1. What is Raynaud's Syndrome?
Raynaud's syndrome is a disorder that affects the small blood vessels in the
fingers, toes, ears, and nose. It is characterized by episodes when the blood
vessels in the fingers and toes become narrow. Raynaud's syndrome affects up to
5 to 10 percent of the population to some degree. Women are more likely than men
to have the disorder and it is more common in colder weather.
2. What happens during an attack?
An attack is usually triggered by exposure to cold or emotional stress and
can last less than a minute or up to several hours. When a person is
exposed to cold, the normal response is to reduce heat loss by reducing the
blood flow to the skin surface. In Raynaud's syndrome, this normal
response to cold is intensified and small blood vessels in the coldest parts of
the skin (e.g. fingers and toes) go into spasm. As a result, the blood
supply to these parts of the skin is greatly decreased and this is evident by
the skin colour change and other symptoms.
Once the attack begins, there are usually three phases of skin colour change:
white, blue, and then red. The order of the change in skin colour is not
the same for all people, and not everyone has all three.
|Pallor (whiteness) occurs in response to the narrowing of the small
arteries by spasm.|
|Cyanosis (blueness) may appear because the skin is not getting enough
oxygen-rich blood. The skin may also feel cold and numb.|
|Rubor (redness) as the blood vessels eventually relax the blood returns to
the digits. Throbbing and tingling may occur in the fingers and toes.|
3. How Is Raynaud's Syndrome classified?
Raynaud's is classified into two forms depending on if there is any
associated conditions which are believed to trigger the Raynaud's
Most people have the milder primary form of Raynaud's syndrome for which
there is no obvious cause. More women than men are affected, and
approximately 75 percent of all cases are diagnosed between the ages of 15
and 40 years. Some people who have primary Raynaud's for several years
later develop a connective tissue disorder such as scleroderma. Less than
one in ten develop a secondary disease.
Much less common than the primary form but a more complex and serious
disorder. Secondary means that patients have an underlying disease or
condition that causes Raynaud's phenomenon. Connective tissue diseases
are the most common cause. Secondary Raynaud's is seen in
approximately 85 to 95 percent of patients with scleroderma and mixed
connective tissue disease, and it is present in about one-third of patients
with systemic lupus erythematosus. Raynaud's can occur with other connective
tissue diseases, including Sjögren's syndrome, dermatomyositis, and
Other possible causes of secondary Raynaud's are carpal tunnel syndrome and
arterial disease. Drugs, including beta-blockers, ergotamine
preparations, agents used in cancer chemotherapy, and drugs that cause
vasoconstriction (e.g. some over-the-counter cold medications) and narcotics
are linked to Raynaud's phenomenon.
People in certain occupations may be more vulnerable to secondary Raynaud's.
Workers in the plastics industry who are exposed to vinyl chloride can develop
a scleroderma-like illness, of which Raynaud's phenomenon can be a part.
Workers who operate vibrating tools can develop a type of Raynaud's phenomenon
called vibration-induced white finger. In addition, people whose
fingers are subject to repeated stress, such as typing or playing the piano,
are more vulnerable to the disorder.
People with secondary Raynaud's often experience associated medical
problems. The more serious problems are skin ulcers or gangrene of the fingers
or toes. Painful ulcers and gangrene are fairly common and can be difficult to
treat. In addition, a person may experience heartburn or difficulty in
swallowing. These two problems are caused by weakness in the muscle of the
gullet and can occur in people with connective tissue diseases, particularly
4. How do you diagnose Raynaud's Syndrome
The description of typical attacks is usually enough to suggest the
diagnosis. It is more difficult to decide if it is the primary or secondary form
and this requires a physical examination and some blood tests. There are
some tests that are only available to specialists:
|Nailfold capillaroscopy can help to distinguish between primary and
secondary Raynaud's. During this test, the doctor puts a drop of oil on the
skin at the base of the fingernail and then examines the blood vessels in
the skin under a microscope. If the capillaries are enlarged or deformed,
the patient may have a connective tissue disease.|
|The doctor may also order some blood tests, an antinuclear antibody (ANA)
test and an erythrocyte sedimentation rate (ESR). The ANA test is often
positive in people who have connective tissue diseases or other autoimmune
disorders. The ESR test is a measure of inflammation in the body.|
5. Diagnostic Criteria for Raynaud's Syndrome
|Periodic vasospastic attacks of pallor or cyanosis for at least 2 years
|Normal nailfold capillary pattern
|Negative antinuclear antibody test
|Normal erythrocyte sedimentation rate
|Absence of pitting scars or ulcers of the skin, or gangrene in the fingers
|Periodic vasospastic attacks of pallor and cyanosis
|Abnormal nailfold capillary pattern
|Positive antinuclear antibody test
|Abnormal erythrocyte sedimentation rate
|Presence of pitting scars or ulcers of the skin, or gangrene in the
fingers or toes|
6. What is the treatment for Raynaud's Syndrome?
There is no specific treatment that cures Raynaud's. The main aim
therefore is to reduce the number and severity of attacks and to prevent tissue
damage and loss in the fingers and toes. Cconservative (non-drug)
treatment and self-help measures are used first. Drugs may be used for
some patients, usually those with secondary Raynaud's in addition to treatment
of any underlying disease or condition.
7. What are non-drug treatments and self-help measures?
Non-drug treatments and self-help measures can decrease the severity of
Raynaud's attacks and promote overall well-being.
|Take action during an attack|
The duration and severity of an attack can be lessened by a few simple
actions. The first and most important action is to warm the hands or feet.
In cold weather, people should go indoors. Running warm water over the
fingers or toes or soaking them in a bowl of warm water will help. Taking
time to relax will further help to end the attack. If a stressful situation
triggers the attack, a person can help stop the attack by getting out of the
stressful situation and relaxing.
It is important to keep the hands and feet warm and to avoid chilling
any part of the body. In cold weather, people with Raynaud's must pay
particular attention to dressing. Several layers of loose clothing, socks,
hats, and gloves or mittens are recommended. A hat is important because a
great deal of body heat is lost through the head. Feet should be kept dry
and warm. Some people find it helpful to wear mittens and socks to bed
during winter. Chemical warmers, such as small heating pouches that can be
placed in pockets, mittens, boots, or shoes, can give added protection
during long periods outdoors. People who have secondary Raynaud's should
talk to their doctors before exercising outdoors in cold weather. People
with Raynaud's should also be aware that air conditioning can trigger
attacks. Turning down the air conditioning or wearing a sweater may help
prevent attacks. Some people find it helpful to use insulated drinking
glasses and to put on gloves before handling frozen or refrigerated foods.
The nicotine in cigarettes causes the skin temperature to drop, which
may lead to an attack.
Stress and emotional upsets may trigger an attack, particularly for
people who have primary Raynaud's. Learning to recognize and avoid stressful
situations may help control the number of attacks. Many people have found
that relaxation or biofeedback training can help decrease the number and
severity of attacks. Biofeedback training teaches people to bring the
temperature of their fingers under voluntary control.
Most people find that exercise promotes overall well-being, increases
energy level, helps control weight, and promotes restful sleep.
|When to see a doctor|
People with Raynaud's should see their doctors if they are worried or
frightened about attacks or if they have questions about caring for
themselves. They should always see their doctors if attacks occur only on
one side of the body (one hand or one foot) and any time an attack results
in sores or ulcers on the fingers or toes.
8. Drug treatment
People with secondary Raynaud's are more likely than those with the primary form
to be treated with medications. The most effective and safest drugs are
calcium-channel blockers, which relax the smooth muscle in the walls of the
blood vessels allowing them to dilate. These drugs decrease the frequency and
severity of attacks in about two-thirds of patients who have primary and
secondary Raynaud's. These drugs also can help heal skin ulcers on the fingers
Other patients find relief with drugs called alpha-blockers that counteract
the actions of adrenaline, a hormone that constricts blood vessels. Some doctors
prescribe a non-specific vasodilator, such as GTN which is applied to the
fingers, to help heal skin ulcers. Patients should keep in mind that the
treatment for Raynaud's is not always successful. Often, patients with the
secondary form will not respond as well to treatment as those with the primary
form of the disorder.
Patients often find that one drug works better than another. Some people may
experience side effects that require stopping the medication. For other people,
a drug may become less effective over time. Women of childbearing age should
know that the medications used to treat Raynaud's may affect the growing foetus
so women who are pregnant or are trying to become pregnant should avoid taking