Raynaud's phenomenon
Raynaud's phenomenon is an extreme reaction to cold conditions.
The blood supply to your fingers and possibly your toes is suddenly
reduced causing them to change colour. You may also have pain or a
tingling sensation when this happens.
Anybody can get Raynaud's, but it's most common in young women
and teenage girls. It can occur on its own or with other conditions
such as lupus or scleroderma, which may be more serious.
It's important to see your doctor and get an accurate
diagnosis, so that appropriate treatment can begin.
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Raynaud's phenomenon symptoms
If you have Raynaud's phenomenon your hands, and sometimes your
feet and the tip of your nose, change colour when exposed to cold
conditions – for example:
- white: as the blood supply to
the fingers is reduced
- blue: as the blood in the
fingers becomes short of oxygen, and finally
- red: as the blood comes
rushing back when the hands become warm again.
You may not experience all three stages but you may have the
accompanying pain, tingling or numbness. Attacks often last only a
few minutes, and moving to somewhere warmer often stops the
attack.
Raynaud's phenomenon may be described as:
- primary (meaning it is not associated with any other
condition)
- secondary (meaning it is associated with another condition such
as lupus or scleroderma).
In primary Raynaud's phenomenon, your fingers return to normal
after each attack. Attacks can be a painful nuisance but they won't
damage your fingers.
Secondary Raynaud's phenomenon can be much more severe and can
cause finger
ulcers or even
gangrene of the fingertip. If the colour doesn't quickly
return to normal or if you develop ulcers on your fingers or toes
you should see your doctor immediately. Usually these problems are
very painful.
If you have scleroderma or lupus it's likely that you will also
have Raynaud's symptoms at some stage. However, having Raynaud's
doesn't mean that you'll go on to develop lupus or
scleroderma.
If there is an associated condition, then it is
important that it is diagnosed promptly.
What causes Raynaud's phenomenon?
A reduction in the blood supply to your fingers and toes is a
normal response to cold conditions and prevents heat loss from the
body. In Raynaud's the response is exaggerated. Simply reaching
into the freezer can bring on an attack, but so can anxiety or
using vibrating machinery.
Emotional changes, such as anxiety, can sometimes cause an
attack of Raynaud's by triggering nerves to shut down the blood
supply to the affected parts.
Using vibrating machinery can also cause Raynaud's phenomenon –
this is called vibration white finger or hand-arm vibration
syndrome. Raynaud's phenomenon can sometimes be a side-effect of
certain drugs such as beta-blockers which are used in the treatment
of raised blood pressure and
angina.
How is Raynaud's phenomenon diagnosed?
Your symptoms should be enough to establish whether you have
Raynaud's, but tests may be needed to check whether there's an
underlying cause.
The most common tests for Raynaud's phenomenon are:
- Blood tests – to check the blood count and the
body's immune
system
- An x-ray – to look for an extra rib at the
base of the neck (called a cervical rib). This can cause Raynaud's
phenomenon by causing pressure on the blood vessels that supply the
arms
- Nailfold microscopy – to check for
abnormalities in the blood vessels at the base of your fingernail.
In some clinics the blood vessels may be examined under a
magnifying lens rather than a microscope.
Raynaud's phenomenon treatments
Many of the treatments are common-sense measures you can take
yourself. However, there are also medications that can help to
maintain normal blood flow.
Drugs
Most of the drugs available for Raynaud's phenomenon work by
making the blood vessels wider. Examples include nifedipine and
amlodipine.
Unfortunately, there is no drug that will act only on
the blood vessels in the fingers and toes, so these medications can
sometimes cause flushing of the face, headaches or dizziness. In
the case of nifedipine, drinking grapefruit juice can increase the
drug's effect and therefore the risk of side-effects. However, most
people don't have serious problems with these drugs.
In severe cases – almost always cases of secondary Raynaud's –
drugs such as iloprost may be given as a drip into a vein.
Self-help and daily living
Raynaud's phenomenon can be helped on a daily basis by making
some simple changes to your lifestyle, including keeping warm,
not smoking, diet and exercise.
Keep warm
This cannot be over-emphasised. Wear warm gloves, socks and a
hat when you are outdoors in cold weather. Warm your hands before
you put the gloves on. Keep your body warm too by dressing suitably
for the cold weather. Electrically heated gloves and portable
heating aids can be very helpful.
Stop smoking
Smoking can damage the circulation, so we strongly recommend
giving it up if you have Raynaud's.
Exercise
Regular exercise helps the circulation and, if you're outside on
a cold day, keeping active will help you to keep warm. .
Diet and nutrition
There is no particular food or diet that has been proved to
help, but we would always recommend a healthy, balanced diet with
plenty of fresh fruit and vegetables.
Complementary therapies
Bio-feedback teaches people to develop a conscious ability to
increase the blood flow in the hands and feet, and has attracted
considerable interest. However, a recent study suggests it isn't
beneficial in primary Raynaud's phenomenon.