Raynaud’s Phenomenon

Symptoms

Raynaud’s Phenomenon (RP) is often triggered by cold temperatures or in stressful situations. People with RP can experience an “attack” of symptoms where blood flow to the fingers and toes is significantly reduced. Some people will experience colour changes in affected areas, which can turn white (pallor), blue (cyanosis), and/or red (rubor) over the course of an attack.

The areas where blood flow is reduced can be quite painful and a burning feeling may be present as the areas re-warm.

Most attacks last around 5 to 10 minutes but they can vary in duration. Some may be very brief, lasting only a minute or two, while others may be much longer, lasting up to several hours.

It is possible to have more than one attack per day.

The areas that are most commonly affected by Raynaud’s are the fingers and the toes. Less commonly, it can also affect the nose, ears, lips and nipples.

In severe cases of secondary Raynaud’s, when the condition is accompanied by an autoimmune or connective tissue disease, it can cause painful ulcers on the fingertips.

Diagnosis

Raynaud’s phenomenon (RP) is best diagnosed by a rheumatologist, a type of doctor that specializes in arthritis and autoimmune disease.

To diagnose RP, they will take a careful and complete history focusing on the nature of their patient’s Raynaud’s attacks, and perform a thorough physical examination. Based on this information, the doctor will likely order tests to confirm the diagnosis, investigate if the Raynaud’s is primary (it appears on its own) or secondary to an undiscovered autoimmune disorder, and to rule out other possible conditions.

The most pertinent sign of Raynaud’s is the lack of blood flow to the fingers or the toes during an attack. This can be seen easily as the area affected will turn white, the red or blue then return to the natural skin colour.

The best way to diagnose Raynaud’s is to ask the patient to bring in pictures of the affected area to observe colour changes.

Another method to test for Raynaud’s is known as the “cold challenge”. A person simply places their hands under cold water. Those with RP will lose circulation to their hands and fingers much more quickly than those not affected. A doctor observing the challenge can tell the difference between normal circulation and the reduced circulation seen with Raynaud’s. This is not done frequently as it is uncomfortable for the patient.

Common Tests to Diagnose Raynaud’s Phenomenon

The following tests are commonly used to help diagnose RP. Other more specific tests might be performed to investigate if there are potential underlying autoimmune diseases that might accompany secondary Raynaud’s.

Causes

Scientists don’t fully understand what causes blood vessels to become more sensitive to cold temperatures and other triggers, such that Raynaud’s phenomenon is developed.

Some experts theorize that Raynaud’s phenomenon might be related to the immune system because it is sometimes associated with autoimmune or connective tissue diseases such as rheumatoid arthritis, scleroderma, Sjogren’s syndrome and lupus.

Attacks of Raynaud’s are usually caused by exposure to cold temperatures. Many other things can trigger an attack too, including emotional stress, trauma (injury), hormonal changes, and smoking.

People have a higher risk of developing Raynaud’s if they have had a previous injury to the extremities like frostbite or surgery, as well as those with a history of repetitive actions or vibrations, such as using a jackhammer, drills, typing, or playing the piano.

Treatments

The most common treatment for Raynaud’s is making accommodations to avoid attacks, including keeping the body, hands, and feet warm. This can also involve avoiding emotional and environmental stress, vibrations, repetitive motions and activities, and lifestyle changes. Medications are only used when these measures do not provide sufficient control of symptoms.

Accommodations to Avoid Attacks

Keeping Warm

One of the best things a person with Raynaud’s can do to manage their symptoms is to keep warm. It is important to keep the whole body warm, not just the hands and feet. When the whole body is warm, it’s easier for the heart to pump warm blood to the extremities.

A warm hat (toque), scarf, and gloves are recommended in colder months. Wearing long underwear, sweaters, scarves, mittens or gloves, and socks can help any time depending on the climate.

It can be helpful to always wear gloves or mittens when handling cold objects, such as taking something out of the freezer.

Making Accommodations in Life and Work

Making certain accommodations help avoid attacks, such as wearing protective gloves in a cold work environment, or avoiding the use of vibrational tools like drills or jackhammers. It is advisable to reduce or avoid jobs or activities that involve repetitive motions.

It is also important to avoid stress and learn to cope with emotionally stressful situations.

Lifestyle and Health Changes (Caffeine, Smoking, Certain Medications)

Caffeine, nicotine, and other stimulants can trigger attacks or make Raynaud’s symptoms worse. It is wise to quit or at least significantly reduce the intake of these substances.

Smoking in general can trigger vasospasm (a sudden constriction of blood vessels) in the arterioles (a small blood vessel), which can exacerbate (intensify) the condition.

Sympathomimetic drugs should be avoided unless supervised by a doctor. These are drugs that affect the sympathetic nervous system. They include illegal drugs like cocaine and methamphetamine, certain supplements like Ephedra, cold medications that contain pseudoephedrine or oxymetazoline, and stimulant treatments for ADHD and narcolepsy.

Medications that Treat Raynaud’s Phenomenon

Most people with Raynaud’s who need medication only take it when they need it, or as instructed by their doctor. In colder climates, a lot of patients who need medication find that they only need to take it regularly during the winter when they know they will be spending extended amounts of time exposed to colder temperatures.

Calcium Channel Blockers (CCB’s)

The first choice of medication to treat Raynaud’s is a type of antihypertensive (blood pressure lowering) medication called a calcium channel blocker (CCB). Examples include long-acting nifedipine, amlodipine, or felodipine.

Other Medications for Raynaud’s

If a calcium channel blocker (CCB) isn’t sufficient to control symptoms or if a person can’t tolerate them, there are many other options to try.

Medications known for erectile dysfunction such as Viagra (sildenafil) or Cialis (tadalafil) can be effective in lower doses.

Losartan is another type of blood pressure medication that has been useful in some people with Raynaud’s.

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, a type of medication best known for as a treatment for depression; and alpha blockers such as prazosin, have also been used to improve RP symptoms.

In very severe cases of RP that have caused ulcers or gangrene (a serious condition where cells die due to lack of blood flow), a medication called iloprost may be given by intravenous infusion in a hospital setting to dilate (open) the blood vessels.

Living with RP

The pain and stiffness caused by RP can sometimes limit people’s normal activities, including work. There are many things people can do to lessen the impact of RP on their work and daily routine.

We recommend adjusting features of the workplace to help make working with RP easier. For example, people that sit for much of the day can adjust the position of chairs and desks for proper posture. Vehicle seats can be adjusted to make driving more comfortable and reduce stress on joints and affected tissues.

Those who find out they have RP while they’re still young can consider choosing work that isn’t physically demanding on their joints and back.

Exercise is important to overall health. It also helps keep the joints moving properly, and helps protect them by strengthening the muscles around them.

The level and amount of exercise people with RP can do depends on the activity of their disease.

A trained arthritis physiotherapist is the best person to help design an exercise program tailored to the needs of patients with RP.

The following are some useful articles on exercising with arthritis:

Exercise and Arthritis: An article by arthritis physiotherapist Marlene Thompson

Exercising in a Flare: Another excellent article by Marlene Thompson on how to cope with flares through your exercise routine.

Alcoholic beverages are not an effective treatment for RP, and they can interact with many medications.

Smoking is not healthy for people with RP. It can make symptoms worse and harder to treat.

Research has shown that some arthritis medications do not work as well in people who smoke.

We recommend that smokers quit immediately to reduce the impact of their symptoms, improve the effectiveness of their medications, and improve their overall health.

Travel is still possible when you have RP.

It is best for people with this disease to get organized well in advance of a trip to ensure a smooth, comfortable, and enjoyable time.

Check out our Travel Checklist page.

Though RP does not particularly cause a loss of sex drive, it can cause pain, fatigue and emotional hardships. These hardships risk creating barriers to sexual needs, ability, and satisfaction.

People with RP can take comfort knowing that sex and intimacy can be maintained. In many cases, it can help draw partners closer together, especially through improved communication.

For more information on intimacy and arthritis, a great book is: Rheumatoid Arthritis: Plan to Win by Cheryl Koehn, Taysha Palmer and John Esdaile.

Raynaud’s Phenomenon (RP) has no effect on fertility. The chances of getting pregnant for people with RP are the same as with people that don’t have it. RP also has no known effects on the developing fetus or the newborn.

The two main issues doctors worry about with RP and pregnancy are:

Following the basics of healthy eating can help improve health and well-being in everyone, including those with RP. Keeping a healthy weight helps reduce the load on weight-bearing joints including the spine, hips, and knees, making it easier to live with the disease.

Unfortuantely, no special diet has ever been proven to significantly alter the course of RP or any other types of arthritis.

In addition, no known natural remedies or complementary therapies have been proven to help RP in any significant way.

People with RP should consult with their doctor to make sure that any supplements or alternative therapies they consume will not negatively interact with their medications.

Its very important for people with RP to attend regularly scheduled appointments with their rheumatologist, and promptly get any tests that are ordered by their doctors.

It is often very important that medications are taken exactly as prescribed. Patients should always talk to their doctor about any issues they experience, or if they would like to change anything.

Raynaud’s Phenomenon is a chronic disease and a rheumatologist is the best partner in helping patients achieve the best quality of life possible.