Raynaud's Disease

What happens in Raynaud's disease

When you get cold, blood vessels in the skin normally narrow to keep heat in your core. In Raynaud's this response is exaggerated. The small arteries of the fingers and toes go into spasm (vasospasm) and almost shut off blood flow. Cold air, holding a cold drink, reaching into a freezer or a sudden temperature change, such as walking into air conditioning, can set it off. Stress triggers it too.

An attack usually goes through color phases:

1. White (pallor): blood flow stops. The finger looks waxy, with a sharp line where it starts, and feels numb and clumsy.
2. Blue (cyanosis): the remaining blood loses its oxygen.
3. Red: when the spasm releases, blood rushes back, causing throbbing, tingling, burning and swelling.

Not everyone has all three colors. On darker skin, the color changes are harder to see, and fingers may look paler or ashy rather than white. Attacks usually last from a few minutes to about 20 minutes, though recovery can take longer. They often start in one or two fingers and spread. Toes, and less often the nose, ears, lips and nipples, can also be affected.

Primary vs secondary Raynaud's

Secondary Raynaud's is covered in more detail on the Raynaud's phenomenon page. Underlying causes include:

• scleroderma (systemic sclerosis), in which Raynaud's affects over 90% of people and often comes first
• lupus, Sjögren's syndrome, rheumatoid arthritis and dermatomyositis
• vibration white finger from vibrating tools
• carpal tunnel syndrome and narrowed arteries
• medicines: beta-blockers, migraine drugs (triptans, ergotamine), ADHD stimulants, some chemotherapy and decongestants
• smoking and frostbite injury

Raynaud's disease symptoms in women

Primary Raynaud's is several times more common in women than men. Estrogen affects how blood vessels respond to cold, which may explain this. Many women notice:

• attacks starting in the teens or twenties, often with a family history
• symptoms varying with the menstrual cycle, and sometimes improving in pregnancy as blood flow increases
• nipple pain and blanching during breastfeeding (nipple vasospasm), which is sometimes mistaken for thrush
• attacks triggered by cold offices and air conditioning

Because autoimmune diseases such as lupus and scleroderma are also more common in women, a doctor will check for warning signs of secondary Raynaud's, especially if symptoms begin after 30.

Diagnosis

Diagnosis is based on your description of color changes, ideally with a photograph of an attack. A doctor will:

• examine your hands, skin and pulses
• look at the tiny blood vessels at the base of the nails with a magnifier (nailfold capillaroscopy)
• order blood tests if secondary Raynaud's is possible: antinuclear antibodies (ANA), inflammation markers and a blood count

Normal capillaries and a negative ANA in a young person with symmetrical symptoms strongly support primary Raynaud's disease.

Treatment

Self-care (the mainstay for primary Raynaud's)

• Keep your whole body warm, not just your hands. Wear layers, a hat and warm socks.
• Use mittens rather than gloves, and hand warmers in cold weather.
• Warm up before going outside, and use insulated cups for cold drinks.
• During an attack, move somewhere warm, wiggle your fingers, swing your arms or run your hands under warm (not hot) water.
• Stop smoking. Nicotine narrows blood vessels.
• Reduce caffeine if it worsens attacks.
• Manage stress, which can trigger attacks.
• Review medicines that may worsen symptoms with your doctor.

Medicines

For frequent or severe attacks, doctors may prescribe a calcium channel blocker such as nifedipine, which relaxes blood vessels. Other options include other vessel-relaxing drugs and, for severe secondary Raynaud's with ulcers, specialist treatments such as IV prostacyclin or botulinum toxin injections. Primary Raynaud's often only needs medicine during winter.

Complications

Primary Raynaud's rarely causes lasting damage. Secondary Raynaud's can cause painful fingertip ulcers, scarring, infection and, rarely, gangrene. Any ulcer needs prompt medical care.

Frequently asked questions

What are the symptoms of Raynaud's disease?

The main symptom is fingers or toes turning white or pale, then blue, then red after exposure to cold or stress. During the white phase the area feels numb and cold. As blood returns, it throbs, tingles and burns. Attacks usually last several minutes.

What are Raynaud's disease symptoms in women?

Women have the same color changes and numbness as men but are affected far more often, usually starting in their teens or twenties. Symptoms may vary with the menstrual cycle, and some women get painful blanching of the nipples, especially while breastfeeding.

Is Raynaud's disease serious?

Primary Raynaud's disease is usually not serious and does not damage the fingers. It is uncomfortable and can be disruptive in cold weather. Secondary Raynaud's, linked to diseases such as scleroderma, can cause ulcers and needs specialist follow-up.

What is the difference between Raynaud's disease and Raynaud's phenomenon?

Raynaud's disease means primary Raynaud's, with no underlying cause. Raynaud's phenomenon is the general term for the color-change attacks and is often used for secondary Raynaud's, caused by another condition such as lupus or scleroderma, a medicine or vibrating tools.

Can Raynaud's disease go away?

Primary Raynaud's often improves over time, and some people find it eases after their thirties or after menopause, though it can persist. Good cold protection and stopping smoking reduce attacks for most people. Secondary Raynaud's depends on control of the underlying condition.