RAYNAUD'S PHENOMENON

General Information

DEFINITION--Primary Raynaud's is a disorder of the circulatory system that affects blood circulation to fingers and occasionally toes. Secondary Raynaud's is a circulatory-system disorder that occurs as a complication of other diseases, medications or activities.

BODY PARTS INVOLVED--Small arteries to the hands and feet.

SEX OR AGE MOST AFFECTED--Both sexes; primary Raynaud's is more common in females under 40; secondary is more common in adults over 40.

SIGNS & SYMPTOMS

Early symptoms:

• Fingers that turn pale when exposed to cold or stress. Paleness is followed by a bluish tinge, then redness. Pain, numbness and tingling accompany the color changes. Warmth relieves these symptoms.

Late symptoms:

• Chronic infections around fingernails and toenails.
• Ulcers on the fingertips caused by inadequate blood circulation in the fingers. Symptoms develop gradually over a period of years but may begin suddenly.

CAUSES--Spasms of arteries that supply blood to the fingers and toes caused by extreme sensitivity to cold. The sensitivity may be due to poor function of the autoimmune system. With primary Raynaud's, there is no known cause. Secondary type can be linked to an underlying disorder, a medication or an activity.

RISK INCREASES WITH

Primary:

Stress; cold, wet weather.

Secondary:

• Scleroderma, lupus erythematosus or other connective-tissue disorders.
• Buerger's disease or cor pulmonale.
• Low levels of thyroid hormone.
• Certain medications, including ergot preparations, antihypertensives, alpha- and beta-adrenergic blockers, some cancer drugs and calcium-channel blockers.
• Smoking (impairs circulation to extremities).
• Occupations that involve work with heavy equipment that vibrates forcefully.
• Occupations that involve physical stress to the fingers (typists, piano players).

HOW TO PREVENT

• Don't smoke. Tobacco triggers the problem. This disease is rare among non-smokers.
• Avoid exposure to all cigarette smoke.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory blood studies, cold challenge test (putting hands in 10-15C water).
• X-rays of the hands and feet.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery to sever sympathetic nerves to the involved extremities. Surgery usually relieves symptoms for 1 to 2 years before they recur.

POSSIBLE COMPLICATIONS

• Permanent weakness and numbness in the toes and fingers.
• Gangrene and amputation (worst cases only).

PROBABLE OUTCOME--

• Most persons cope well with primary Raynaud's and live a normal life span if complications don't arise. In about half of the patients, the disease may improve or disappear after several years.
• Secondary Raynaud's may be curable if the underlying cause can be cured.

How To Treat

GENERAL MEASURES--

• Stop smoking.
• Avoid exposure to cold in any form. Wear mittens or gloves in cold environments.
• Wear comfortable, roomy shoes and wool socks.
• Avoid stressful situations.
• To stop an attack, briskly swing the arms in 360-degree circles (as if to release an underhand pitch) for a minute or two. This can help bring blood into constricted vessels.
• Move to a warm climate, if possible.
• Biofeedback training may be helpful.
• Avoid vasoconstrictive drugs.

MEDICATION--Your doctor may prescribe:

• Vasodilator drugs to dilate the small arteries and improve circulation.
• Sedatives to reduce stress.

ACTIVITY--No restrictions, except to keep warm. Avoid chilling while participating in sports.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of Raynaud's disease or phenomenon.
• Discomfort worsens, despite treatment.
• Ulcers that do not heal appear on fingers or toes.