor may perform a cold challenge test to bring out color changes in the hands or a nailfold capillaroscopy where your fingernail is examined under a microscope.

Tests to determine which form—primary or secondary—of Raynaud's phenomenon a patient may have include a medical exam, blood tests, and a complete medical history. 

What is the treatment for Raynaud's phenomenon?

Specific treatment for Raynaud's phenomenon will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the disease

  • Your opinion or preference

Although there is no cure for Raynaud's phenomenon, the disorder can often be successfully managed with proper treatment. Treatment may include:

  • Preventive measures, such as avoiding cold exposure and wearing extra layers to keep warm, including warm gloves, socks, scarf, and a hat 

  • Smoking cessation

  • Wearing finger guards over ulcerated fingers

  • Avoiding trauma or vibration to the hand (such as vibrating tools)

  • Medications that are usually used to treat high blood pressure (antihypertensive medications) may be given during the winter months (to help reduce constriction of the blood vessels)

Individuals who first experience Raynaud's phenomenon after ages 35 to 40 may be tested for an underlying disease. The primary form of Raynaud's is the most common type, and usually begins between ages 15 and 25. It's less severe, and few people with this form develop another related condition.