A Profile on: Raynaud’s Disease

A Profile on: Raynaud’s Disease

Raynaud’s disease (primary) or phenomenon (secondary) is a medical condition that causes reduced blood flow to the hands and feet and in some cases, it can affect ears, nipples, knees or nose. The reduction in blood flow is caused by spasms in the arteries, with the blood vessels overreacting to cold or as a result of emotional stress. Its pathophysiology includes hyperactivation of the sympathetic nervous system causing extreme vasoconstriction of the peripheral blood vessels, leading to tissue hypoxia (a lack of oxygen). Affected areas often turn white or blue and the color change is accompanied by numbness or pain. Once the spasms subside and blood flow is restored affected areas turn red and a burning or pins and needles sensation may be experienced before returning to a normal shade. Typically, these episodes last only minutes but can last up to several hours.

Higher Incidence in Autoimmune Patients

Primary Raynaud’s is idiopathic and not related to another disease. Secondary Raynaud’s occurs as a result of another condition. Often occurring in relation to autoimmune and rheumatic diseases. Raynaud’s disease affects between 5-10 % of the general population but occurs at much higher frequencies in autoimmune populations. Raynaud’s is seen in 90-95 % of scleroderma patients, 85 % of mixed connective tissue disease patients, 40% of systemic lupus erythematosus patients and between 8-22% of rheumatic patients with conditions such as rheumatoid arthritis. Diagnosis is typically based on the symptoms presented. Your physician will perform a physical examination which may include a cold challenge test. This is done to see the color changes in the hands and fingers. During the test, your hands are exposed to cold. Your physician could opt to look at the tiny blood vessels in your fingernails with a microscope. Adults who start to have Raynaud’s phenomenon after age 35 may be tested for an underlying disease. You may have blood tests to see if your condition is primary or secondary. Raynaud’s can precede the diseases it is associated with by a number of years, making it the first presenting symptom.

An Ounce of Prevention is Worth a Pound of Cure

Mild secondary Raynaud’s disease is treated by managing the underlying condition. Treatment also involves avoiding triggers such as cold, emotional and environmental stress, vibrations and repetitive motions, and smoking (as well as passive smoking). For moderate to severe cases, medication may be necessary.

Alpha-1 blockers can counter the effect of norepinephrine, which constricts blood vessels. Dihydropyridine calcium channel blockers relax the smaller blood vessels of the hands and feet. Topical nitroglycerin ointment applied to the affected area appears to relieve the symptoms by improving blood flow and cardiac output and decreasing blood pressure. Other vasodilators dilate the veins, easing symptoms. Examples include losartan, sildenafil (Viagra), fluoxetine (Prozac), and prostaglandin.

In extremely severe cases more invasive treatment options may need to be considered. Specific chemicals that block sympathetic nerve fibers from carrying out vasoconstriction can be injected and are an effective way to relieve symptoms. Local anesthetics or onabotulinumtoxin type A, or Botox, work well for some patients, but requires repeated treatment as the effects wear off and can be costly. The vasoconstriction that causes Raynaud’s is controlled by sympathetic nerves in the affected areas. A surgeon can make small incisions and strip the nerves away from the blood vessels, to decrease the frequency or severity of attacks. This is, however, not always successful.

Healing in your own hands

In addition to the options listed above, there are a number of small ways in which patients with Raynaud’s (either primary or secondary) can greatly reduce the frequency and severity of attacks. First and foremost, ensure that affected areas are wrapped up to reduce cold exposure. While at home ensure the thermostat maintains the house at a pleasant temperature. Underfloor heating can help but is an expensive option. Microwaveable pocket warmers are great to slip into your coat pocket in winter, microwavable slippers are a great idea if your feet are the affected area. As far as possible avoid emotional stress, try meditation apps or keeping a gratuity journal to help with that. Exercise can be a great way to reduce stress, increase circulation, and promote overall health. Keep a symptom checker, record what medications and other substances you’ve taken before a flare. If you can see a definite pattern, discuss altering these medications with your physician. Limit your caffeine (consider switching to decaf coffee) and alcohol consumption. Avoid both primary and secondary smoking as this causes the blood vessel to constrict.

For most patients, Raynaud’s tends to be more of an inconvenience than a serious problem. Secondary Raynaud’s associated with a number of autoimmune conditions may be more difficult to control and often requires good control of the underlying diseases as well, in which case these patients should also experience fewer and less severe attacks.

Article Author
Arthritis National Research Foundation
arthritisresearch@curearthritis.org

The Arthritis National Research Foundation's mission is to provide initial research funding to brilliant, investigative scientists with new ideas to cure arthritis and related autoimmune diseases. Writing articles about the patients affected and the science being done to find a cure shows why we need to come together to #CureArthritis!

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