Spotlight on Raynaud's phenomenon

Raynaud's phenomenon is a condition in which there is an exaggerated blood vessel tightening in response to cold or emotional stress, restricting blood flow to certain areas of the body-most often the fingers, but sometimes the toes, ears, or the end of the nose. Affected areas generally first turn white in colour, and then may become blue then red.

Raynaud's phenomenon affects approximately 3 to 5 percent of the population - women more commonly than men.

Raynaud's phenomenon sometimes occurs in combination with other types of arthritis. For example, the majority of people diagnosed with scleroderma are also diagnosed with Raynaud's phenomenon, and up to 35% of people with Sjögren's syndrome are also affected by Raynaud's phenomenon. That said, the majority of people with Raynaud's phenomenon do not have another disorder.

When Raynaud's phenomenon occurs in combination with another disorder (such as scleroderma or systemic lupus erythematosus), it is called "secondary Raynaud's phenomenon". When it occurs alone, it is referred to as "primary Raynaud's phenomenon".

The exaggerated vascular response (tightening) in Raynaud's phenomenon is called vasospasm, which often occur in response to cold, or emotional distress. With vasospasm, the fingers turn white and cold then blue with dilated veins followed by relaxation of the vessel and normal blood flow causing a red 'flushing'.

Diagnosis of Raynaud's phenomenon

Raynaud's phenomenon has several warning signs, which may be present at the onset of disease. These include:
  • Fingers, toes, ears, and/or nose turning white or blue when they are exposed to cold, or at times of emotional distress
  • Pain in the fingers or toes when they are exposed to changes in temperature
  • Tingling in extremities when they have been exposed to cold and are warming up

Doctors are often able to diagnose Raynaud's phenomenon based on the patient's medical history (for example, a diagnosis of scleroderma or Sjögren's syndrome dramatically increases the risk of Raynaud's phenomenon), along with observations of the body's response to temperature changes. The colour pattern, of skin in affected areas turning white, then blue, then flushing red at the end of a vasospasm, is often indicative of Raynaud's phenomenon.

To confirm a diagnosis, doctors may order tests to determine the rate of blood flow within vessels. Blood tests may also be conducted to rule out other disorders with similar symptoms.

Treatment of Raynaud's phenomenon

Once a doctor has diagnosed Raynaud's phenomenon, there are several simple, effective methods to help manage the symptoms. While there is no known cure for Raynaud's phenomenon, people with the disease are usually able to manage their symptoms with medications and behavior modification.

In many cases, medications are not necessary to treat Raynaud's phenomenon. Non-medicinal strategies can often be very effective.

There are a number of strategies to treat the symptoms of Raynaud's phenomenon. Most importantly, protecting the core body (hat, scarf, layered clothes) as well as the hands and feet from cold temperatures will help prevent discomfort. Wearing gloves and heavy socks in winter is a simple protection strategy. Some people with Raynaud's phenomenon even find it helpful to wear cotton gloves or oven mitts reach into freezers, to protect sensitive hands and reduce the risk of vasospasms.

People with Raynaud's phenomenon should not smoke or be exposed to second-hand smoke, as smoking restricts blood vessels and can exacerbate the condition.

There are several medications which are sometimes used to treat Raynaud's phenomenon. These work to relax the walls of the blood vessels, and include: diltiazem (Cardizem® and Dilacor®), nicardipine (Cardene®), nifedipine (Procardia®, Adalat®). In less severe cases, medications that work to thin the blood, like low doses of acetylsalicylic acid (Aspirin®), can help to prevent or treat symptoms.

With severe Raynaud's phenomenon, there are stronger medications that may reduce blood vessel spasms such as nitrates. There are some 'off label' or experimental medications that can be used for Raynaud's phenomenon. A rheumatologist is the best person to discuss these treatment options with.

Because vasospasms can be triggered by emotional distress, relaxation techniques are a very important component of a well-rounded treatment plan for Raynaud's phenomenon. Techniques like muscular relaxation, stretching, deep breathing, and visualization are often helpful.

As with any form of arthritis, maintaining a healthy lifestyle is also a critical part of any Raynaud's phenomenon treatment plan. Poor diet, lack of exercise, and high levels of stress may make disease activity worse, so healthy eating, appropriate levels of aerobic and strengthening exercise are highly recommended. Recreational drugs such as cocaine and other 'stimulants' may make Raynaud's phenomenon worse.