What you need to know about Raynaud’s disease

An individual suffering from Raynaud ‘s disease feels pain in the extremities, such as the fingers, when temperature drops.

Blood vessels narrow and nearly shut down. Fingers or toes turn from white to blue, and then flush red as the blood returns.

Raynaud’s disease , also known as Raynaud ‘s syndrome or Raynaud ‘s phenomenon, affects 5 to 10 percent of Americans, but only 1 in 10 seek treatment. It is estimated that females are nine times more likely to get affected than males.

Important facts about Raynaud’s disease

Here are a few key points on Raynaud ‘s illness. The main article provides more descriptions and supporting information.

  • Raynaud’s disease is caused by peripheral blood vessels overreacting to cold.
  • The condition affects 5-10 percent of Americans.
  • Maurice Raynaud first described the disease in 1862.
  • Females and people living in colder climates are more often affected.
  • A capillaroscopy can help diagnose Raynaud’s disease.

Treatment

on a cold day
People with Raynaud ‘s disease should be careful to wrap up before going out on a cold day from home.

Raynaud ‘s disease does not get cured, but there are ways to manage the symptoms.

For mild types of Raynaud ‘s disease it can help to cover exposed skin before leaving the house. If an attack occurs, the affected parts are soaked in warm, not hot, water can alleviate symptoms and prevent worse.

If stress is a factor it can help you learn how to manage stress.

Medication may be required for moderate to extreme cases.

Alpha-1 blockers can counter the effect of norepinephrine, which constricts blood vessels. Examples include doxazosin and prazosin.

Dihydropyridine calcium channel blockers relax the smaller blood vessels of the hands and feet. Examples include amlodipine, nifedipine, and felodipine.

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 very severe cases, more invasive procedures are an option:

Nerve surgery: Sympathectomy

The vasoconstriction causes the Raynaud’s is regulated in the affected areas by sympathetic nerves. A surgeon can make small incisions and strip the nerves away from the blood vessels, to decrease the frequency or severity of attacks. That doesn’t always work.

Chemical injections

It can be effective to inject certain chemicals which block sympathetic nerve fibers from performing vasoconstriction. Local anesthetics or type A onabotulinumtoxin, or Botox, work well for some individuals. The effect will wear off, however, and need to be repeated in treatment.

Living with Raynaud’s

People who are prone to Raynaud’s can take steps to avoid certain triggers.

The National Heart, Lung, and Blood Institute (NHLBI) suggest:

  • wrapping up and keeping the house warm when temperatures are cold
  • as far as possible, avoiding emotional stress
  • exercise to promote a healthy lifestyle and reduce stress
  • avoiding medicines and substances that trigger the symptoms
  • limiting consumption of caffeine and alcohol
  • not smoking

They also recommend to follow up with a doctor, particularly if sores grow on the extremities. Getting medical help can prevent symptoms from getting worse and serious complications from getting worse.

Causes

Exactly what causes Raynaud’s remains unclear but a sympathetic nervous system hyperactivation is known to cause extreme narrowing of the blood vessels, known as vasoconstriction.

If the person enters a cold place, opens a fridge, or places his hands in cold water, it can happen.

When faced with stress, some people experience symptoms even without an associated drop in temperature.

The circulatory system at the extremities, such as the fingers and toes, reacts in healthy individuals to conserve heat under cold conditions. The small arteries that supply oxygen narrow to the skin to minimize the amount of heat lost through the surface of the exposed skin.

This narrowning is excessive in people with Raynaud ‘s disease. This is what almost causes the blood vessels to shut down.

Types

There are two types of Raynaud’s disease: Primary and secondary.

Primary Raynaud’s, or Raynaud’s disease, is more common, and it affects people who do not have a secondary medical condition.

Secondary Raynaud’s, or Raynaud’s phenomenon or syndrome, results from an underlying medical issue. It is less common and tends to be more serious.

Causes of secondary Raynaud’s

Causes of secondary Raynaud’s include:

Diseases of the arteries: The signs of Raynaud can be caused by atherosclerosis, a plaque build-up of blood vessels, or Buerger ‘s syndrome, a disorder where blood vessels in the hands and feet become inflamed. The condition also has been related to primary pulmonary hypertension.

Diseases of the connective tissue: Most people with scleroderma have Raynaud ‘s disease, a condition that contributes to hardened skin. The signs are commonly associated with lupus, rheumatoid arthritis, and Sjogren ‘s syndrome, an autoimmune condition that affects glands.

Repetition or vibration: People whose activities or occupations include repetitive movements, such as guitar or piano typing or playing, are at risk of developing the symptoms of Raynaud. Also at risk are those whose jobs involve the use of vibrating tools such as a jackhammer.

Carpal tunnel syndrome: This condition places pressure on the hand traveling nerves and increases sensitivity to the symptoms of Raynaud.

Medications: Drugs that can induce Raynaud’s include beta blockers, ergotamine or sumatriptan-containing migraine medications, ADHD medications, certain chemotherapy medications, and some over-the-counter cold remedies.

Exposure to certain substances: Smoking narrows the blood vessels and Raynaud’s is a potential cause. Other chemicals might also play a role, such as vinyl chloride.

Injuries: after injuries such as frostbite, a broken wrist, or local surgery, Raynaud’s may start.

Raynaud ‘s tend to have more effect on women than on males. Primary Raynaud’s normally begin between the ages of 15 and 25, and secondary Raynaud’s between 35 and 40.

The disease is apparently running in families. An individual with Raynaud’s in first degree relative is more likely to develop it.

Possible pathways of Raynaud’s disease

It is not clear the exact causes of Raynaud ‘s disease, but it likely stems from a combination of factors, and the combination of factors is likely to vary between individuals.

Vascular mediators

Nitric oxide is a strong vasodilator. It has been found in people with secondary Raynaud’s but less so in those with primary Raynaud’s disease.

Endothelin-1 is a potent vasoconstrictor. People with primary Raynaud’s have been found to have high levels of this protein.

Serotonin, a neurotransmitter, has been found in high concentrations in people with Raynaud’s

Other possibilities

Platelet activation appears to be higher in people with Raynaud’s. Platelets are components in blood that clump together to help prevent bleeding.

Fibrinolysis is a natural reaction that takes place in the body to reduce clotting. Some studies have linked low levels of fibrinolysis with Raynaud’s.

Oxidative stress is caused by an increase in free radicals, and it could be involved in Raynaud’s.

Symptoms

Raynaud’s disease affects some individuals when exposed to cold.

The blood vessels contract in the fingers or in the toes as temperatures drop. This contraction causes the affected tissues to get hypoxia, or lack of oxygen. Fingers and toes feel cold and possibly numb to the touch.

The affected area sometimes turns white, then turns blue afterwards. Once the area is warmed and the blood flow returns, a sensation of tingling may accompany a red flush and possibly swell. A painful, throbbing sensation can also be present.

Toes and fingers are most commonly affected but nose , lips, and ears can be affected by Raynaud’s.

Some women may experience the phenomenon of Raynaud’s nipples, especially during breastfeeding. It causes severe throbbing, similar to the one experienced with a fungal infection of Candida albicans (C. albicans), which can lead to misdiagnosis.

An episode normally lasts about 15 minutes, including the time the body needs to normalize.

Raynaud’s feet

Raynaud’s syndrome can affect either the hands or feet, or both.

It can help keep the feet and hands warm, stop smoking and get enough exercise to minimize the risk of an attack.

When an attack starts, for example by massaging them, it can be reduced or prevented by warming the hands and feet at once.

The feet and hands should be protected as far as possible from cuts , bruises and other injuries, because the loss of circulation will make healing more difficult for them. Use lotion to prevent cracking of the skin, and ensure that you have comfortable, well-fitting shoes.

Diagnosis

The doctor will ask the patient questions about symptoms, diet, behaviors and hobbies. The patient should be willing to explain when the symptoms first appeared, how often they have them and what they appear to be causing. Holding a diary with this knowledge will help.

The doctor may do a capillaroscopy to differentiate between the secondary and primary Raynaud’s. This includes examining the skin at the base of the fingernail, and checking it for malformed or enlarged capillaries under a microscope.

A blood test can be performed to check for antinuclear antibodies or to calculate the sedimentation rate of erythrocytes, which may suggest autoimmune diseases or other inflammatory processes.

Complications

Raynaud’s are usually not life-threatening but complications may occur.

Chilblains occur when there is a blood circulation problem and one possible cause is Raynaud’s. The skin becomes itchy, red, and swollen, and hot, burning, and tender may feel. Chilblains typically resolve within 1 to 2 weeks, but can return. Maintaining the extremities warm may help to prevent them. If the hands and feet get cold, heat them up slowly, since too much heat can cause further damage.

If symptoms worsen and there is a significant reduction in blood supply for a long time, the fingers and toes may become deformed.

If oxygen is completely cut off from the area, skin ulcers and gangrenous tissue can develop. Both of these conditions are hard to treat. In the end, they can need amputation.

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