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Encyclopaedia


Raynaud's phenomenon

Introduction

Raynaud's phenomenon

Raynaud’s phenomenon is a common condition that affects the blood supply to certain parts of the body – usually the fingers and toes.

It's often referred to as Raynaud’s syndrome, Raynaud’s disease or just Raynaud's.

Why does it happen?

Raynaud’s is usually triggered by cold temperatures, anxiety or stress. 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 red, as the bloodflow returns. You may also experience numbness, pain, and pins and needles. Symptoms of Raynaud's can last from a few minutes to several hours.

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

Other parts of the body that can be affected by Raynaud’s include the ears, nose, nipples and lips.

Treating Raynaud's

In many cases, it may be possible to control the symptoms of Raynaud’s yourself by avoiding the cold, wearing gloves and using relaxation techniques when feeling stressed.

Stopping smoking can also improve symptoms, as smoking can affect your circulation.

If you're unable to control your symptoms yourself, then a medication called nifedipine may be recommended.

Read more about treating Raynaud’s.

Types of Raynaud's

There are two types of Raynaud's:

  • primary – when the condition develops by itself (this is the most common type)
  • secondary – when it's caused by another health condition

Most cases of secondary Raynaud’s are associated with conditions that cause the immune system to attack healthy tissue (autoimmune conditions), such as rheumatoid arthritis and lupus.

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

Your GP can help to determine whether you have primary or secondary Raynaud's by examining your symptoms and carrying out blood tests.

Read more about what causes Raynaud’s and diagnosing Raynaud's.

Possible complications

Secondary Raynaud’s can severely restrict the blood supply, so it carries a higher risk of complications, such as ulcers, scarring and even tissue death (gangrene) in the most serious cases. However, severe complications are rare.

Read more about the complications of Raynaud’s.

Who gets Raynaud’s?

Raynaud’s phenomenon is a common condition. It affects up to 20% of the adult population worldwide. There may be as many as 10 million people with the condition in the UK.

Primary Raynaud’s usually begins in your 20s or 30s. Secondary Raynaud’s can develop at any age, depending on the cause.

Raynaud's is slightly more common in women than men.

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Causes

Raynaud's phenomenon is the result of over-sensitive blood vessels in the body's extremities. In many cases, no cause is identified, although it's sometimes linked to other health conditions.

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

In people with Raynaud's, the sensitive blood vessels overreact to cold temperatures and become narrower than usual, significantly restricting the blood flow.

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

The most common form of Raynaud's is primary Raynaud's phenomenon. This means the condition occurs by itself, without being associated with another health condition.

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

There's 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, an underlying health condition could be causing the blood vessels to overreact. This is called secondary Raynaud's.

Autoimmune conditions

The majority of cases of secondary Raynaud’s are associated with autoimmune conditions, which cause the immune system to attack healthy tissue.

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

Blood-born viral infections, hepatitis B and hepatitis C, can occasionally trigger Raynaud’s in some people.

Cancer

Some types of cancer 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 also be a side effect of taking certain medicines, including:

Illegal drugs, such as cocaine and amphetamines, can also cause secondary Raynaud’s.

Injury and overuse

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

Skin and tissue damage caused by frostbite can also lead to Raynaud's.

Smoking

Smoking cigarettes also increases your risk of developing Raynaud's. Read about the support available to help you quit smoking.

Vibration white finger

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

  • sanders, grinders and disc cutters
  • hammer drills
  • chainsaws, hedge trimmers and power mowers

Any vibrating tool that causes tingling or numbness in your fingers could lead to vibration white finger.

Your employer has a responsibility to protect you from vibration white finger. If the job can't be done without vibrating tools:

  • ask to use suitable low-vibration tools
  • make sure you're 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 don't have cold handles when next used
  • encourage your blood circulation by keeping warm, stopping smoking and massaging and exercising your fingers during your breaks

If you're diagnosed with the condition, tell your employer as soon as possible. If you stop using vibrating tools at an early stage, you may recover fully.

By law, your employer must contact the Health and Safety Executive about your condition. You may be entitled to an Industrial Injuries Disablement Benefit, which is a payment given to people who have become ill or injured as a result of their work.

See the GOV.UK website for more information about the Industrial Injuries Disablement Benefit.

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Diagnosis

Raynaud's phenomenon can usually be diagnosed after an examination of your symptoms and some blood tests.

Your GP may place your hands in cold water or cool air to see if you show symptoms of Raynaud’s.

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, referral to a specialist.

Secondary Raynaud’s may be suspected if:

  • your symptoms only started when you were over 30 years of age – most cases of primary Raynaud’s begin between the ages of 20 to 30
  • you're 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, found where your nail meets the finger. These capillaries are often larger in people with secondary Raynaud’s, and look like red pen marks.

Blood tests

Your GP may also refer you for blood tests to check for other health conditions that could be causing your symptoms. These tests may include:

  • a full blood count – to check for infection or, much less commonly, a cancer of the blood, such as leukaemia
  • an antinuclear antibodies (ANA) test – to check for an overactive immune system, which is common in people with autoimmune conditions such as rheumatoid arthritis and lupus
  • erythrocyte sedimentation rate – to check for an autoimmune disorder

Raynaud's and Scleroderma Association

If you've been diagnosed with Raynaud’s, the Raynaud's & Scleroderma Association's website may be helpful.

The association is the UK’s leading charity for people affected by the condition

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Treatment

You can usually treat Raynaud's phenomenon yourself, although medication is sometimes necessary.

If you've been diagnosed with secondary Raynaud’s, you may be referred to a specialist in the treatment of the underlying condition.

If your secondary Raynaud’s may be a side effect of a medication, you may be asked to stop taking it, to see if your symptoms improve.

Self-help

The following advice is recommended for 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, stop. Quitting smoking will improve your circulation, which should help to improve symptoms.
  • Exercise regularly, as this helps to improve your circulation and reduce stress levels (see below). For most people, 150 minutes of vigorous exercise a week is recommended. Read more about exercise.
  • Try to 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 therapies for stress.

Medication:

Nifedipine

If your symptoms fail to improve, you may be prescribed nifedipine. This is the only medicine licensed to treat Raynaud's phenomenon in the UK. It doesn't cure Raynaud's, but can help to relieve the symptoms.

Nifedipine is a calcium channel blocker – a type of medication that encourages the blood vessels to widen.

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 as prevention; for example, during a sudden snap of cold weather.

Side effects are common and include:

Don't drink grapefruit juice when taking nifedipine, as this could make side effects worse.

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

Other medications

Other medications have been used to treat Raynaud’s, but their use is controversial, as there is limited evidence to show they're effective in most people. However, some people have claimed to benefit from treatment. These medications include:

  • angiotensin-converting enzyme (ACE) inhibitors
  • fluoxetine – which was widely used in the treatment of depression
  • sildenafil – which is used to treat erectile dysfunction (inability to get or maintain an erection)

These medicines are not licensed for the treatment of Raynaud's in the UK, but you may be prescribed them if it's thought the potential benefit outweighs the possible risks.

Surgery

Surgery for Raynaud's is rare. It's usually only recommended if your symptoms are so severe that there's a risk the affected body part, such as your fingers, could lose their blood supply and begin to die. Read more about the complications of Raynaud's phenomenon.

A type of surgery called sympathectomy is sometimes used. It involves cutting the nerves causing the affected blood vessels to spasm.

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

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Complications

People with Raynaud's phenomenon have an increased risk of developing other problems, such as scleroderma.

Scleroderma

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

Scleroderma is when the body produces excessively high levels of 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, known as dysphagia
  • diarrhoea, bloating or constipation

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

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

For more information, visit the website of the Scleroderma Society, a UK charity for people affected by scleroderma.

Ulcers and gangrene

In severe cases of Raynaud’s, the blood supply to an affected body part can become severely diminished. Without a constant supply of blood, the tissue in the body part will begin to die. This problem is rare and normally only occurs in secondary Raynaud's.

The initial sign is an open sore, known as an ulcer, which develops on the surface of the body part. If you suspect a skin ulcer, contact your GP for advice.

Left untreated, the tissue can die, which is known as gangrene (specifically, 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 tissue becomes cold and numb, and can be painful as the tissue dies. However, many people, particularly the elderly, experience no sensations.

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

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

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

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 27/04/2015 10:42:42

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