Raynauds disease

Raynaud's disease is a condition affecting the circulation of blood in the fingers and toes, usually when exposed to cold. Typical symptoms include fingers and toes turning white or blue and becoming numb; and then, when warmed, turning red and becoming painful.

Raynaud’s disease (also referred to as Raynaud's syndrome or Raynaud’s phenomenon) is estimated to affect up to 10% of New Zealanders.

It is a progressive condition, meaning it tends to worsen as a person gets older. Initially it may only affect the tips of the fingers or toes, but over time may affect whole fingers and toes. The rate of progression differs greatly amongst individuals.

Primary and Secondary Raynaud’s disease

There are two types of Raynaud’s disease – Primary and Secondary:

Primary Raynaud’s disease

In these cases, the cause of the condition is unknown. It does run in families, however, so a genetic cause is suspected. Primary Raynaud’s disease is the more common form and affects women more than men.

Primary Raynaud’s disease is usually a mild condition and produces few complications. It usually starts in a person's teenage years or twenties.

Secondary Raynaud’s disease

Secondary Raynaud’s disease is so called because it is triggered by something else, such as:

• Diseases that affect the skin and joints eg: scleroderma, rheumatoid arthritis, or systemic lupus erythematosus (SLE)

• Medications that narrow the blood vessels, eg: beta-blockers (which are used to treat high blood pressure), some migraine medications, decongestants, and some chemotherapy drugs

• Hormone imbalances, eg: underactive thyroid

• Injury, eg: frost bite, surgery, wrist fracture

• Cigarette smoking (nicotine constricts blood vessels)

• Occupational exposure to constant vibration (eg: chainsaws) or repetitive movement (eg: typing).

Secondary Raynaud's disease can develop at any age.

Signs and symptoms

Raynaud’s disease occurs in “episodes”, where symptoms are present for a period of time, and then resolve. Most episodes occur in response to exposure to cold, sudden changes in temperature or emotional stress. An episode tends to come on very quickly and can last for minutes or a number of hours.

In mild cases, only skin discolouration or minor tingling may be experienced. In more severe cases the lack of oxygen due to the reduced blood supply can irritate nerves, causing pain, and can damage the tissues beneath the skin. In rare cases the prolonged lack of oxygen can cause cracked skin or chilblains, or small ulcers at the tips of the fingers.

There are three distinct phases to an episode of Raynaud’s disease:

• Small arteries become narrow (constrict), reducing the flow of blood through them. The affected fingers and toes become pale due to lack of blood.

• Lack of oxygen causes the affected fingers and toes to become blue in colour. They may also feel cold, numb and tingly.

• The arteries dilate again, increasing blood flow and causing the affected fingers and toes to flush bright red. They may also feel warm and may throb painfully.

A general feeling of tightness in the affected area may also be experienced during an episode.

Diagnosis

For many people living with Raynaud’s disease is more of an inconvenience than a problem. However, if symptoms worsen or a person gets sores or infections on affected fingers and toes, they should see a doctor.

The doctor will ask about symptoms and medical history, and look at the problem areas. The tiny blood vessels in the skin at the base of your fingernails may be examined for deformities using a magnifier or microscope. You may be given a cold challenge test, which is done to see the colour changes in the fingers after your hands are exposed to cold.

Adults who start to develop Raynaud’s disease after about age 35 years may be tested for an underlying disease. Blood tests may be done to help determine whether the condition is primary or secondary.

Treatment

There is no known way to prevent the development of Raynaud’s disease and there is no known cure for the condition. However, episodes can be prevented by avoiding situations that trigger them. Practical steps that can help to achieve this include:

• Keeping warm and maintaining a constant body temperature

• Wearing gloves and warm socks when out in the cold

• Quit smoking — nicotine can narrow the blood vessels

• Not directly handling cold things, eg: bottles of milk, items out of the freezer

• Keeping the skin supple by using moisturisers

• Learning how to manage stress and emotional situations

• Avoiding medications that can aggravate blood vessel spasm, eg: beta blockers and some cold and flu medications.

Where treatment is required, this may include:

• Warming the hands and feet with clothing or warm water

• Medications to widen the blood vessels and promote circulation (eg: calcium channel blockers, alpha blockers, vasodilators)

• Medications to thin the blood, eg: aspirin

• Treatment of underlying conditions in cases of secondary Raynaud’s disease.

In severe cases of Raynaud’s disease, surgery to prevent the small nerves in the fingers and toes from stimulating the blood vessels to spasm may be considered. This is known as sympathectomy and involves cutting the nerves that constrict the peripheral blood vessels. However, the procedure is not without complications and has a fairly low success rate so would normally only be considered if other approaches fail.

References

Mayo Clinic (2017). Raynaud’s disease (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571 [Accessed: 12/06/20]
NHS Choices (2017). Raynaud’s phenomenon (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/raynauds/ [Accessed: 12/06/20]
O’Toole, M.T. (Ed.) (2017). Raynaud’s disease. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
Purdie, G. et al. (2009). Prevalence of Raynaud's phenomenon in the adult New Zealand population. N Z Med J. 2009;122(1306):55–62.
Johns Hopkins Medicine (date not stated). Raynaud’s phenomenon (Web Page). Baltimore, MD: Johns Hopkins University. https://www.hopkinsmedicine.org/health/conditions-and-diseases/raynauds-phenomenon [Accessed: 12/06/20)

Last Reviewed – June 2020

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