Raynaud's syndrome (also called Raynaud's phenomenon) is a disorder characterized by blood vessel abnormality caused by overactivity of smooth muscle in the wall of arteries, leading to spasms (vasospasms with narrowing) of the small vessels that supply blood to the arms, legs, hands, feet, and sometimes the ears and nose. The typical features of Raynaud's syndrome include changes in the color of skin from pale to bluish to red, which typically occur after exposure to cold temperatures. Raynaud's syndrome is usually diagnosed in people younger than 40 years of age and occurs five times more frequently in women than in men. The disorder is sometimes referred to as "white fingers disease."
The classification of Raynaud's syndrome is usually separated into two categories: idiopathic or primary Raynaud's syndrome, when no associated disease is identified, and Raynaud's syndrome secondary to other diseases (usually autoimmune).
Some people are more likely to develop Raynaud's syndrome compared to others. Risk factors that have been identified include the following:
When someone has an attack of Raynaud's syndrome, the small arteries of the arms and legs go into spasm or become narrow, which limits blood flow to the distal organs. The tissues become deprived of the blood's oxygen, which causes color changes in the skin. However, Raynaud's syndrome is not the same as frostbite.
The Raynaud's syndrome attack usually lasts a few minutes, although sometimes it may last several hours.
Attacks of Raynaud's syndrome may be harmless and resolve on their own, especially if you have reversible causes and no underlying serious internal disease. However, your doctor may suggest ways to manage and treat the disease.
Call your doctor in the following instances:
If you have continuing discoloration of the fingertips or on parts of your arms or legs, or if it appears that skin breakdown or ulcerations may be present, prompt medical evaluation is needed.
Raynaud's syndrome is treated by a number of health care professionals. Often, the diagnosis is made by the primary care physician or a rheumatologist. Sometimes, the diagnosis may also be made by a dermatologist (skin doctor) or a vascular surgeon. When the disease is stable, the majority of patients follow up with their primary care physician. Those who have flare-ups with ulcers of the fingertips may need to be seen by a vascular surgeon for removing the dead tissues. Vascular surgeons and rheumatologists also play an active role when deciding on medication treatment.
Attacks of Raynaud's syndrome are usually temporary. A doctor relies on your medical history to make a diagnosis of Raynaud's syndrome. Unfortunately, there is no single laboratory test to make a diagnosis of Raynaud's syndrome. If the doctor suspects that you may have Raynaud's syndrome caused by a specific disease, he or she may take X-rays of your cervical spine and perform blood tests to check for antinuclear antibodies, rheumatoid factor, cryoglobulins, and serum protein electrophoreses. Occasionally, a doctor may perform angiography (injected dye) to determine the type and location of disease in the blood vessels.
Treatment is primarily aimed toward education and prevention. Information about avoiding cold or stress may be given, as well as more information about how to stop smoking. However, in some cases, the disease may progress to the point where medication may be required to help relieve symptoms.
Medications that widen blood vessels (vasodilators) help relax and widen the walls of the arteries; this can increase blood to the hands and feet. The following drugs have been used when an inadequate response to preventive treatment occurs. The calcium channel blockers, in particular nifedipine (Adalat, Procardia XL), are the most widely studied drugs for Raynaud's syndrome and are considered to be the drug of choice if drug treatment is warranted.
Prevention is the best treatment.
Surgery is rarely offered as a treatment for Raynaud's syndrome. When symptoms cannot be managed and medications are inadequate or have too many side effects, surgical sympathectomy may be offered. This is a rare procedure and is almost never done, since the sympathetic discharge is already at its maximum. Surgical sympathectomy was done in the past with almost no benefit. If the tip of the toe or fingertip is necrotic or gangrenous, debridement (cleaning dead tissue) or amputation may be required, but this is not common.
A more localized form of sympathectomy for the hand, a digital sympathectomy, can be performed by interrupting the nerves of the palm of the hand to restore circulation to the fingers.
Many alternative care products and health supplements are sold for the treatment of Raynaud's syndrome. Some alternative care practitioners recommend fish oil, gingko biloba, and biofeedback therapy. Unfortunately, there are no clinical studies to validate the claims made by the manufacturers of these therapies. It is best to speak to your doctor before you start with any of these therapies.
Uncommonly, Raynaud's syndrome is recurrent, and the episodes are prolonged enough to cause ulceration and tissue loss on the finger and toe tips. In people who continue to smoke or have Buerger's disease, frank gangrene of the toes and fingers is a real possibility. In some cases, there may be persistent pain and paleness of the digits. Infections are rare but can occur in people who also have diabetes. When complications occur, there is often more workup required to rule out the presence of vasculitis (disease of blood vessels), blood clots, or atherosclerosis.
Preventing the arteries from narrowing is the key to living successfully with Raynaud's syndrome.
Raynaud's syndrome is not life-threatening, but one still needs a thorough, complete exam by the doctor to exclude any secondary causes that may be responsible for it. The symptoms of Raynaud's syndrome usually go away when the person has moved to a warm environment or has eliminated the stressors that brought on the symptoms.
In those with persistent risk factors, like smoking and exposure to the cold, complications can develop. When the arteries remain constricted for prolonged periods of time, ulceration of the fingertips may occur. This typically complicates scleroderma, with additional thinning and tightening of the skin. To prevent complications, it is vital that patients with Raynaud's syndrome avoid all situations that trigger the attacks. The hands and feet should always be insulated from the cold.
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