Raynaud's Phenomenon

Kailey Stiles, OMS III

What is Raynaud’s Phenomenon?

Raynaud’s phenomenon, also known as Raynaud Syndrome, is an exaggerated response to a normal physiologic process. This means that the body reacts as it is supposed to, but in an exaggerated way. Normally, when a healthy individual is exposed to cold temperatures the blood vessels in the fingers and toes vasoconstrict or narrow. This diverts blood to the body’s core, which ensures blood flow is going to the body’s vital organs. In Raynaud’s phenomenon this vasoconstriction occurs, but to a more dramatic extent to the point of causing a change in skin color and symptoms such as aching, numbness and tingling in response to cold. This usually includes a sudden onset of cold in digits on hands or toes followed by a three-color change from white to blue to red. Vasoconstriction of the digits can also occur due to emotional stress. Raynaud phenomenon is more common in young women and in those with a family history.

What causes Raynaud’s Phenomenon?

The cause is not completely clear. Most commonly occurs due to exposure of cold temperatures, which causes an exaggerated vasoconstriction of the blood vessels to the fingers and toes. This results in decreased blood flow to those areas. In addition, emotional stress can cause an attack due to the stimulation of the sympathetic nervous system. This is the “fight or flight” part of the nervous system.

What do patients with Raynaud’s Phenomenon experience?

Commonly, symptoms occur from low blood flow to fingers and toes. Patients can experience numbness, aching, pain, clumsiness of motor skills of the hand, and sensations of “pins and needles”. Normally when the fingers and toes warm again the symptoms will completely go away and leave no residual effects. Very rarely, when blood flow is severely impeded tissue ischemia results in ulcerations of the skin, which occurs at the very tips of the fingers and toes.

What is the difference between primary and secondary Raynaud’s phenomenon?

Primary Raynaud’s phenomenon is idiopathic, which means we do not know what causes it. It is not considered to be a pathologic or a disease process. It is simply an exaggerated vasoconstriction of the digits, which affects the normal blood supply.

Secondary Raynaud’s phenomenon includes patients whom an associated disease or cause is responsible for the disruption of blood flow to the digits and surrounding skin. Some of these diseases include: autoimmune rheumatic diseases such as systemic lupus erythematosis, amphetamines and chemotherapeutic agents like cisplatin and bleomycin, and hematologic abnormalities including cryoglobulinemia and cold agglutin disease. Additionally, causes of secondary Raynaud phenomenon include vascular trauma, frostbite, carpal tunnel syndrome, overuse of vibrating hand tools, vasculitis, and hypothyroidism.

How is Raynaud’s Phenomenon diagnosed?

Evaluation begins with three screening questions:
  1. Are your fingers or toes unusually sensitive to cold?
  2. Do your fingers or toes change color when they are exposed to cold temperatures?
  3. Do your fingers or toes turn white, blue, or both?
If a patient answers yes to all three of these questions, then they most likely have Raynaud phenomenon. It is not always necessary to induce an attack, such as a coldwater challenge or inducing an emotional stress attack due to the responses to those challenges being inconsistent for those patients with Raynaud phenomenon.

What is the treatment for Raynaud’s Phenomenon?

The initial treatment of Raynaud syndrome is to avoid things that trigger an attack. This includes avoidance of cold temperatures and sudden temperature changes, which can even occur when entering the frozen food section at the supermarket. Maintaining whole body warmth is important as well. Avoid repeat trauma of fingertips, vasoconstrictive drugs, and encourage smoking cessation when appropriate. Educating patients on the link between emotional stress and Raynaud’s phenomenon is important and attention to mental health disorders should be considered. Unless there is another disease that is causing the Raynaud’s, Raynaud’s itself is rarely harmful and usually doesn’t require treatment beyond avoiding inciting causes.

If the symptoms are extremely debilitating, or cause ulceration of the tips of fingers or toes, pharmacological therapy and referral to a rheumatologist to look for autoimmune disease causes may also be considered. Very few patients with Raynaud’s should be offered drug treatment, because the side effects of the medications are more dangerous than the Raynaud’s they are used to treat.
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