Raynaud’s Disease Diagnosis and Treatments: Don’t Get Left Out in The Cold
Raynaud’s Disease is a rare disorder that causes blood vessels in the extremities to spasm when cold or stressed. Here’s how to prevent an attack.
“Mom! You’ve got yellow finger disease again,” my daughter said as I emerged from a dip in the cool lake. I looked down and sure enough, four fingers on my left hand and two on my right were a pale yellow. A few of my toes had also lost their color due to Raynaud’s disease.
A rare disorder affecting the arteries that carry blood from the heart to other areas of the body, Raynaud’s disease and its cousin, Raynaud’s phenomenon, affect nearly 5 percent of the U.S. population. Once exposed to cold or stress, the blood vessels narrow briefly in vasospasm, reducing blood flow to the extremities (i.e. fingers and toes.) I felt the tell-tale warning signs as soon as I jumped into the cold water – tingling and numbness crept into my fingers as the blood (and color) retreated.
What Is Raynaud’s Disease?
There are two main types of Raynaud’s: primary (a.k.a. Raynaud’s disease) and secondary (a.k.a. Raynaud’s phenomenon). Although Raynaud’s disease is the most common form, its cause is unknown, says Aruni Jayatilleke, Associate Professor of Drexel University College of Medicine. Its main symptom, she says, is “blood vessel constriction in response to cold temperature. Usually it affects all the fingers except the thumb. This is reversible and usually not associated with permanent damage such as ulcers at the fingertips.” The majority of those who suffer from Raynaud’s disease see it as more of a nuisance than a serious illness and are able to manage their condition without resorting to medication or major lifestyle changes.
Raynaud’s phenomenon is a more severe form of the disorder often caused by an underlying medical condition such as a connective tissue or autoimmune disease (e.g. lupus, scleroderma, or rheumatoid arthritis). The symptoms of this disorder also worsen in the cold, but the blood vessel narrowing and reduction in blood flow can become permanent, says Jayatilleke. Raynaud’s phenomenon “does not always affect all the fingers, and can sometimes cause tissue injury such as ulcers, or in severe cases, tissue death in the fingertips related to lack of blood flow,” she explains.
What Parts of the Body Are Affected by Raynaud’s Disease?
According to the National Heart, Lung, and Blood Institute, the majority of those who suffer from Raynaud’s disease experience symptoms in their fingers, with 40 percent of sufferers complaining of similar issues in their toes as well. In extremely rare cases, a person’s nose, ears, lips and nipples can also be affected.
What Causes Raynaud’s Disease?
As mentioned above, there is no clearly defined cause for Raynaud’s disease. Raynaud’s phenomenon, on the other hand, can be attributed to one or more of the following factors:
- Beta blockers
- Birth control pills
- Cancer medications (i.e. cisplatin and vinblastine)
- Certain medications that can narrow arteries or affect blood pressure (e.g. migraine medications that contain ergotamine can cause narrowing of the arteries)
- Exposure to certain chemicals (i.e. vinyl chloride)
- Hand or foot injuries
- Repetitive actions such as typing or using a vibrating tool such as a leaf blower
- Some over-the-counter cold and allergy medications and diet aids
- Underlying diseases or conditions that damage arteries or nerves in the hands and feet
What Other Conditions Are Associated with Raynaud’s Disease?
The following ailments are potential causes of Raynaud’s phenomenon, according to the National Heart, Lung and Blood Institute:
- Blood disorders (i.e. cryoglobulinemia and polycythemia)
- Buerger’s disease
- Carpal Tunnel Syndrome
- Rheumatoid arthritis
- Pulmonary hypertension
- Sjögren’s syndrome
- Thyroid problems
RISK FACTORS FOR RAYNAUD’S PHENOMENON
The main risk factors for Raynaud’s phenomenon include:
- Age: Raynaud’s phenomenon usually occurs after 30
- Exposure to certain chemicals
- Family history of Raynaud’s disease
- High levels of stress
- Injuries to hands or feet
- Living in a cold climate
- Medications (i.e. cancer drugs, migraine meds, cold or allergy meds
- Repetitive actions (i.e. typing)
- Underlying medical conditions such as lupus or arthritis
Risk Factors for Raynaud’s Disease
The main risk factors for Raynaud’s disease include:
- Age: Raynaud’s disease affects those between 15 and 30
- Family history: While more research is needed in this area, having a close relative with Raynaud’s disease may predispose you to the condition
- Gender: More women than men contract Raynaud’s disease
- High levels of stress
- Living in a cold climate
Check out the sidebar to learn more about the risk factors for Raynaud’s phenomenon.
Can Raynaud’s Disease Turn Fatal?
In extreme cases, yes, says Jayatilleke. Associated diseases such as scleroderma and lupus can cause potentially fatal conditions such as kidney or lung disease. “In addition, severe cases of secondary Raynaud’s may cause permanent tissue damage or gangrene, and in rare instances infections may occur that can be life-threatening. Primary Raynaud’s is unlikely to be fatal in the absence of another serious disorder,” she explains.
Symptoms of Raynaud’s Disease
Once in vasospasm, the extremities often turn white as the blood stops circulating in that area. This can cause a feeling of numbness and discomfort. When the extremity is rewarmed and blood flow returns, it will turn a blue or purple color followed by bright red. This is accompanied by a painful prickling, throbbing and pulsing sensation that takes about 15 minutes to disappear.
EHLERS DANLOW SYDNROME AND RAYNAUD’S DISEASE: IS THERE A LINK?
A large number of those who suffer from the connective tissue disease Ehlers Danlos Syndrome experience Raynaud’s, however as of yet, there is no scientifically proven connection between the two disorders.
How Is Raynaud’s Disease Diagnosed?
The first step to diagnosing Raynaud’s is to take a history. The doctor will likely ask for a description of the person’s symptoms. For instance, do their fingers and/or toes turn white or blue in response to cold and then red upon rewarming? “The symptoms can be elicited in the doctor’s office by exposure to cold temperatures, but this is not done frequently,” Jayatilleke says. Next, the doctor may examine the blood vessels at the base of the fingernail. This is done using a magnifying glass and a light. “There is no single blood test for Raynaud’s,” says Jayatilleke, “though blood tests are sometimes done to look for those associated conditions.”
How Is Raynaud’s Disease Treated?
The number one treatment for Raynaud’s disease and Raynaud’s phenomenon is prevention. Common sense methods such as avoiding exposure to cold and drastic temperature changes are important. Avoiding stress, smoking and medications that can trigger Raynaud’s Disease are also essential to managing symptoms.
Bundle up when you head outside, wear gloves when taking things out of the freezer or shopping in the refrigerated section of the grocery store, and use chemical heat packs in your socks and gloves. Once the fingers have turned white, rewarming the hands (or feet) in warm (not hot) water will increase circulation, recommends Jayatilleke.
In some, more serious cases of Raynaud’s phenomenon, medications are used to help reduce blood vessel narrowing. Blood pressure medications such as calcium channel blockers are favored among many for this use. “Other medications which improve blood flow to the fingers include phosphodiesterase type 5 (PDE5) inhibitors and endothelin receptor antagonists, though this use is not approved by the FDA,” Jayatilleke says. Prostacyclins have also been used in severe cases as a temporary treatment, as has topical nitroglycerin for less severe symptoms, she explains.
As a very last resort, surgery may be required to either cut out damaged tissue, amputate a diseased extremity or to cut the nerves that control the narrowing of the blood vessels or widen the blood vessels themselves.
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Raynaud's Disease can cause the extremities to turn white as the blood stops circulating in that area. This can cause a feeling of numbness and discomfort.
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