Raynaud’s Disease

By Dr. Loretta Lanphier, ND, CN, HHP, CH

What is Raynaud’s Disease?

Raynaud’s Disease describes a disorder that is characterized by your fingers, toes, and some other body parts becoming suddenly cold and numb due to reduced circulation. It involves the abnormal constriction of the small blood vessels that supply blood to your skin. Raynaud’s can be primary or secondary. When you have secondary Raynaud’s, the condition is linked to another disease.

Primary Raynaud’s, also known as idiopathic (cause unknown) Raynaud’s, is the term used when Raynaud’s is a stand-alone disorder, with no other accompanying conditions that could be responsible for the symptoms.  Primary Raynaud’s disease is the most common type, accounting for over 50% of cases. It is also generally less severe and results in fewer complications.

Secondary Raynaud’s disease, also called Raynaud’s Phenomenon, usually exhibits more intense signs, and tends to progress more often and to a greater degree than primary. It is associated with other disorders that contribute to the symptoms.

Raynaud’s disease is relatively rare in America, and it afflicts more women than men. Females are five times more likely to get primary Raynaud’s disease than are males. It is more common in colder climates, and the average age of diagnosis is 20-40 years.

What Are the Symptoms of Raynaud’s Disease?

Raynaud’s disease is a distinct disorder, different from frostbite or simply having cold hands or feet. It is the result of abnormal spasms of certain blood vessels. It usually attacks the fingers and toes, but rarely will manifest itself in the tip of the tongue, end of the nose, on the ears, or on the cheeks as well. Typical signs include a sequence of color changes in the affected areas:

  • The areas afflicted usually will turn white first. This is due to spasmodic contractions of the arterioles (tiny arteries) in the area. The skin is deprived of oxygen, and so becomes pale and white, as well as cold.
  • In response to this, the veins expand (dilate), and the area turns blue due to the influx of deoxygenated blood. The patient often experiences cold, numbness, and a tingling sensation in the affected areas.
  • The final phase occurs as the area begins to warm. The arteries begin to dilate, and the area turns a bright red. Patients describe the areas as feeling warm, with a painful throbbing sensation.

The length of a Raynaud’s attack can vary from less than a minute, to several hours. Most of the time, Raynaud’s starts at the end of one finger or toe, and may progress over time to affect the entire digit. In some folks, the condition jumps around from fingers to toes and on to other body parts. Eventually, it progresses with many people to affect all the digits at once. Raynaud’s has many faces, and it affects different people in different patterns. It is definitely a progressive disease that gets more severe over time.

What Are the Causes of Raynaud’s Disease?

Cold temperatures or emotional stress are thought to be the two main factors that trigger primary Raynaud’s. When the trigger is tripped, the blood vessels over-react and set the process off. When a digit gets cold, it is a normal response for the muscles that control the blood vessels to contract. But when you have Raynaud’s, the contractions are abnormally intense and quick, and the body does not react normally to compensate for these spasms. The whole cycle of symptoms is due to a chain reaction based on the initial vasospasms.

It is clearly seen, in some patients, that emotional stress, such as fear, anger, or even excitement and joy, can trigger a primary Raynaud’s attack. It also is thought to possibly be linked to inherited traits, but no specific genes have yet been identified. One of the problems with an illness like Raynaud’s is that it is perceived as a relatively innocuous condition that is more an inconvenience than a serious threat to health. Illnesses such as this are not likely to get many research dollars allotted to them, so we may never discover all the facts about Raynaud’s.

It is known that most cases or attacks are brought on by exposure to cold temperatures. This can happen when the temperatures are bitter outside, but Raynaud’s sufferers also have to be careful about putting their hands into a freezer or running cold water on them. These too are often enough to set off an attack.

Secondary Raynaud’s disease is associated with other disorders that contribute to its symptoms. It is typically linked with the following conditions:

  • Scleroderma:  Most people who have this rare connective tissue disease also have Raynaud’s, and in about 30% of the cases, the Raynaud’s will develop first. Scleroderma causes the tissues of the skin, lung, heart, esophagus, and kidneys to become thick and toughened. The blood vessels in the affected areas become constricted, blood flow is reduced, and Raynaud’s is easily enabled to progress.
  • Lupus:  Lupus is an inflammatory autoimmune disease that can affect much of the body, including the skin, joints, blood vessels, and many organs. Lupus is caused by the immune system turning on itself and attacking healthy tissues.
  • Rheumatoid Arthritis:  As with scleroderma, Raynaud’s may show up first before a person exhibits symptoms of arthritis. This condition causes inflammation and stiffness in the joints, and is commonly found in the hands and feet just like Raynaud’s.
  • Sjogren’s syndrome:  This rare connective tissue disorder often accompanies scleroderma, lupus, or rheumatoid arthritis, and is often found in conjunction with Raynaud’s. The defining symptom of Sjogren’s syndrome is chronic dryness of the mouth and eyes.
  • Diseases of the arteries:  Raynaud’s is commonly associated with atherosclerosis (build up of plaque in the coronary arteries), pulmonary hypertension (high blood pressure that damages the arteries of the lungs), or Buerger’s Disease (inflammation of the arteries in the hands and feet).
  • Carpal tunnel syndrome:  This nervous system disorder results in pain and loss of feeling in the hand due to inflammation of one of the major nerves of the hand. Hands affected by carpal tunnel syndrome are much more likely to be affected by Raynaud’s phenomenon as well.
  • Injuries or repetitive trauma:  These types of things can cause nerve damage to the blood vessels of the affected areas. Examples include workers who operate vibrating machinery such as jackhammers or chainsaws. There is even a specific condition related to this called “vibration-induced white finger,” officially a form of Raynaud’s phenomenon. Other’s who can suffer from Raynaud’s include piano players, computer (keyboard) workers, typists, electric shock victims, and frostbite victims. Other injuries can also increase risk for Raynaud’s, such as broken bones or surgery in the hands or feet.
  • Certain medications:  Beta blockers (for treating high blood pressure), migraine headache drugs (containing ergotamine), birth control pills, some chemotherapy drugs, and some vasoconstrictors (cause the blood vessels to narrow) often found in over-the-counter cold remedies. All of the above are associated with increased risk for Raynaud’s phenomenon.
  • Environmental toxins:  Several chemicals are suspected of aggravating Raynaud’s, but exposure to vinyl chloride has been clearly identified as a risk factor for scleroderma and Raynaud’s. Vinyl chloride is a common byproduct produced by the plastics industry.
  • Hypothyroidism:  Raynaud’s phenomenon is linked to this illness that is the result of an underactive thyroid gland.
  • Cancer:  In rare cases, certain kinds of cancers are linked to increased risk for Raynaud’s.
  • Smoking: Tobacco use also increases risk for Raynaud’s because of its harmful effects on the circulatory system. Smoking constricts the blood vessels, and some have even gone so far as to state that smoking is one of the causes of Raynaud’s syndrome.

What Complications Can Occur With Raynaud’s Syndrome?

In severe cases, circulation to the digits can be permanently reduced, causing deformities of the fingers and toes. In some cases, a complication called sclerodactyly can occur whereby the skin over the fingers or toes becomes taught, thick, white, shiny, and smooth.  When an artery becomes permanently blocked to an area, the tissues are no longer able to receive adequate oxygen or nutrients, and cells may begin to die. This causes sores that do not heal easily, and the result can be dead tissues, or a condition known as gangrene. Sometimes there is no alternative other than amputation in order to keep the gangrene from worsening and spreading. Gangrene is rare, occurring in only about 1% of Raynaud’s cases.

How is Raynaud’s Diagnosed?

The symptoms most often will point your health care provider to Raynaud’s syndrome or phenomenon. This is a much more complex process with the phenomenon than with the syndrome. There are some tests that can help with diagnosis, but none that can specifically identify Raynaud’s:

  • Blood tests:  Blood can be drawn and analyzed for antibodies that indicate the immune system is fighting connective tissue or autoimmune illnesses such as arthritis. A positive result points toward possible Raynaud’s phenomenon.
  • Erythrocyte sedimentation rate (ESR):  This test measures the rate at which red blood cells settle to the bottom of a solution. As with the above antibodies test, a positive result indicates connective tissue or autoimmune disorders.
  • Cold stimulation test:  Thermometers are attached to affected digits, and they are introduced into ice water. The speed of recovery to room temperature is then measured, and compared to normal values. If the patient recovers too slowly, Raynaud’s is cosidered a possibility.

What Treatments are Available for Raynaud’s?

Of course there are medications that are often prescribed. But as with most pharmaceutical drugs, the side effects can be troublesome and sometimes downright dangerous. I would not recommend them except in severe cases where tissue damage may be avoided if they are used. But hopefully, Raynaud’s will be caught and dealt with before it reaches that point.

Common sense precautions such as avoiding cold temperatures and protecting oneself when that is not possible will go along way to alleviate or avoid symptoms of Raynaud’s. If you have secondary Raynaud’s, it goes without saying (but I’ll say it anyway) that treating or preventing the accompanying conditions will be extremely helpful.

Dealing with stress in constructive ways such as exercise and relaxation is helpful to many Raynaud’s patients as well.

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