Raynaud’s Phenomenon — Know It All!

Editorial

All you need to know about Raynaud’s Phenomenon.

Raynaud’s Phenomenon 

Know your ailment well, so you can manage it better!!

Here we come with Raynaud’s Phenomenon today!

Overview:

A condition that affects your blood vessels is the phenomenon of Raynaud. In response to cold temperatures or stress, it causes certain areas of your body, especially your hands and feet, to feel numb and cold. The phenomenon of Raynaud is also called Raynaud disease or Raynaud’s syndrome.

What Happens in the disease:

If you have the phenomenon of Raynaud, when your body does not send enough blood to your hands and feet, you have “attacks.” Attacks usually happen when you are cold or feeling stressed. Your fingers and toes can feel very cold or numb during an attack and may change color. Such attacks are known as vasospasms, too.

You may experience three stages of skin color changes in your fingers or toes once an attack begins, typically from white to blue to red.

  • Whiteness (called pallor) may occur in response to the collapse of the veins that supply the fingers and toes with blood.
  • Blueness (called cyanosis) may appear because the fingers or toes are not getting enough oxygen-rich blood.
  • Finally, as blood returns to the fingers and toes, redness (rubor) may occur. During this stage, the fingers and toes may tingle or throb.

During an attack, your blood flow to the skin will remain low until the skin is rewarmed. After warming, it usually takes 15 minutes to recover normal blood flow to the skin.

Your prognosis often depends on what form of the disease you have and what underlying health condition(s) you have. Many people with Raynaud’s phenomenon have mild symptoms that do not cause any blood vessels or tissue damage. These symptoms are easily managed, often without medicines. Others have more severe symptoms. For most people with Raynaud’s phenomenon, the disease is lifelong.

Raynaud’s Phenomenon 

Who gets the disease:

Anyone can get Raynaud’s phenomenon but some people are more at risk for developing the disease. Risk factors include:

  • Your sex: Women are more likely to develop Raynaud’s phenomenon.
  • Where you live: People who live in cold places are more likely to develop Raynaud’s phenomenon.
  • Certain health conditions: Certain health conditions increase the risk of Raynaud’s phenomenon.

It is especially common in people who have connective tissue diseases, which affects how blood flows to the organs and other body tissues. Connective tissue diseases include:

  • Lupus, which causes the immune system to attack healthy tissues in the body.
  • Scleroderma, which causes the skin and other tissues in the body to harden.
  • Sjögren’s syndrome, which causes dryness in the mouth and eyes.

Other health conditions can also increase your risk of developing Raynaud’s phenomenon. These include:

  • Carpal tunnel syndrome, which affects nerves in the wrists.
  • Blood vessel disease, which causes the blood vessels in the legs, arms, and belly to narrow.

Medicines: Taking certain medicines increases your risk of developing Raynaud’s phenomenon. These include:

  • Medicines used to treat high blood pressure, migraines, or cancer.
  • Over-the-counter cold medicines.
  • Narcotics.

Your job: People with certain jobs may be more likely to develop Raynaud’s phenomenon. These include:

  • People who are around certain chemicals.
  • People who use tools that vibrate, such as a jackhammer.

Genetics: Some research suggests that Raynaud’s phenomenon runs in certain families, but more research is needed.

Types:

Primary vs. secondary Raynaud’s

There are two main types of the condition.

  • Primary Raynaud’s. Also called Raynaud’s disease, this most common form isn’t the result of an associated medical condition. It can be so mild that many people with primary Raynaud’s don’t seek treatment. And it can resolve on its own.
  • Secondary Raynaud’s. Also called Raynaud’s phenomenon, this form is caused by an underlying problem. Although secondary Raynaud’s is less common than the primary form, it tends to be more serious.
    Signs and symptoms of secondary Raynaud’s usually appear around age 40, later than they do for primary Raynaud’s.
Raynaud’s Phenomenon 

Symptoms:

RP symptoms depend on the severity, frequency, and length of the spasm of the blood vessel. After cold exposure, most patients with the mild disease only notice skin discoloration. They may also experience mild tingling and numbness of the digit(s) involved which, once the color returns to normal, will disappear. The sensory nerves become irritated by the absence of oxygen when the blood-vessel spasms become more sustained and can cause pain in the digit(s) involved. Poor supply of oxygen to the tissue can rarely cause the tips of the digits to ulcerate. Digits that are ulcerated can become infected. Gangrene of the digits can occur with a continued lack of oxygen.

The nose, ears, and tongue are less common areas of the body that can be impacted by RP. While these areas rarely develop ulcers, a sensation of numbness and pain can be associated with them.

Symptoms related to their underlying diseases can also be present in patients with secondary RP. In most patients with scleroderma, skin and joint disease, RP is the initial symptom. Lupus, rheumatoid arthritis, and Sjögren ‘s syndrome are other rheumatic illnesses frequently associated with RP.

Causes:

  • Connective tissue diseases. Most people who have a rare disease that leads to hardening and scarring of the skin (scleroderma) have Raynaud’s. Other diseases that increase the risk of Raynaud’s include lupus, rheumatoid arthritis, and Sjogren’s syndrome.
  • Diseases of the arteries. These include a buildup of plaques in blood vessels that feed the heart (atherosclerosis), a disorder in which the blood vessels of the hands and feet become inflamed (Buerger’s disease), and a type of high blood pressure that affects the arteries of the lungs (primary pulmonary hypertension).
  • Carpal tunnel syndrome. This condition involves pressure on a major nerve to your hand, producing numbness and pain in the hand that can make the hand more susceptible to cold temperatures.
  • Repetitive action or vibration. Typing, playing the piano, or doing similar movements for long periods and operating vibrating tools, such as jackhammers, can lead to overuse injuries.
  • Smoking. Smoking constricts blood vessels.
  • Injuries to the hands or feet. These include wrist fracture, surgery, or frostbite.
  • Certain medications. These include beta-blockers, used to treat high blood pressure; migraine medications that contain ergotamine or sumatriptan; attention-deficit/hyperactivity disorder medications; certain chemotherapy agents; and drugs that cause blood vessels to narrow, such as some over-the-counter cold medications.

Risk factors:

Risk factors for primary Raynaud’s include:

  • Sex. More women than men are affected.
  • Age. Although anyone can develop the condition, primary Raynaud’s often begins between the ages of 15 and 30.
  • Climate. The disorder is also more common in people who live in colder climates.
  • Family history. A first-degree relative — a parent, sibling or child — having the disease appears to increase your risk of primary Raynaud’s.

Risk factors for secondary Raynaud’s include:

  • Associated diseases. These include conditions such as scleroderma and lupus.
  • Certain occupations. These include jobs that cause repetitive trauma, such as operating tools that vibrate.
  • Exposure to certain substances. This includes smoking, taking medications that affect the blood vessels and being exposed to certain chemicals, such as vinyl chloride.

Complications:

  • Diminished blood circulation to your fingers or toes could cause tissue damage if secondary Raynaud’s is severe, which is rare.
  • Sores (skin ulcers) or dead tissue (gangrene) can result from a totally blocked artery, both of which can be difficult to treat. Extreme, untreated cases may rarely require removal (amputation) of the affected part of your body.

Diagnosis:

There is no single test to diagnose Raynaud’s phenomenon. Doctors usually diagnose Raynaud’s phenomenon after taking a complete medical history, an exam, and tests. Tests may include:

  • Blood tests.
  • Looking at fingernail tissue with a microscope.

If you are diagnosed with Raynaud’s phenomenon, your doctor will likely perform more tests to determine what form of the disease you have.

  • Nailfold capillaroscopy: During this test, your doctor will put a drop of oil on your nail folds, the skin at the base of the fingernail. Your doctor will then examine your nail folds under a microscope to look for problems in the tiny blood vessels called capillaries. If your capillaries are enlarged or malformed, you may have a connective tissue disease.
  • Antinuclear antibody (ANA) test: In this blood test, the doctor determines whether your body is producing special proteins called antibodies. These abnormal antibodies are often found in people who have connective tissue diseases or autoimmune disorders.
  • Erythrocyte sedimentation rate (ESR or sed rate): This blood test measures how quickly your red blood cells fall to the bottom of a test tube of unclotted blood. Red blood cells that fall rapidly may suggest you have inflammation in your body. This is a sign that you may have an inflammatory disease.
Raynaud’s Phenomenon 

Treatment Options:

Management of the phenomenon of Raynaud includes the prevention of blood vessel spasms by protecting the fingers and toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasm should be avoided by patients with RP. Medications that dilate the blood vessels can be given to patients with persistent symptoms.

For patients with Raynaud’s phenomenon who have no symptoms other than limb color changes, only home remedy measures may be required to prevent complications. Prevention measures are important in primary and secondary RP regardless of the severity. Simple initial care involves keeping the body warm, especially the extremities. Warm clothing is essential in colder environments. When searching for a freezer, cotton gloves can be helpful. Through minimizing heat dissipation, headwear can help the body retain heat. Room temperatures are not expected to be too cool. While washing dishes, rubber gloves protect the hands and prevent cooling. Walking barefoot should be minimized. It is necessary to avoid compression of the blood vessels by tight-fitting wrist bands, rings, or footwear.

Note: For those who suffer from Raynaud‘s phenomenon because of the additional heating requirements, some energy companies offer some discounts on utility bills.

Those with RP should protect their hands and feet from direct wounds and trauma. For the prevention of more serious infections, any wounds or infections should be treated early. The frequency of attacks may be lowered by avoiding emotional stresses and instruments that vibrate the hand. In some patients, biofeedback can also help to decrease the severity and frequency of RP.

Patients with RP should avoid direct and indirect smoking (passive or secondhand smoke). Chemicals in tobacco smoke can cause constriction of the blood vessels and lead to atherosclerosis (hardening of the arteries), which can further impair the supply of oxygen to the limbs.

To avoid injuring sensitive toes and fingertips, care of the nails must be carried out carefully. Ulcers at the tip of the digits should be closely monitored by a doctor. They can get infected. To protect ulcerated areas, gently applied finger splints are used. Ointments that open the blood vessels (nitroglycerin ointment) are sometimes used to allow increased blood supply and healing on the sides of severely affected digits.

By taking oral medications that open (dilate) the blood vessels, patients with persistent or bothersome symptoms may be helped. These include calcium antagonists (or calcium channel blockers), such as diltiazem (Cardizem, Dilacor), nicardipine (Cardene), nifedipine (Procardia), and other drugs used in the treatment of blood pressure, such as methyldopa (Aldomet) and prazosin (Minipress). (Sometimes these drugs are decreased or eliminated when the environment is warmer, such as during summer months.) Recent research has shown that losartan (Cozaar, Hyzaar), a blood-pressure drug, can reduce the severity of RP episodes.

Blood-thinning medications, such as low doses of aspirin or dipyridamole (Persantine), are sometimes beneficial.

By adding a medication called pentoxifylline (Trental), which makes red blood cells more pliable and thus improves circulation, some patients with persistent symptoms may benefit.

Severe RP can result in gangrene and loss of digits due to a lack of supply of blood. Nerve surgery called “sympathectomy” is sometimes considered for severe illnesses. In this procedure, to prevent blood-vessel spasm, the nerves that stimulate the constriction of the vessels (sympathetic nerves) are surgically interrupted. This is usually performed during an operation located on the sides of the base of the hand‘s fingers. The tiny nerves around the blood vessels are stripped away through small incisions. A digital sympathectomy is known as this procedure.

How to cope up:

The following steps might help you in managing your disease:

  • Just keep warm. Put a higher temperature on your thermostat. You lose a lot of hearing from your body through your head; wear a hat. Keep your feet dry and warm. Wear multiple layers of loose clothes, socks, hats, and gloves or mittens in cold weather. Keep pocket warmers in your pockets if you will be outside for a long time. When drinking something cold, use insulated drinking glasses. Prior to handling frozen or refrigerated foods, put on gloves.
  • Avoid shifting temperatures and damp climates quickly. An attack can be brought on quickly by moving from 90 degrees outside to a 70-degree air-conditioned room. So can damp rainy weather.
  • Avoid being air-conditioned. In warm weather, air conditioning also can bring on attacks.
  • Hey, don’t smoke. The nicotine in cigarettes causes the temperature of the skin to drop, which can result in an attack.
  • Avoid medicines that cause attacks to occur. The blood vessel is narrowed by certain medicines, which can cause an attack. These include beta-blockers, medications for cold, caffeine, narcotics, some medications for migraine headaches, and some chemotherapy drugs. Before starting any new medication, talk to your doctor. Do not stop taking any medication that you are taking without first talking to your doctor.
  • Stress control. Because stress can cause an attack, it is important to learn how to manage or control stress. Talk about stress reduction techniques with your doctor.
  • Regularly exercise. Your general well-being can be improved by exercise. Furthermore, it can increase your level of energy, help control your weight, keep your heart healthy, and improve sleep. Before starting an exercise program, talk to your doctor.

References:

https://www.niams.nih.gov/health-topics/raynauds-phenomenon/

https://emedicine.medscape.com/article/331197-overview#a4

https://www.medicinenet.com/raynauds_phenomenon/article.htm

https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.