What is Raynaud's Disease?
Raynaud’s phenomenon (Raynaud’s, or RP) is a condition which reduces blood flow to the extremities. It reduces blood flow to the extremities (usually the fingers and toes), causing the small blood vessels go into spasm in cold temperatures. As the fingers and toes warm up, the skin usually turns another colour such as red or blue, then returns to normal.
Primary and Secondary Types of Raynaud's
If you have primary Raynaud’s, there is no associated underlying autoimmune disease, but it can run in your family. Women in their 20s or 30s are most commonly affected, and it occurs more often in young women who are thin.
Secondary Raynaud’s occurs alongside a secondary autoimmune disease like lupus, scleroderma or rheumatoid arthritis. This type of Raynaud’s is usually more severe than the primary type, and the symptoms may worsen over time.
Secondary Raynaud’s is typically associated with underlying autoimmune diseases. Nearly all patients with systemic sclerosis (scleroderma) also have Raynaud’s.
Causes of Attacks
Attacks of Raynaud’s are typically caused by exposure to cold temperatures, and may last anywhere from a few minutes to a few hours. In some patients, the attack lasts longer than a few hours. Other things that can trigger attacks include injury, emotional stress, smoking and hormonal changes.
Patients are at a higher risk of developing Raynaud’s if they have had a previous injury to the fingers and toes, such as surgery or frostbite. People who work in professions where they perform repetitive actions or experience vibrations, such as using a drill or jackhammer, are also at a higher risk.
Experts don’t understood what causes the blood vessels to become more sensitive to cold temperatures and other triggers. However, it’s believed the disease is related to the immune system because Raynaud’s can be associated with autoimmune or connective tissue diseases.
Pregnancy can be more complicated in women who have Raynaud’s phenomenon and an underlying autoimmune disease. Some women are at risk of multiple miscarriages.
Symptoms of Raynaud’s Phenomenon
Raynaud’s most commonly affects the fingers and toes. In rare cases, it can affects the ears, nose, lips and nipples. Women who are breastfeeding may have difficulty if Raynaud’s affects the nipples.
In severe cases of secondary Raynaud’s, a person may develop painful ulcers on the fingertips.
People with Raynaud’s often experience an attack of symptoms, which reduces blood flow to the fingers and toes. Some people notice colour changes in affected areas over the course of an attack, first turning white, then red or blue before returning to the natural skin colour. Many patients find Raynaud’s painful as the areas re-warm.
Raynaud’s phenomenon can be triggered by cold temperatures and in stressful situations. For most patients, attacks last about five to ten minutes, but can vary in duration.
Diagnosis of Raynaud’s
If your family doctor suspects you have Raynaud’s phenomenon, he or she will likely refer you to a rheumatologist, a type of physician that specializes in arthritis and autoimmune disease.
To diagnose Raynaud’s phenomenon, the rheumatologist will take your medical history and perform a physical examination. Your doctor will likely order tests to confirm the diagnosis. The rheumatologist may ask you to bring in photos of the affected areas to confirm the diagnosis of Raynaud’s.
Common Tests for Raynaud’s Phenomenon
While other tests might be performed to determine if there are potential underlying autoimmune diseases that might accompany secondary Raynaud’s, the following tests are most commonly used to diagnose Raynaud’s.
Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP): These tests look for inflammation, and may produce abnormal results in patients with Raynaud’s.
Rheumatoid Factor (RF) and Anti-Nuclear-Antibody (ANA): These tests look for signs of autoimmune disease to identify secondary Raynaud’s.
Thyroid Stimulating Hormone (TSH) test: This will rule out thyroid conditions that might be associated with Raynaud’s.
The most common treatment for Raynaud’s is preventing attacks, including keeping the body, hands, and feet warm. It can also be beneficial to avoid stress, vibrations and repetitive motions. Making lifestyle changes such as avoiding caffeine and nicotine may also help. Medications are only used for Raynaud’s when other treatments don’t work.
Medications for Raynaud’s Phenomenon
Many patients only take medications when the need to, such as in colder climates. Common medications for Raynaud’s include:
Calcium channel blockers: The most common type of medication used to treat Raynaud’s is a blood pressure lowering medication. Examples of calcium channel blockers include nifedipine, amlodipine, or felodipine.
Erectile dysfunction medications: Drugs such as Viagra (sildenafil) or Cialis (tadalafil) may be effective in lower doses.
Selective serotonin reuptake inhibitors (SSRIs): Drugs such as fluoxetine, a type of medication used to treat depression, may improve symptoms.