Raynaud disease

What is Raynaud\'s disease?

Raynaud\'s disease is a rare disorder that involves the arteries. Arteries are the blood vessels that carry blood your heart to other parts of the body. Raynaud\'s disease changes how blood flows through the arteries to the skin.

Symptoms

What are the symptoms of Raynaud\'s disease?

During an episode of Raynaud\'s, the arteries constrict (become narrow). Blood does not flow well to the skin\'s surface and causes the skin to change its normal color to blue (because of the lack of oxygen-rich blood). The skin may also feel numb and cold. A Raynaud\'s episode can last several minutes to an hour or more.

Once an episode is over, the skin turns red as the blood rushes back through the arteries. The skin begins to tingle or throb as it warms up again. It can take up to 15 minutes for blood flow to return to normal.

Raynaud\'s disease usually affects the fingers and toes. In rare instances, it also may affect the nose, ears, nipples and lips.

While most people have no long-term tissue damage or disability the disease, those with severe Raynaud\'s can develop skin sores or infections long or repeated attacks.

Causes & Risk Factors

What causes Raynaud\'s?

There are two types of Raynaud\'s disease:

Primary Raynaud\'s diseaseis the most common type, making up about 80% of the cases. Primary Raynaud\'s occurs when the blood vessels in the hands or feet overreact to stress or cold temperatures. Often, people who have primary Raynaud\'s have mild symptoms that can be treated with lifestyle changes.

Secondary Raynaud\'s syndromeoccurs in people who have some other health problem that leads to or triggers Raynaud\'s syndrome. Secondary Raynaud\'s is a more serious disease that can require both medicine and lifestyle changes to manage. Secondary Raynaud\'s may be related to:

• Connective tissue disorders, such as polymyositis/dermatomyositis, rheumatoid arthritis, scleroderma, Sjögren\'s syndrome, lupus
• Endocrine (gland) disorders, such as hypothyroidism
• Blood disorders, such as cold agglutinin disease, Polycythemia vera
• Neoplastic (cell growth) disorders, such as carcinoid syndrome, paraneoplastic syndrome
• Problems that affect the nervous system, such as carpal tunnel syndrome
• Vascular disorders, such as thoracic outlet syndrome
• Artery diseases, such as atherosclerosis (hardening of the arteries), Buerger\'s disease, pulmonary hypertension

Some medicines also can trigger Raynaud\'s:

• Certain high blood pressure medicines called beta blockers
• Migraine medicines that contain ergotamine
• Estrogen-containing medicines, such as birth control pills
• Chemotherapy medicine, such as cisplatin and vinblastine
• Certain cold medicines that cause blood vessels to narrow, such as those containing pseudoephedrine

Who is at risk for Raynaud\'s?

Raynaud\'s disease affects about 3% to 5% of people. It is most common in women and occurs more often in colder climates.

Primary Raynaud\'s usually occurs between 15 and 25 years of age. People who have a family history of the disease are at a greater risk.

Secondary Raynaud\'s occurs later in life, usually in people 30 years of age and older. Certain diseases (see above), medicines (see above), smoking, injuries to the hands or feet, frostbite, chemical exposure, and occupations that involve repetitive motion or vibration have also been linked to Raynaud\'s disease.

Diagnosis & Tests

How is Raynaud\'s diagnosed?

Your doctor will likely check your medical history to find out if you have relatives with Raynaud\'s or health conditions that are linked to Raynaud\'s. Your doctor may ask about your symptoms, especially when you are cold or stressed.

A physical exam will help determine if you have Raynaud\'s or some other problem that can cause similar symptoms. Your doctor may examine your fingernails to check the blood vessels there. He or she may trigger a Raynaud\'s episode using cold water or air to see your response. Blood tests also may be used to identify the form of the disease or if other diseases are causing your symptoms.

Treatment

How is Raynaud\'s treated?

Both types of Raynaud\'s are lifelong conditions. To date, no cure has been found. But research is under way to improve diagnosis and treatment. And lifestyle changes can help with the symptoms.

• Reduce exposure to cold or temperature extremes, such as going outdoors in winter or removing items a freezer.
• Quit smoking.
• Learn stress-relief techniques.
• Warm your hands or feet during an episode with warm water or chemical warmers, which are small packets that you can put in your pockets or shoes.
• Exercise to increase blood flow (especially for primary Raynaud\'s disease).
• Avoid wearing clothes with tight cuffs, or tight jewelry such as rings or bracelets.
• Limit caffeine and alcohol.

Medicines that help Reynaud\'s symptoms include:

• Many different calcium channel blockers can be used to reduce how often you have episodes and how long the episodes last. These medicines relax the small blood vessels so they can open up again.
• Alpha blockers can be helpful. They block a hormone called epinephrine that constricts blood vessels.
• Medicine that helps blood cells flow through small channels better, such as pentoxifylline
• ACE inhibitors, such as captopril
• Intravenous (IV) prostaglandins

New medicines for people whose Raynaud\'s symptoms don\'t seem to be controlled by other methods include fluoxetine, phosphodiesterase inhibitors such as cilostazol, sildenafil and an angiotensin II receptor antagonist losartan.

Sometimes the affected area can be injected with a medicine that helps block the nerves that are triggering the blood vessel changes. This treatment may be needed more than once.

If your Raynaud\'s is especially serious—for example, if lack of blood flow is so extreme you could lose a finger or toe—you may need surgery to improve the blood flow to your fingers and toes, or surgery or shots to block the nerves that control the arteries. In rare cases, damaged or destroyed tissue may need to be treated or removed.

If another condition is causing secondary Raynaud\'s disease, you may need treatment for that condition. Talk to your doctor about your options.

See your doctor often for ongoing care. Contact your doctor right away if symptoms occur on only one side of your body, or if you get sores or ulcers on your fingers or toes.

Tips on How to Manage a Raynaud\'s Episode

• Get warm: Move inside if it\'s cold outside or move to warmer place. Use warm water to soak your hands and feet.
• Move around: Wiggle your fingers and toes. Move your arms in wide circles.
• Encourage circulation. Massage your fingers and toes.
• De-stress. Get away a stressful situation if that is part of what is causing your symptoms.

Other Organizations

Questions to Ask Your Doctor

• Are my family members at risk of Raynaud\'s disease?
• Do I have primary or secondary Raynaud\'s?
• What is the best treatment for me? How do we manage my symptoms?
• Am I at risk for infection in the affected body part(s)?
• Does Raynaud\'s disease put me at risk for any other health problems?
• What can I do at home to prevent episodes of Raynaud\'s disease?
• Do I need to make any lifestyle changes?
• Is it safe for me to exercise? What kind of exercise should I do?