Raynaud's phenomenon

Page last reviewed: 13/07/2011

Raynaud's disease is a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes.

You may have heard of it referred to as Raynaud's syndrome, Raynaud's phenomenon or just Raynaud's.

Why does it happen?

The condition occurs because your blood vessels go into a temporary spasm which blocks the flow of blood. This causes the affected area to change colour to white, then blue and then finally red as the blood flow returns.

You may also experience pain, numbness and pins and needles in the affected body parts. Symptoms can last from a few minutes to several hours.

Raynaud's is usually triggered by cold temperatures or by anxiety or stress.

It is not a serious threat to your health but it can be annoying to live with. People with Raynaud's often go for long periods without any symptoms and sometimes the condition goes away altogether.

Read more about the symptoms of Raynaud's.

Treatment

In many cases it may be possible to control the symptoms of Raynaud's using self-care techniques such as avoiding the cold, wearing gloves and using relaxation techniques when feeling stressed.

Quitting smoking can also help improve symptoms, as smoking can affect your circulation.

If the above does not help with the symptoms, then a medication called nifedipine has proved effective with some people.

Read more about the treatment of Raynaud's.

Types of Raynaud's

There are two types of Raynaud's. It can either be:

  • primary: when the condition develops by itself (this is the most common type)
  • secondary: when it develops in association with another health condition

The causes of primary Raynaud's are unclear. However 1 in 10 people with primary Raynaud's will go on to develop a condition associated with secondary Raynaud's such as lupus.

Most cases of secondary Raynaud's are associated with conditions where the immune system goes wrong and starts attacking healthy tissue, such as:

  • rheumatoid arthritis: when the immune system attacks the joints causing pain and swelling
  • lupus: when the immune system attacks many different parts of the body causing a range of symptoms, such as tiredness, joint pain and skin rashes

Read more about what causes Raynaud's.

Secondary Raynaud's can cause a more severe restriction of blood supply so it does carry a higher risk of causing complications such as ulcers, scarring and in the most serious of cases of tissue death, which is known as gangrene.

Read more about the complications of Raynaud's.

Who gets Raynaud's?

Raynaud's disease is a common condition. It may affect as many as one in every nine women and 1 in every 12 men. (It is hard to be entirely sure as rates can differ widely from area to area depending on how cold the temperature is).

Primary Raynaud's usually begins in your 20s or 30s. Secondary Raynaud's can develop at any age depending on the underlying condition it is associated with.

Blood vessels

Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.  

Numbness

Numbness is a lack of sensation in a part of the body.  

Disease

A disease is an illness or condition that interferes with normal body functions.

Page last reviewed: 13/07/2011

The symptoms of Raynaud's usually happen in three stages:

  • stage one: the affected body part first turns white (there is less blood supply)
  • stage two: it then turns blue because of lack of oxygen (blood carries oxygen molecules), during this phase the body part can feel cold and numb
  • stage three: the body part turns red as the blood returns at a higher rate than normal - during this stage you may feel a tingling or throbbing sensation, and there may be some swelling in the affected body part

These symptoms gradually disappear as the flow of blood returns to normal.

Not everyone will experience all three stages and they can occasionally occur in a different order.

An 'attack' of Raynaud's can last from several minutes to several hours.

The most commonly affected areas of the body are the fingers and toes. Sometimes only a few fingers or toes may be affected.

Other parts of the body that can be affected by Raynaud's include:

  • earlobes
  • nose
  • nipples
  • tongue
  • and in very rare cases - the penis

Page last reviewed: 13/07/2011

When your body is exposed to cold temperatures, the extremities of your body, such as your fingers and toes, lose heat. This is because the small blood vessels under the skin become narrower, slowing down the blood supply that helps to preserve your body's core temperature.

In people with Raynaud's, the small blood vessels in the fingers and toes are more sensitive than usual and overreact to cold temperatures. This makes them spasm, which means they narrow much more than usual allowing much less blood to flow through them.

Symptoms can be triggered by mildly cool weather, getting something out of the freezer or running your hands under a cold tap. Strong emotions such as stress or anxiety may also trigger symptoms.

Primary Raynaud's

It seems that primary Raynaud's is caused by disruptions in how the nervous system controls blood vessels. Exactly what causes these disruptions is still unclear.

There is some evidence that Primary Raynaud's may be an inherited condition as cases have been known to run in families.

Secondary Raynaud's

In some cases, there is an underlying reason, usually a health condition, that causes the blood vessels to overreact. This is called secondary Raynaud's.

Autoimmune conditions

The majority of cases of secondary Raynaud's are associated with what are known as autoimmune conditions. These are conditions where the body defence against infection, the immune system mistakes healthy tissue as a threat to the body. It then sends disease-fighting antibodies to the tissue which can cause a range of symptoms, such as redness and swelling in the affected area.

Autoimmune conditions known to be associated with secondary Raynaud's include:

  • scleroderma: a condition that causes hardening and thickening of the skin
  • rheumatoid arthritis: which causes joint pain and swelling
  • Sjogren's syndrome: where the immune system attacks the body's sweat and tear glands
  • lupus: which causes tiredness, joint pain and skin rashes

Around 1 in 10 people with primary Raynaud's go on to develop an autoimmune condition.

Infections

Two blood-born viral infections, hepatitis B and hepatitis C can occasionally trigger Raynaud's in some people.

Cancer

Some types of cancers can cause secondary Raynaud's. These are usually cancers that develop inside the blood, bone marrow or immune system, such as:

  • acute lymphoblastic leukaemia: a cancer of the white blood cells that mainly affects children
  • lymphoma: a cancer that develops inside one or more of the glands that are part of the immune system
  • multiple myeloma: a cancer that develops inside bone marrow

Medicines

Secondary Raynaud's can be a side effect of taking certain medicines, including:

The illegal drugs cocaine and amphetamine can also cause secondary Raynaud's.

Injury and overuse

Raynaud's sometimes results from a physical injury to the affected area. It can also affect musicians, people who type a lot or other people who use their fingers and hands more than usual.

Vibration white finger

Vibration white finger is a term used when secondary Raynaud's has been caused by exposure to vibration. This typically happens to people who regularly use certain types of vibrating tools, including:

  • concrete breakers and pokers
  • sanders, grinders and disc cutters
  • hammer drills
  • chipping hammers
  • chainsaws, hedge trimmers and power mowers
  • scabblers and needle guns

Any vibrating tool that causes tingling or numbness in your fingers after five minutes of continuous use could lead to vibration white finger.

Your employer has a responsibility to protect you from vibration white finger. You can help your employer by asking if the job could be done differently without using vibrating tools. If this is not possible:

  • ask to use suitable low-vibration tools
  • make sure you are using the right tool for the job
  • check tools are properly maintained
  • keep cutting tools sharp
  • reduce the amount of time you use the tool in one go by doing other jobs in between
  • keep warm at work
  • wear anti-vibration gloves
  • store tools indoors so they do not have cold handles when next used
  • encourage your blood circulation by keeping warm, giving up smoking and massaging and exercising your fingers during your breaks

If you are diagnosed with vibration white finger, tell your employer as soon as possible. If you stop using vibrating tools at an early stage of the condition, you may recover fully.

Page last reviewed: 13/07/2011

To diagnose Raynaud's your GP may place your hands in cold water or cool air to see the symptoms of Raynaud's themselves.

While Raynaud's can normally be diagnosed by studying your symptoms further, testing is usually recommended to find out whether you have primary or secondary Raynaud's.

Secondary Raynaud's may require more treatment and in some cases a referral to a specialist.

The first step is usually to check if you have the following features as these would suggest that you have secondary Raynaud's:

  • your symptoms only started when you were older than 30 years of age - most cases of primary Raynaud's begin between the ages of 20 to 30, so the onset of symptoms after this time suggests that it may be secondary Raynaud's
  • you are experiencing severe pain during an attack of Raynaud's
  • only one side of your body is affected

Your GP may also check the tiny blood vessels, known as capillaries, that can be found at the the base of where your nail meets the finger. These capillaries are commonly larger than normal in people with secondary Raynaud's, and look like red pen marks.

Depending on these factors your GP may then refer you for further blood tests that are described below.

Full blood count

As the name suggests a full blood count is a measurement of how many of the different types of blood cells you have in your blood.

High levels of white blood cells could indicate that you have an infection, or much less commonly, a cancer of the blood such as leukaemia.

Antinuclear antibodies (ANA) test

This blood test checks for antinuclear antibodies in your blood. These antibodies are produced by your immune system and attack your body's own tissues.

If these antibodies are present, it indicates an overactive immune system, which is common in people with autoimmune conditions, such as rheumatoid arthritis and lupus. A positive result would strongly indicate that you have secondary Raynaud's.

Erythrocyte sedimentation rate

This blood test measures how fast your red blood cells settle to the bottom of a test tube. A faster-than-normal fall rate suggests inflammation (swelling of the tissues), which can indicate an autoimmune disorder.

Page last reviewed: 13/07/2011

If you have been diagnosed with primary Raynaud's then you can probably be treated by your GP.

If you have been diagnosed with secondary Raynaud's due to with an underlying condition, you may need to be referred to a specialist in the treatment of that condition. For example, people with rheumatoid arthritis may need to be referred to a specialist in treating conditions affecting the joints (rheumatologist) and people with lupus may need to be referred to a skin specialist (dermatologist).

The recommended treatment plan for primary Raynaud's is to first see if self-help methods can help control symptoms. If this does not work then a medication called nifedipine can be used.

The treatment plan for secondary Raynaud's is largely the same although additional medications may be required to treat any underlying health condition. For example, steroid tablets (corticosteroids) are used to treat lupus.

If it is thought that a case of secondary Raynaud's may be arising as a side effect of a medication you are taking, you may be asked to stop taking it to see if your symptoms get better.

Self-help

The advice below is recommended for people with both primary and secondary Raynaud's.

  • Keep your whole body warm, especially your hands and feet. Wear gloves and warm footwear in cold weather.
  • If you smoke, quit. Quitting smoking will improve your circulation, which should help improve symptoms. Research has shown that you are up to four times more likely to successfully give up smoking if you use support together with stop-smoking medicines, such as patches or gum.
  • If you decide to stop smoking, your GP will be able to refer you to a local smoking cessation service which will provide you with dedicated help and advice about the best ways for you to give up smoking. You can also call the National Smokers Quitline at 1850201203, or log on to www.quit.ie, or join our facebook page at www.facebook.com/hsequit for further support
  • Exercise regularly as this helps improve your circulation and reduce stress levels (see below). For most people 30 minutes of vigorous exercise a day, at least five times a week, is recommended. Your GP can also give you more advice about the how much exercise is best for you.
  • Try and minimise your stress levels. Regular exercise, eating a healthy diet and relaxation techniques, such as deep breathing or activities such as yoga, can help. You may find it useful to avoid stimulants such as coffee, tea and cola.

If you find it difficult to control feelings of stress, you may require additional treatment such as counselling. Read more about the treatment of stress.

Medication

Nifedipine

If your symptoms fail to improve then you may be prescribed nifedipine. Nifedipine is a calcium channel blocker. These types of medication encourage the blood vessels to widen, which can help prevent them going into spasm.

Depending on the pattern of your symptoms and how well you respond to treatment you may be asked to take your medication every day. Alternatively, you may only need to take it on a preventative basis; for example, if there was a sudden snap of cold weather.

Side effects are common and include:

  • swelling of certain parts of the body, such as your hands and feet, due to a build-up of fluid  (the medical term for this is oedema)
  • headache
  • flushing
  • dizziness

If you do experience dizziness, do not drive or use tools or machines.

Do not drink grapefruit juice when taking nifedipine as this could make the side effects much worse.

The side effects of Raynaud's should improve as your body gets used to the medicine but if you find them particualry troublesome tell your GP. There are alternative calcium channel blockers that may you suit you better.

Other medications

Other medications have been used in the treatment of Raynaud's but their use is controversial as there is limited or insufficient evidence to show that they are effective in most people. However, some people have claimed to benefit from treatment. The medications include:

  • angiotensin-converting enzyme (ACE) inhibitors
  • fluoxetine (sold under the brand name Prozac), which was widely used in the treatment of depression)
  • sildenafil (sold under the brand name Viagra), which is used to treat erectile dysfunction (inability to get or maintain an erection)

Surgery

Surgery is usually only recommended if your symptoms are so severe that there is a risk the affected body part, such as your fingers, could totally lose their blood supply and begin to die.

A type of surgery called sympathectomy is recommended. It involves cutting the nerves causing the affected blood vessels to go into spasm.

As well as preventing tissue loss, a sympathectomy should help improve any pain you may feel.

The results of a sympathectomy are often only temporary and further treatment and possibly more surgery may be required after a few years.

Page last reviewed: 13/07/2011

Ulcers and gangrene

In very severe cases of Raynaud's the blood supply to an affected body part can become severely diminished, which normally only occurs in secondary, not primary, Raynaud's. Without a constant supply of blood, the tissue in the body part will begin to die.

The initial sign of this process is an open sore, known as a skin ulcer, which develops on the surface of the body part.

If you suspect that you have developed a skin ulcer you should contact your GP for advice.

Left untreated more extensive tissue damage and tissue death can occur, which is known as gangrene (specifically a type of gangrene known as dry gangrene).

The symptoms of dry gangrene normally begin with a red line on the skin that marks the edges of the affected tissue. The area will become cold and numb. As the tissue dies, you may experience some pain. However, many people, particularly the elderly, experience no sensations.

The affected area of tissue will change colour from red, to brown, to black. The dead tissue will then shrivel up, separate from the healthy tissue and fall off.

If you suspect that you have developed gangrene then immediately call your GP for advice.

These complications will normally require admission to hospital where you will be given medication that is designed to thin your blood, which should help restore blood flow.

If you fail to respond to treatment you may require surgery to unblock or repair damaged blood vessels.

Scleroderma

Around 1 in 16 woman and 1 in 50 men with Raynaud's will go on to develop a condition called scleroderma, usually between the ages of 25 and 55.

Scleroderma is when the body produces excessively high levels of a tough yet flexible substance, known as collagen.

Scleroderma is a Greek word meaning hard skin, but it can affect other areas of the body such as the kidneys, heart and lungs.

Symptoms of scleroderma include:

  • puffy and itchy skin
  • tight and uncomfortable joints
  • small calcium spots and red spots under the skin
  • trouble swallowing, which is known as dysphagia
  • diarrhoea, bloating or constipation

There is no cure for scleroderma, but there are ways of overcoming the problems it may cause.

For example, medicines can reverse or slow down the processes that cause damage around the body.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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