Raynaud’s phenomenon is a result of deficient blood flow in the extremities, in particular the fingers and the toes. It is a condition named after the physician who first described it, Dr. Maurice Raynaud in France. This condition classically occurs after exposure to the cold. At times, it may be persistent and individuals suffering from Raynaud’s phenomenon may have constant discoloration of the fingers and toes associated with pain, burning sensations and numbness. Cold exposure may be as little as walking through an air conditioned room or a supermarket or may occur after holding a cold drink from the refrigerator.
While Raynaud’s phenomenon may occur in otherwise healthy individuals, it is frequently a symptom of one of the rheumatic diseases. The rheumatic diseases in particular that are associated with Raynaud’s phenomenon include: systemic lupus erythematosus, scleroderma, Sjogren’s syndrome, rheumatoid arthritis and mixed connective tissue disease.
What happens in Raynaud’s phenomenon is that the blood vessel in the fingers or toes goes into spasm, usually for a short time, resulting in deficiency of blood to these extremities. As this happens, the extremities will change colors, first turning white when they are without blood, then blue when the blood that remains in the extremities becomes deprived of oxygen and finally red, as blood flow returns to normal when the spasm relaxes. At time, only one color may be distinguished by the patient as the changes may be very subtle. The course of events may take only a few minutes or may last for many hours.
In addition to exposure to cold, emotional stress can also cause spasm of the blood vessel. The symptoms of Raynaud’s vary depending upon the severity of the disease. In most individuals, they are relatively mild and are simply uncomfortable with exposure to cold. However, in more severe instances, the symptoms can persist and one may actually get ulceration of the fingers or toes and because of the deficiency in blood supply, gangrene may even set, with the potential to lose the involved finger or toe. If you think you may be suffering from this condition, it is very important to rule out the possibility of other pre-existing illnesses as mentioned, although in the majority of people, there is no underlying cause.
There are a number of ways to manage Raynaud’s phenomenon. Obviously, the first thing to do is to avoid cold exposure and this may mean wearing gloves or socks and limiting exposure to air conditioning, cold refrigerators, etc. Raynaud’s phenomenon is far worse in the cold northern climates than it is in Florida, as we do not have the cold extremes that so often provoke this condition. Smoking is absolutely contraindicated in this condition, as cigarette smoking can further cause spasm of the blood vessels and by smoking one is, in fact, adding insult to injury. It is also very important to try to be relaxed and to try to limit emotional stress and, in fact, one of the treatments for this condition is biofeedback training, which has been shown to help relax the blood vessels by being more relaxed. Other causes of vasospasm such as migraine headache medications and certain blood pressure pills should also be avoided in this condition.
There are certain medications that are now being shown to be very helpful in this condition. The calcium channel blockers, a new group of medications, initially introduced for the treatment of angina have been helpful in reducing vasospasm. The topical use of nitroglycerin ointment may also cause some vasodilatation and counteract the spasm. Finally, if all else fails and the symptoms are persistent and ulcerations are occurring, a surgical procedure called a sympathectomy may be done with some degree of success. Overall, however, people with this condition can usually control their symptoms by avoiding emotional upsets, avoiding cold, taking care of their skin and making sure they do not have any underlying rheumatic disorder.
Author: Norman B. Gaylis, M.D., F.A.C.P., M.A.C.R.