Raynaud's Disease

(Secondary Raynaud's Phenomenon)

Raynaud's (pronounced ray-nose) disease is a circulatory disorder characterized by spasms of the arteries that carry blood to the fingers and toes. Exposure to cold or emotional stress triggers the spasms; researchers theorize that the underlying mechanism may be similar to that of migraine headaches.

Typical symptoms are sensations of coldness, numbness, and tingling in the affected areas. There are also pronounced changes in color, ranging from pale pink or white due to reduced blood flow, to blue because of insufficient oxygen reaching the affected tissues, and finally, a deep red as extra blood rushes to the area. In about 10 percent of patients, the skin of affected fingers and toes becomes smooth, shiny, and tight due to a loss of underlying tissue. In severe cases, the blood vessels may thicken and become blocked by the formation of clots.

Raynaud's phenomenon was first described as a neurotic disorder in 1862 by the French physician for whom it is named. Doctors now recognize that there are two different forms of the disease. Primary, or idiopathic, Raynaud's, which has no identifiable cause, is comparatively mild and most common among young women. Secondary Raynaud's, which is potentially more serious, is always associated with some other ailment, such as a thyroid disorder, or is triggered by an identifiable circumstance, such as occupational hazards or the use of various drugs, including ergot medications.

Diagnostic Studies and Procedures

A doctor can usually diagnose Raynaud's disease and identify the type by asking detailed questions about the symptoms, the triggering circumstances, and other medical problems. A physical exam and blood and urine tests can help determine whether the condition is primary or secondary to some other disorder. The doctor will look for tissue damage, especially skin ulcers, and signs of arthritis or other connective tissue disease. He will also feel pulses in the hands and feet and note their response to cold.

In a diagnostic procedure called nail-fold capillarioscopy, the skin at the base of the fingernails is viewed through a magnifying lens. The presence of abnormally large or deformed cuticles around the fingernails points to a connective tissue disease, such as scleroderma, a condition in which the skin thickens and hardens, or dermatomyositis, a skin inflammation that can cause secondary Raynaud's.

Medical Treatments

Mild primary Raynauds disease can usually be controlled with self-treatment or alternative therapies. If not. drugs that open, or dilate, the small arteries may be prescribed. Possible medications include prazosin (Minipress or Minizide) or nifedipine (Procardia or Adalat), agents more commonly used to treat high blood pressure. Promising results also have been reported from experimental use of pentoxifylline (Trental), a drug used to treat reduced blood flow to the legs.

Secondary Raynaud's usually can be alleviated by treating or removing the underlying cause. For example, if the spasms are due to ergot preparations, prescribed for migraine headaches, or beta blockers, often used to treat high blood pressure and angina, alternative medications can be substituted.

For severe cases, an operation called sympathectomy may be recommended. In this procedure, the small nerves serving the affected blood vessels are destroyed. Unfortunately, benefits are often temporary, and symptoms typically return in one to two years.

Alternative Therapies

Acupuncture. Studies at New York's Rusk Institute of Rehabilitation Medicine have demonstrated that acupuncture can increase blood flow and raise the temperature of hands and feet affected by Raynaud's disease. The symptoms may recur, however, and require repeated treatments.

Biofeedback Training. Most patients with primary Raynaud's disease can be taught to increase circulation to their extremities by using special electronic temperature sensors. The objective is to learn to raise the temperature of the fingers and toes by increasing the flow of blood to these areas.

Meditation. Spasms triggered by stress can be alleviated by meditation and similar relaxation techniques.

Self-Treatment

Primary Raynaud's disease can usually be controlled by consistently protecting the hands and feet from cold. When the weather is even mildly chilly, wear woolen socks and mittens (or wool-lined gloves) and layers of garments for insulation and ease of movement. If your job or recreational pursuits require hours of outdoor exposure in cold weather, investigate battery-powered "hot" socks and chemical warmers that can be inserted into gloves and footwear. Wear cotton tights instead of nylon hose in cold weather, and make sure your shoes permit free movement of your toes. You may also need to wear mittens and warm socks to bed.

Handling cold objects often provokes spasms. Wear gloves to take items from a freezer or refrigerator, and cover a glass containing an iced drink with an insulator to protect your hands.

If you smoke, make every effort to stop. Also, abstain from alcoholic beverages before going out into the cold.

Try this simple exercise to relieve circulatory spasms in your fingers: extend your arms straight out from the shoulders and swing them around energetically windmill fashion several times.

Other Causes of Cold Extremities

Secondary Raynaud's phenomenon may accompany scleroderma, carpal tunnel syndrome, rheumatoid arthritis, psoriasis, cancer, and lupus.