Who Knows? Raynaud's!

Raynaud's phenomenon is a medical condition in which the arteries in the fingers and toes become suddenly narrowed in response to cold exposure, causing the digits to turn sequentially white, blue, or red. It is named after the French physician, Maurice Raynaud, who first described it. Although fingers of healthy individuals may become pale in response to severe cold, the effect is exaggerated in individuals with Raynaud's symptoms, so that even mild cold exposure, such as within one's home, can cause significant symptoms. Raynaud's symptoms have been estimated to be present in as many as one in twenty people, so it is helpful to understand this condition and what may help.

Primary "Raynaud's disease" refers to vasospasm (severe, temporary narrowing of the arteries) that happens with cold or stress without any other related medical condition. Some people have other medical illnesses, such as scleroderma or systemic lupus erythematosus. In these cases, the term, secondary "Raynaud's phenomenon" is used to describe vasospasm of the digits in response to cold.

Raynaud's disease affects women more often than men, occurs more commonly in youth (between ages 15 and 35 years) and may occur more frequently in members of the same family. The cause is not known.

• 80% of sufferers are women
• As many as 5% of the US population has it
• Most people have primary Raynaud's disease
• Most common before age 35 (women age 15-40)
• Arteries are normal between attacks

People with Raynaud's disease experience an attack during which their fingers initially turn white and become cold and numb. The finger looks as though there is no blood flow, because during the attack the finger arteries are very narrow and blood flow is decreased. Attacks may happen in one or both hands. Toes are less commonly affected. The whiteness may affect just the tip of a single finger, or involve many fingers. The fingers may then turn a dusky, dark shade of blue. When the artery constriction ends, blood rushes into the arteries making the finger turn red and warm and may cause a burning, throbbing pain. Not all of the changes occur in the order described, nor do all occur in each attack.

Most of the time, the skin texture stays normal. In some cases, the skin may thicken. In persons with severe recurrent episodes of Raynaud's phenomenon, ulcers or sores on the tips of the fingers may result. This happens rarely in patients with primary Raynaud's disease. Patients should seek advice from a health care provider if sores occur.

Treatment of Raynaud's Disease
The best treatment is to avoid the cause(s) of the attacks. Most individuals can achieve satisfactory control of the frequency and severity of attacks by avoiding cold, using protective garments (including extra layers of clothing, hats, mittens, and warm socks and shoes), or occasionally taking medications that relax the arteries. Usually, a decrease of attacks is achievable, but there is no "cure" for Raynaud's.

Some helpful suggestions for Raynaud's Disease:

• Avoid abrupt changes in temperatures Ñespecially going from warm air into air conditioning.
• Do not go outside without a coat and mittens (gloves allow more cold air to get between the fingers). Wear a hat.
• Use mittens to take anything out of a freezer.
• Do not smoke.

Treatment of Raynaud's Phenomenon
The physician should evaluate the patient for other illnesses associated with Raynaud's phenomenon. These include: connective tissue disorders (lupus, rheumatoid arthritis, and scleroderma), vibration injury from use of power tools, thoracic outlet syndrome, and other arterial diseases that compromise blood flow to the hands. Tests for secondary Raynaud's may include non-invasive blood flow studies of the hand and arm, a blood test called an ANA or rheumatoid factor.

Some helpful suggestions for Raynaud's Phenomenon:

• Keep your hands from getting cold
• Do not use vibrating tools
• Wear mittens instead of gloves
• Avoid excessive stress
• See your doctor if you get worse-or if you notice a finger sore

In rare cases, medications such as calcium channel blockers or alpha adrenergic blockers can be used to dilate finger arteries. You should consult with your health care provider before starting any prescription or over the counter medication, or even herbal remedies as none have been shown to be effective. Biofeedback is safe and occasionally effective, and may be something to discuss with your physician. In patients with secondary Raynaud's phenomenon and severe, persistent digital vasospasm, and threatened fingers, a surgical procedure called "digital sympathectomy" may be considered if other measures fail.