Raynaud’s Phenomenon

Although estimates vary, recent surveys show that Raynaud’s phenomenon may affect 5 to 10 percent of the general population in the United States.

Women are more likely than men to have the disorder.

Raynaud’s phenomenon appears to be more common in people who live in colder climates. However, people with the disorder who live in milder climates may have more attacks during periods of colder weather.

What is Raynaud’s Phenomenon?

Raynaud’s phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (narrow).

What Happens during an attack?

For most people, an attack is usually triggered by exposure to cold or emotional stress. In general, attacks affect the fingers or toes but may affect the nose, lips, or ear lobes.

Reduced Blood Supply to the Extremities: When a person is exposed to cold, the body’s normal response is to slow the loss of heat and preserve its core temperature. To maintain this temperature, the blood vessels that control blood flow to the skin surface move blood from arteries near the surface to veins deeper in the body. For people who have Raynaud’s phenomenon, this normal body response is intensified by the sudden spasmodic contractions of the small blood vessels (arterioles) that supply blood to the fingers and toes. The arteries of the fingers and toes may also collapse. As a result, the blood supply to the extremities is greatly decreased, causing a reaction that includes skin discoloration and other changes.

Changes in Skin Color and Sensation: Once the attack begins, a person may experience three phases of skin color changes (white, blue, and red) in the fingers or toes. The order of the changes of color is not the same for all people, and not everyone has all three colors. Pallor (whiteness) may occur in response to spasm of the arterioles and the resulting collapse of the digital arteries. Cyanosis (blueness) may appear because the fingers or toes are not getting enough oxygen-rich blood. The fingers or toes may also feel cold and numb. Finally, as the arterioles dilate (relax) and blood returns to the digits, rubor (redness) may occur. As the attack ends, throbbing and tingling may occur in the fingers and toes. An attack can last from less than a minute to several hours. 

How is it classified?

Doctors classify Raynaud’s phenomenon as either the primary or the secondary form. In medical literature, “primary Raynaud’s phenomenon” may also be called Raynaud’s disease, idiopathic Raynaud’s phenomenon, or primary Raynaud’s syndrome. The terms idiopathic and primary both mean that the cause is unknown.

How is it diagnosed?

If a doctor suspects Raynaud’s phenomenon, he or she will ask the patient for a detailed medical history. The doctor will then examine the patient to rule out other medical problems. The patient might have a vasospastic attack during the office visit, which makes it easier for the doctor to diagnose Raynaud’s phenomenon. Most doctors find it fairly easy to diagnose Raynaud’s phenomenon but more difficult to identify the form of the disorder. (See below for the criteria doctors use to diagnose primary or secondary Raynaud’s phenomenon.)

Diagnostic Criteria for Raynaud’s Phenomenon

Primary Raynaud’s Phenomenon

Periodic vasospastic attacks of pallor or cyanosis (some doctors include the additional criterion of the presence of these attacks for at least 2 years)

Normal nailfold capillary pattern

Negative antinuclear antibody test

Normal erythrocyte sedimentation rate

Absence of pitting scars or ulcers of the skin, or gangrene (tissue death) in the fingers or toes

Secondary Raynaud’s Phenomenon

Periodic vasospastic attacks of pallor and cyanosis 

Abnormal nailfold capillary pattern

Positive antinuclear antibody test

Abnormal erythrocyte sedimentation rate

Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes 

How is it treated?

Nondrug Treatments and Self-Help Measures: Several nondrug treatments and self-help measures can decrease the severity of Raynaud’s attacks and promote overall well-being.

Take action during an attack 

Keep warm 

Don’t smoke 

Control stress 

Exercise regularly 

See a doctor if questions or concerns develop 

Medications:

People with secondary Raynaud’s phenomenon are more likely than those with the primary form to be treated with medications. Many doctors believe that the most effective and safest drugs are calcium-channel blockers, which relax smooth muscle and dilate the small blood vessels. These drugs decrease the frequency and severity of attacks in about two-thirds of patients who have primary and secondary Raynaud’s phenomenon. These drugs also can help heal skin ulcers on the fingers or toes.

Other patients have found relief with drugs called alpha-blockers that counteract the actions of norepinephrine, a hormone that constricts blood vessels. Some doctors prescribe a nonspecific vasodilator (drug that relaxes blood vessels), such as nitroglycerine paste, which is applied to the fingers, to help heal skin ulcers. Patients should keep in mind that the treatment for Raynaud’s phenomenon is not always successful. Often, patients with the secondary form will not respond as well to treatment as those with the primary form of the disorder. 

Patients may find that one drug works better than another. Some people may experience side effects that require stopping the medication. For other people, a drug may become less effective over time. Women of childbearing age should know that the medications used to treat Raynaud’s phenomenon may affect the growing fetus. Therefore, women who are pregnant or are trying to become pregnant should avoid taking these medications if possible. 

What research is being done?

Researchers are studying the use of other drugs to treat Raynaud’s phenomenon; for example, oral and intravenous prostaglandins, such as iloprost. Other investigators are studying the molecular mechanisms behind Raynaud’s phenomenon and the anatomy of blood vessels. Several medical centers in the United States are studying the use of biofeedback to control attacks. Researchers studying scleroderma and other connective tissue diseases are also investigating Raynaud’s phenomenon in relation to these diseases.

Some of the related information found on Arthritis Insight:

For medication information see our Medication Index.

For more sites about Raynaud’s check out our Web Links.

For more information:

Raynaud’s Foundation 

The Arthritis Foundation

Raynaud’s Association – About Raynaud’s Phenomenon 

The Arthritis Society – Raynaud’s

References: 

The National Institute of Arthritis and Musculoskeletal diseases, Questions & Answers about Raynaud’s