Raynaud's Phenomenon Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Raynaud's Phenomenon Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


What Is Raynaud's Phenomenon?


Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (narrow). Raynaud's phenomenon can occur on its own, or it can be secondary to another condition such as scleroderma or lupus.

Raynaud's Phenomenon Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies
Raynaud's Phenomenon


Although estimates vary, recent surveys show that Raynaud's phenomenon may affect 5 to 10 percent of the general population in the United States. Women are more likely than men to have the disorder. Raynaud's phenomenon appears to be more common in people who live in colder climates. However, people with the disorder who live in milder climates may have more attacks during periods of colder weather.

Read more: Reactive Arthritis (Reiter's Syndrome) Causes, Symptoms, Diagnosis, Treatment, Prevention

What causes Raynaud's Phenomenon?How Is Raynaud's Phenomenon Classified?


Doctors classify Raynaud's phenomenon as either the primary or the secondary form. In medical literature, "primary Raynaud's phenomenon" may also be called Raynaud's disease, idiopathic Raynaud's phenomenon, or primary Raynaud's syndrome. The terms idiopathic and primary both mean that the cause is unknown.

Primary Raynaud's Phenomenon - when the cause is not known


In most cases there is no known cause (more than 9 in 10 cases). This is called primary Raynaud's Phenomenon. The small blood vessels in the fingers, toes, etc, just appear to be more sensitive than normal to cool temperatures. There is no other underlying disease. Symptoms are triggered more easily in some people than in others. Even mildly cool weather, or getting something out of the freezer, can trigger symptoms in some people. Strong emotion may also trigger symptoms in some cases.

Usually, all fingers on both hands are affected in primary Raynaud's Phenomenon. It also tends to run in some families. Women are affected much more often than men. It usually first develops before the age of 30. There are no other symptoms apart from those described above, and symptoms go completely after each bout.

Secondary Raynaud's Phenomenon - due to an underlying cause


In less than 1 in 10 cases, there is an underlying cause. This is called secondary Raynaud's Phenomenon. Various conditions of blood vessels, joints, muscles, nerves or skin can cause secondary Raynaud's Phenomenon. For example, scleroderma, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus (SLE) and other 'connective tissue' diseases.

If you have secondary Raynaud's Phenomenon you will normally have other symptoms in addition to the symptoms of Raynaud's Phenomenon. The Raynaud's Phenomenon is just one feature of the condition. For example, you may also have joint pains, rashes, joint swelling, etc.

Often, the underlying condition is already present, and you may develop Raynaud's Phenomenon as a complication. Sometimes the symptoms of Raynaud's Phenomenon occur first, and other symptoms of the underlying condition develop weeks, months or even years later.

In secondary Raynaud's Phenomenon, symptoms may first begin in just one or two fingers on one hand. This is in contrast to primary Raynaud's Phenomenon when all fingers on both hands are typically affected. Certain medicines may also cause secondary Raynaud's Phenomenon as a side-effect (see below).

Hand-arm vibration syndrome (vibration white finger) is one common cause of secondary Raynaud's Phenomenon. This is caused by using vibrating tools regularly over a long time. For example, it occurs in some shipyard workers, mine workers, road diggers, etc. It is thought that repeated vibrations over time may damage the small blood vessels or their nerve supply.

What are the symptoms of Raynaud's Phenomenon?


Typically, symptoms develop in fingers when you become cool - for example, in cold weather.


Raynaud's Phenomenon Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies
Raynaud's Phenomenon  Symptoms on hand


  • At first the fingers go white and cool. This happens because the small blood vessels in the fingers narrow (constrict).
  • The fingers then go a bluish colour (or even purple or black in severe cases). This happens because the oxygen is used up quickly from the blood in the narrowed blood vessels.
  • The fingers then go bright red. This happens because blood vessels open up again (dilate) and the blood flow returns. This may cause tingling, throbbing, numbness and pain (which can be severe in some cases).


Many people with Raynaud's Phenomenon do not have the full classic colour changes, but develop bouts of uncomfortable, pale, cold fingers. Only the fingers are affected in most cases. In some cases the toes are also affected. Less commonly other extremities of the body are affected, such as the earlobes, nose, nipples or tongue. Each bout of symptoms can last from minutes to hours.

Raynaud's Phenomenon is usually mild, with infrequent, brief bouts of symptoms that last just a few minutes. Sometimes it is moderate with more frequent bouts of symptoms that last longer. Rarely, it is severe with repeated frequent bouts, with each bout lasting longer periods of time.

What Happens During Raynaud's Phenomenon Attack?


For most people, an attack is usually triggered by exposure to cold or emotional stress. In general, attacks affect the fingers or toes but may affect the nose, lips, or ear lobes.

Reduced Blood Supply to the Extremities


When a person is exposed to cold, the body's normal response is to slow the loss of heat and preserve its core temperature. To maintain this temperature, the blood vessels that control blood flow to the skin surface move blood from arteries near the surface to veins deeper in the body. For people who have Raynaud's phenomenon, this normal body response is intensified by the sudden spasmodic contractions of the small blood vessels (arterioles) that supply blood to the fingers and toes. The arteries of the fingers and toes may also collapse. As a result, the blood supply to the extremities is greatly decreased, causing a reaction that includes skin discoloration and other changes.

Changes in Skin Color and Sensation


Once the attack begins, a person may experience three phases of skin color changes (white, blue, and red) in the fingers or toes. The order of the changes of color is not the same for all people, and not everyone has all three colors. Pallor (whiteness) may occur in response to spasm of the arterioles and the resulting collapse of the digital arteries. Cyanosis (blueness) may appear because the fingers or toes are not getting enough oxygen-rich blood. The fingers or toes may also feel cold and numb. Finally, as the arterioles dilate (relax) and blood returns to the digits, rubor (redness) may occur. As the attack ends, throbbing and tingling may occur in the fingers and toes. An attack can last from less than a minute to several hours.

How Does a Doctor Diagnose Raynaud's Phenomenon?


If a doctor suspects Raynaud's phenomenon, he or she will ask the patient for a detailed medical history. The doctor will then examine the patient to rule out other medical problems. The patient might have a vasospastic attack during the office visit, which makes it easier for the doctor to diagnose Raynaud's phenomenon. Most doctors find it fairly easy to diagnose Raynaud's phenomenon but more difficult to identify the form of the disorder. (See the box for the criteria doctors use to diagnose primary or secondary Raynaud's phenomenon.)

Raynaud's Phenomenon Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies
Raynaud's Phenomenon on foot

Nailfold capillaroscopy (study of capillaries under a microscope) can help the doctor distinguish between primary and secondary Raynaud's phenomenon. During this test, the doctor puts a drop of oil on the patient's nailfolds, the skin at the base of the fingernail. The doctor then examines the nailfolds under a microscope to look for abnormalities of the tiny blood vessels called capillaries. If the capillaries are enlarged or deformed, the patient may have a connective tissue disease.

The doctor may also order two particular blood tests, an antinuclear antibody test (ANA) and an erythrocyte sedimentation rate (ESR). The ANA test determines whether the body is producing special proteins (antibodies) often found in people who have connective tissue diseases or other autoimmune disorders. The ESR test is a measure of inflammation in the body and tests how fast red blood cells settle out of unclotted blood. Inflammation in the body causes an elevated ESR.


Diagnostic Criteria for Primary Raynaud's Phenomenon



  • Periodic vasospastic attacks of pallor or cyanosis (some doctors include the additional criterion of the presence of these attacks for at least 2 years)
  • Normal nailfold capillary pattern
  • Negative antinuclear antibody test
  • Normal erythrocyte sedimentation rate 
  • Absence of pitting scars or ulcers of the skin, or gangrene (tissue death) in the fingers or toes


Diagnostic Criteria for Secondary Raynaud's Phenomenon



  • Periodic vasospastic attacks of pallor and cyanosis
  • Abnormal nailfold capillary pattern
  • Positive antinuclear antibody test
  • Abnormal erythrocyte sedimentation rate
  • Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes


What Is the Treatment for Raynaud's Phenomenon?


The aims of treatment are to reduce the number and severity of attacks and to prevent tissue damage and loss in the fingers and toes. Most doctors are conservative in treating patients with primary and secondary Raynaud's phenomenon; that is, they recommend nondrug treatments and self-help measures first. Doctors may prescribe medications for some patients, usually those with secondary Raynaud's phenomenon. In addition, patients are treated for any underlying disease or condition that causes secondary Raynaud's phenomenon.

Nondrug Treatments and Home Remedies for Raynaud's Phenomenon


Several nondrug treatments and self-help measures can decrease the severity of Raynaud's attacks and promote overall well-being.

Take action during an attack

An attack should not be ignored. Its length and severity can be lessened by a few simple actions. The first and most important action is to warm the hands or feet. In cold weather, people should go indoors. Running warm water over the fingers or toes or soaking them in a bowl of warm water will warm them. Taking time to relax will further help to end the attack. If a stressful situation triggers the attack, a person can help stop the attack by getting out of the stressful situation and relaxing. People who are trained in biofeedback can use this technique along with warming the hands or feet in water to help lessen the attack. 

Keep warm

It is important not only to keep the extremities warm but also to avoid chilling any part of the body. In cold weather, people with Raynaud's phenomenon must pay particular attention to dressing. Several layers of loose clothing, socks, hats, and gloves or mittens are recommended. A hat is important because a great deal of body heat is lost through the scalp. Feet should be kept dry and warm. Some people find it helpful to wear mittens and socks to bed during winter. Chemical warmers, such as small heating pouches that can be placed in pockets, mittens, boots, or shoes, can give added protection during long periods outdoors. People who have secondary Raynaud's phenomenon should talk to their doctors before exercising outdoors in cold weather. 

People with Raynaud's phenomenon should also be aware that air conditioning can trigger attacks. Turning down the air conditioning or wearing a sweater may help prevent attacks. Some people find it helpful to use insulated drinking glasses and to put on gloves before handling frozen or refrigerated foods.

Quit smoking

The nicotine in cigarettes causes the skin temperature to drop, which may lead to an attack. 


Because stress and emotional upsets may trigger an attack, particularly for people who have primary Raynaud's phenomenon, learning to recognize and avoid stressful situations may help control the number of attacks. Many people have found that relaxation or biofeedback training can help decrease the number and severity of attacks. Biofeedback training teaches people to bring the temperature of their fingers under voluntary control. Local hospitals and other community organizations, such as schools, often offer programs in stress management.

Exercise

Many doctors encourage patients who have Raynaud's phenomenon, particularly the primary form, to exercise regularly. Most people find that exercise promotes overall well-being, increases energy level, helps control weight, and promotes restful sleep. Patients with Raynaud's phenomenon should talk to their doctors before starting an exercise program.

See a doctor

People with Raynaud's phenomenon should see their doctors if they are worried or frightened about attacks or if they have questions about caring for themselves. They should always see their doctors if attacks occur only on one side of the body (one hand or one foot) and any time an attack results in sores or ulcers on the fingers or toes.

Treatment With Medications for Raynaud's Phenomenon


People with secondary Raynaud's phenomenon are more likely than those with the primary form to be treated with medications. Many doctors believe that the most effective and safest drugs are calcium-channel blockers, which relax smooth muscle and dilate the small blood vessels. These drugs decrease the frequency and severity of attacks in about two-thirds of patients who have primary and secondary Raynaud's phenomenon. These drugs also can help heal skin ulcers on the fingers or toes.

Other patients have found relief with drugs called alpha blockers that counteract the actions of norepinephrine, a hormone that constricts blood vessels. Some doctors prescribe a nonspecific vasodilator (drug that relaxes blood vessels), such as nitroglycerine paste, which is applied to the fingers, to help heal skin ulcers. Patients should keep in mind that the treatment for Raynaud's phenomenon is not always successful. Often, patients with the secondary form will not respond as well to treatment as those with the primary form of the disorder.

Patients may find that one drug works better than another. Some people may experience side effects that require stopping the medication. For other people, a drug may become less effective over time. Women of childbearing age should know that the medications used to treat Raynaud's phenomenon may affect the growing fetus. Therefore, women who are pregnant or are trying to become pregnant should avoid taking these medications if possible.

Prevention for Raynaud's Phenomenon


Take precautions indoors


Wear socks. When taking food out of the refrigerator or freezer, wear gloves, mittens or oven mitts. Some people find it helpful to wear mittens and socks to bed during winter. Because air conditioning can trigger attacks, setting your air conditioner to a warmer temperature may help prevent attacks. You may also find it helpful to use insulated drinking glasses.

Dress warmly outdoors


In winter, wear a hat, scarf, socks and boots, and mittens or gloves under mittens when you go outside. Put them on before you go outside. A hat is important because you lose a great deal of body heat through your head. Wear a coat with fairly snug cuffs to go around your mittens or gloves, to prevent cold air from reaching your hands. Wear earmuffs and a face mask if the tip of your nose and your earlobes are sensitive to cold. Run your car heater for a few minutes before driving in cold weather.

Consider moving to a location with a milder climate


Moving to a warmer climate may help people with severe Raynaud's. However, Raynaud's can occur even in warmer climates when the temperature decreases.

What is the prognosis (outlook) for Raynaud's phenomenon?


The outlook for those affected by Raynaud's phenomenon depends on its severity and whether or not there is associated underlying medical illness. Most people affected by Raynaud's phenomenon do very well in response to simple measures, with or without medications.

What Research Is Being Conducted To Help People Who Have Raynaud's Phenomenon?


Researchers are studying ways to better diagnose Raynaud's phenomenon and predict and monitor its course and association with other diseases. They are also evaluating the use of new drugs to improve blood flow in Raynaud's phenomenon; for example, the prostaglandins iloprost and alprostadil, the high blood pressure drug losartan, and a substance applied to the skin that generates the blood vessel dilating gas nitric oxide. Basic investigators are studying the molecular mechanisms behind Raynaud's phenomenon, the anatomy of blood vessels, and possible genetic associations. Some researchers are studying the use of biofeedback to control attacks. Researchers in scleroderma and other connective tissue diseases are also investigating Raynaud's phenomenon in relation to these diseases.