Raynaud’s Syndrome
Raynaud's syndrome can be managed via medication, minimally invasive surgery, or in combination. The goal of treatment is to reduce the number and severity of attacks, prevent tissue damage, and treat underlying disease conditions.
What is Raynaud’s Syndrome?
Raynaud’s syndrome affects the arteries of the body, which are the blood vessels responsible for carrying blood away from the heart to different parts of the body. The disease is often accompanied by changes in the color of the skin.
The smaller arteries that supply blood to the skin intermittently vasospasm or constrict, limiting the blood flow to certain areas of the body. The most common areas affected are the fingers, ears, toes, nipples, knees, or nose. Over time these arteries can thicken, limiting blood flow even more. Exposure to cold temperatures or emotional stress can result in a vasospasm attack.
Why do I have Raynaud’s Syndrome?
The exact cause of this condition is not well understood and may be considered primary or secondary. The primary condition isn’t related to any underlying condition and the cause is often unknown.
Secondary Raynaud’s phenomenon is related to another underlying condition, tends to be more serious, and appears later in life past the age of 40. Risk factors that may contribute to this phenomenon may be related to the following:
Connective tissue diseases, such as scleroderma.
History of autoimmune disease such as lupus, rheumatoid arthritis, or Sjogren’s syndrome.
Arterial diseases, such as Buerger’s disease, atherosclerosis, or primary pulmonary hypertension.
Carpal tunnel syndrome.
Repetitive actions or vibrations.
Smoking.
Injuries to the hands or feet, such as fracture, surgery, or frostbite.
Certain medications, such as beta-blockers, migraine medication, attention-deficit/hyperactivity disorder (ADHD) drugs, chemotherapy agents, or over-the-counter cold medications that can narrow the blood vessels.
First degree relative family history.
Female gender.
Living in a cold climate.
How is Raynaud’s Syndrome diagnosed?
Diagnosis is made by a physical examination, patient reported symptoms, and testing to rule out other conditions. Symptoms that patients report include:
Cold fingers and toes.
Color changes in your skin from pale/white to blue and then to red when rewarmed.
Swollen, painful areas when re-warmed.
Ulcerations of finger or toe pads.
To determine if an autoimmune or connective tissue disorder is part of the underlying problem, blood tests may be ordered such as antinuclear antibodies test or an erythrocyte sedimentation rate. There is no blood test or diagnostic test that is used to diagnose Raynaud’s syndrome.
What are my treatment options for Raynaud’s Syndrome?
The goal for treatment of Raynaud’s syndrome, is to reduce the number and severity of attacks, prevent tissue damage, and treat any underlying diseases or conditions. Keeping hands and feet warm when in cold environments, avoiding medications that may cause narrowing of the blood vessels, and quitting smoking are very important. Additional treatments include the following:
Calcium Channel Blockers
These medications relax and open the small blood vessels of your hands and feet, which decreases the number and severity of attacks; an example would be the drug Norvasc.
Alpha Blockers
These medications counteract a hormone in the body that causes constriction or narrowing of your blood vessels; an example would be the drug Cardura.
Vasodilators
These medications relax the blood vessels and may help heal skin ulcers on the fingers or toes; an example would be the drug nitroglycerin.
Sympathectomy Surgery
During this procedure, small incisions are made in your affected hands or feet, and the tiny nerves around your blood vessels are stripped away. This may reduce the frequency and duration of attacks.
Botox or Anesthetic Injections
Injections of these substances are made into the nerves of your affected hands and feet. This procedure may need to be repeated to continue to decrease the rate and duration of attacks.
How can I prevent Raynaud’s Syndrome?
Whether primary (cause unknown) or secondly to another underlying condition, the mechanism involved in Raynaud’s phenomenon creates, upon certain provocations, an exaggerated vascular response leading to diminished blood supply to the smaller arteries in the hands, feet, ears, or areas of the body near the terminal branches of the arterial tree.
To prevent the paresthesia, numbness, or aching that results, avoidance of the provocations is the best prevention. In secondary Raynaud’s phenomenon, adequate management of the underlying illness will help decrease episodes.
Management of autoimmune disease medically, such as rheumatoid arthritis, lupus, or Sjogren’s syndrome.
Surgical treatment of vasoconstrictive causes such as carpal tunnel syndrome.
Smoking cessation to obviate the vasoconstriction from nicotine.
Avoidance of exposure to cold weather; avoid exposing the fingers, specifically, to cold ingredients of food preparation, snow, cold beverages in containers that transmit cold, etc. (Exposure of any part of the body can evoke the changes in the fingers).
Avoid repetitive strain injury, such as typing.
Avoid vasoconstrictive medications by using substitutes that are efficacious without causing symptoms of Raynaud’s syndrome.
Avoid substance abuse that has sympathomimetic effects, such as cocaine and amphetamines.
Avoid undue stress that provokes Raynaud’s syndrome; if stress is unavoidable in domestic situations, seek counseling for coping strategies.