Raynaud's Syndrome

This article is all about Raynaud’s Syndrome, also referred to as Raynaud's Disease, Raynaud's Phenomenon, or just plain Raynauds. We will look at what the condition is, what the symptoms are, what causes it, how it’s diagnosed and how we treat it. 

The information is also available in video format below.

What Is Raynaud’s ?

Raynaud’s syndrome is a vascular problem. It’s categorised as an episodic vasospasm, which means that the symptoms occur intermittently, and it involves the blood vessels becoming narrow and constricted, which restricts blood flow. In Raynaud’s its the blood flow to the hands and fingers that’s most commonly affected. 

We don’t know why some people get it but it does tend to run in families which suggests a possible genetic cause. And while I said that Raynauds is a vascular problem, strictly speaking it is actually a neurological problem because the diameter of the blood vessels is controlled by nerves, called sympathetic nerves. The sympathetic NS controls various involuntary, or automatic body systems such as your heart rate, the diameter of the pupils in your eyes, your skin - such as goose bumps and the control of sweat glands as well as the function of many internal organs. But these nerves can also control the diameter of the small blood vessels all around the body. They do this by controlling the activity of tiny muscles that wrap around the blood vessels. 

When these muscles activate they essentially squeeze the vessels, narrowing them and reducing the biood flow. This is a process called vasoconstriction and its a perfectly normal and useful process, particularly when the body is trying to conserve central body heat or to raise blood pressure when necessary. But in Raynauds, vasoconstriction occurs for no good reason. It’s almost like the sympathetic nerves have become overly sensitive. They activate far too easily and reduce blood flow, particularly to the hands, when it’s not really needed. 

Who gets Raynaud’s ?

Anyone can get Raynauds and it can start at any age but is is most common between the ages of 15 and 30. It affects about 5% of the general population which equates to about 17 million people in the US. It is more common in women by about 5:1. It’s also more commonly seen in colder countries and in people who already have poor circulation such as smokers, diabetics and people with peripheral vascular disease.

Now what ive described so far is Primary Raynauds which starts for no obvious reason and accounts for nearly 90% of people with the condition. But there is another type of Raynauds called Secondary Raynauds Disease which is less common and is associated with other conditions, typically some of the autoimune diseases such as lupus and scleroderma. 

What are the symptoms ?

The first symptoms that people tend notice are painful fingers when exposed to cold temperatures. And it can be triggered by just reaching into the fridge or freezer or when the air conditioning is turned on, or even when holding a cold drink.

Raynaud’s symptoms tends to occur intermittently in a Raynauds attack which is often triggered by these sudden changes in temperature, although Stress and anxiety have also been found to trigger a Raynauds attack. The symptoms are cold, numb, painful fingers which classically change colour, first turning white as the blood vessels constrict, then blue as the oxygen in the fingers depletes. The fingers can then turn red as the attack ends and the blood flushes back to the fingers, often causing tingling sensations and stinging pains. All 3 colour changes don’t have to occur with a Raynauds attack but the white blanching colour will always tend to happen. After that, you might get the blue or red colours, but not always.  

The typical colour changes during a Raynaud's Attack

While the symptoms most commonly affect the fingers they can also affect other vascular beds such as the feet and toes, the lips, ears, tip of the nose and the nipples. In more severe cases, or if the problem has gone untreated for a long time, the skin can start to break down causing sores, ulcers, blisters and rashes.

How is Raynauds diagnosed ?

Raynaud’s is usually diagnosed clinically meaning that a clinician will listen to your symptoms, examine your hands and then make the diagnosis based on that information. Blood tests are often used to exclude other causes and to test for the autoimmune diseases associated with secondary Raynauds. Occasionally there might be a need to confirm the diagnosis and that’s done by using a test called nail fold cappilaroscopy. The skin at the base of nails is examined using a small camera or microscope. In Raynaud’s the tiny capillaries have a distinctive appearance. 

Nail Fold Cappilaroscopy

How is Raynauds treated ?

During an attack it’s best to keep your fingers moving to help restore circulation. You could also try massaging your hands or feet. If you’re outside, then putting your hands into your armpits can warm them up nicely. if you’re inside then you can warm them up slowly using warm water. Don’t use water that's too hot though as this can be painful. 

To stop a raynauds attack in the first place the most helpful preventive measure is the obvious one - just keep your hands warm in colder weather and avoid exposing your hands or feet to sudden changes in temperature. So of course, using  warm socks and gloves is going to be important. Compressions Gloves, and Gloves using silver thread have been found to be particularly helpful in Raynauds. 

Compression Gloves for Raynaud's

You can also buy rechargeable electrically heated gloves which are good for a few hours and also hand warming power packs. When outside on cold days, the warmest item you can use for your hands are Mitts which are generally much warmer than gloves but of course they do reduce your finger dexterity while wearing them. 

Rechargeable Battery Heated Gloves

Rechargable Hand Warmers

Mitts are much warmer than gloves

If you’re a smoker then stopping will be the best thing you can do to help with symptoms and improving your circulation, and similarly if you’re a diabetic then optimising your control should be your main goal.

Raynaud's support groups often recommend the use of a heated hand massager to help with both circulations and warmth.

Heated Hand Massager

There is some evidence to support the use of Supplements in Raynauds. Fish oils and Gingko are the most commonly used but also Vitamin D, particularly if a blood test has found that your vitamin D levels are low. There is an opinion that Vitamin E, magnesium, niacin and evening primrose oil can also help, amongst many other more obscure supplements but they aren’t supported by the current research.

Supplements for Raynaud's

If these simple things don’t work in your case then you will need to see a HCP as the next treatments will usually involve drugs which have a vasodilation effect. These work by acting on those sympathetic nerves which control the diameter of the blood vessels and they can increase the blood flow to your hands and feet. There are a number of different drugs used for this purpose but the calcium channel blockers are main category used with a drug called Nifedipine being the most effective of these. 

If you’re still struggling with symptoms after all we’ve discussed then you might need to see a Rheumatologist, who are the specialist doctors who treat Raynauds symptoms that don’t respond to the usual treatments. And they might try some of the other speciality drugs available such as the Prostanoids which are used intravenously or the PDE5 inhibitors among which is Viagra.

After that, in severe cases, there are Botox Injections into the hands or feet, and there is a surgical treatment called Sympathectomy where the surgeon removes some of those sympathetic nerves that control the constriction of the blood vessels.


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