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Raynaud’s disease Symptoms and Treatment

Suffering from Raynaud’s disease or Raynaud’s syndrome, which are two slightly different conditions, is not just about having cold hands or feet. It is a chronic disorder of the circulation of the blood in the extremities, which occurs periodically, in case of exposure to the cold and, more rarely, in case of emotional stress .

The affected parts suddenly become white, cold and sometimes numb or numb, because the blood is no longer circulating. The disease specifically affects the extremities, most often the fingers (the thumb is usually spared) and toes, but also, in some cases, the nose, lips and earlobes or even the nipples. A crisis can last from a few minutes to a few hours.

It is a French doctor, Maurice Raynaud, who first described the manifestations of this disease, in 1862.

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How does the body react to the cold?

Normally, when exposed to the cold, the body tries to reduce its heat loss by tightening the small arteries just under the skin (arterioles), this is called vasoconstriction. This mechanism reduces the exposure of blood to cold and increases its influx into the deep veins. This helps the body maintain its internal temperature.

In people with Raynaud’s disease, this reaction is excessive. The nerves that control the tightening of arterioles are hypersensitive and do not cause normal vasoconstriction, but rather a sharp decrease in the size of the arteries (so-called spasm). When the spasm stops, the arterioles dilate again, which restores the blood circulation?

 

Disease and syndrome: two different attacks

We distinguish 2 forms of the disease according to the cause.

  • The primary form (Raynaud’s disease). This is the most common form, 90% of cases. Most of the time, the symptoms are mild: they create an uncomfortable sensation, but do not cause damage to vessels or tissues. It occurs most often between the ages of 15 and 25 years. In about two-thirds of cases, the disease resolves itself after a few years. It has also been found that her symptoms decrease during pregnancy. The cause of the primary form of Raynaud’s disease is unknown.
  • Secondary form (Raynaud’s syndrome). This syndrome, also called Raynaud’s phenomenon, is much rarer and generally more serious. It is caused by diseases that reach the blood vessels, such as scleroderma .
    Some events – or activities – can also cause damage to the vessels: frostbite or manipulation of tools that vibrate a lot or that because repeated impacts to the hands, for example.
    Taking certain long-term medications can also lead to Raynaud’s syndrome. For more information, see the section at Risk.
    Raynaud’s syndrome (secondary form) usually appears around midlife. Severe cases require specialized medical monitoring in rheumatology.

According to data compiled in different countries, it is estimated that 3% to 5% of the population suffers from the disease or Raynaud’s syndrome.

Possible complications

In severe cases, which are rare, the permanent decrease of the blood circulation can result in the deformation of the fingers or toes.

If one or more vessels become completely blocked, painful ulcers may appear on the fingertips or even gangrene (tissue death). These two complications, difficult to treat, occur mostly in people with scleroderma.

The symptoms of Raynaud’s disease

A seizure can last from minutes to hours and result in one or more of the following symptoms.

  • change in skin color in the affected area, which often changes from natural rosé to white when the circulation in the arteries decreases. In this first phase of the crisis, there is often numbness and cooling, with or without loss of sensitivity.
  • Sometimes the affected part turns blue, indicating that it is no longer supplied with oxygen.
  • When the affected parties warm up or when the stress fades, you can feel tingling, pulsations and pain (more rarely). Sometimes there is a slight swelling and redness.

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Note. The symptoms are more severe, more intense and last longer in patients with Raynaud’s syndrome. In people with diseases associated with this syndrome, other symptoms specific to these conditions are usually present

People at risk for Raynaud’s disease

Raynaud’s disease

  • The women are more affected than men: 75% to 90% of cases of Raynaud’s disease are women aged 15 to 40 years.
  • People with a direct parent (father, mother, brother, sister) are affected by the disease: 30% of them are also affected.

Raynaud’s syndrome

  • People who suffer from certain autoimmune diseases : 90% of people with scleroderma, 85% of people with Sharp disease (mixed connective tissue disease), 30% of people with Sjögren’s syndrome and 30 % of people with lupus are also affected by Raynaud’s syndrome.
  • People with rheumatoid arthritis, carpal tunnel syndrome , atherosclerosis , thyroid disorders or Buerger’s disease are also at higher risk than average.

Workers in certain occupational sectors

  • People who expose their hands to repeated trauma: office workers (keyboard work), pianists and regular users of the palm of the hand as “tool” to crush, squeeze or twist objects (tilers or bodybuilders, for example).
  • Plastic workers exposed to vinyl chloride may have Raynaud’s syndrome associated with scleroderma. It should be noted that workers’ protection measures are now more adequate and that the risk of toxic exposure would be low, according to the Canadian Center for Occupational Health and Safety (see Sites of Interest).
  • Fish workers (alternating hot and cold and handling ice or any other refrigerant).
  •  Workers who use mechanical tools that generate vibrations (chain saws, jackhammers, rock hammers) are very vulnerable. From 25% to 50% of them can be affected and these percentages can reach 90% among those who have 20 years of experience.
  • People who have taken or need to take medicines that cause blood vessels to contract: beta-blockers (used to treat hypertension and heart disease), ergotamine (used to treat migraines and headaches), some chemotherapy treatments.

Risk factors

Have suffered injuries or frostbite on your feet and hands.

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Prevention of Raynaud’s disease

Measures to prevent crises

Protect yourself from the cold

This is the best protection available.

Outside

  • Dress warmly in the winterOverlaying layers of thin clothing is more effective than wearing a single thick layer to keep it warm. Of course, it is essential to wear gloves or mittensand warm socks, but it is also necessary to cover the rest of the body, because a drop in internal temperature is enough to trigger a crisis. A hat is also essential because the body loses a lot of heat through the scalp.
  • When you have to go outside for a long time or in very cold weather, using handwarmers and toe warmers is a good thing. These small bags contain chemicals that, once stirred, generate heat for a few hours. We can put them in his mittens, his pockets, and his hat. Some are intended for boots, provided that they are not too tight. They are usually sold in sportshunting and fishing stores.
  • In summer, sudden changes in temperature are to be avoided, for example when entering an air-conditioned place and it is very hot outside. To reduce thermal shock, always think of having extra clothing and gloves with you when you have to go to the grocery store, for example, or in any other air-conditioned place.

Inside

  • In summer, if the accommodation is air-conditioned, keep the air conditioning to a minimum.
  • Wear gloves before handling refrigerated and frozen products.
  • Use an insulated container when taking cold drinks.
  • In winter, if seizures occur at night, wear gloves and socks in bed.

No smoking

In addition to all its other harmful effects, smoking has direct and quite undesirable consequences for people who suffer from Raynaud’s disease or Raynaud’s syndrome. Smoking triggers the tightening of the blood vessels, which increases the risk of seizure, as well as the intensity and duration of the symptoms. In addition, smoking increases the risk of obstruction of small vessels, which can cause gangrene. Smoking must be absolutely avoided. See the sheet Smoking.

Better manage stress

Learning to manage stress better can greatly help people whose illness is triggered by this factor. See our stress file for more information.

Other measures

  • Make physical activity regularly. This warms the body, improves blood circulation and helps to relax.
  • Be alert to avoid injury to the hands or toes.
  • Do not wear jewelry or tight accessories on your hands (rings, bracelets, etc.), ankles or feet (shoes).
  • When working with mechanical tools that vibrate a lot, use only those that are well maintained and in good working order. Further guidance is provided in the Canadian Center for Occupational Health and Safety online document.  The doctor can also recommend a change of professional activity.
  • Avoid caffeine because it has a vasoconstrictor effect.
  • Avoid drugs that cause vasoconstriction  : this is particularly the case of over-the- counter decongestants that contain pseudoephedrine (eg Sudafed and Claritin) or phenylephrine (Sudafed PE), certain weight loss products (containing ephedrine, also known as Ma Huang , is prohibited for sale in Canada) and migraine medications containing ergotamine.
  • Patients with Raynaud’s syndrome (secondary form) should avoid the birth control pill. In fact, the vessels of these patients are predisposed to obstructions and the birth control pill increases this risk.

Medical treatment of Raynaud’s disease

There is still no definitive cure for Raynaud’s disease (primary form). However, it is possible to reduce the frequency of seizures by modifying certain habits, such as quitting or protecting oneself from the cold.

In addition, the symptoms should not be overlooked as they may hide another problem or be the first symptom of an underlying disease such as rheumatoid arthritis or scleroderma . It could then be that we are in the presence of Raynaud’s syndrome (secondary form). In this case, the treatment will seek to cure the underlying disease, which requires a medical consultation.

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What to do in the event of a crisis?

Getting warm is the first thing to do, to calm the spasm of the blood vessels.

  • To warm your hands or feet, you can:
    place them under the armpits,
    soak them in warm water (not hot) or let lukewarm water run on them.
  • To restore circulation:
    move your fingers or toes,
    massage affected areas,
    move your arms in large circles.

When stress is the cause of the crisis, go to a quiet place and, while warming the affected parties, use an anti-stress technique. Or, get out of the stressful situation, with the help of a third party if necessary, to relax.

Pharmaceuticals

People with Raynaud’s disease rarely need medication. However, these become necessary in case of severe Raynaud’s syndrome.

Vasodilators. These medications promote the irrigation of the extremities by increasing the opening of the blood vessels.

  • Calcium inhibitors. These drugs (pinaverium, nifedipine, buflomedil, nimodipine, etc.) have the effect of relaxing the muscles and dilating the small blood vessels . They are usually prescribed to treat certain heart conditions and hypertension. Calcium inhibitors relieve two-thirds of patients with Raynaud’s disease (primary or secondary). They also help heal skin ulcers on the fingers and toes .
  • Alpha-blockers . These medications (prazosin, doxasosin, etc.) relieve some patients by counteracting the action of norepinephrine, a hormone involved in the narrowing of blood vessels. They are also used to treat hypertension. Their effect on Raynaud’s syndrome is modest; a more specific alpha-blocker is being studied at this time.
  • The nitroglycerin in the form of cream is also sometimes used for this purpose.
  • The sildenafil (Viagra). This type 5 phosphodiesterase inhibitor (IPDE-5), used primarily to treat erectile dysfunction, can reduce the frequency of seizures. It is reserved for patients for whom other vasodilator treatments are ineffective.

Adjuvant treatment. When a patient does not respond to treatment, the doctor may prescribe other drugs that increase the effect of vasodilators.

  • Fluoxetine (antidepressant)
  • Cilostazol
  • Pentoxifillin

Note. The various treatments recommended are not always effective, especially to treat Raynaud’s syndrome . Some people are more sensitive to adverse effects and have poor tolerance for treatment.

In the most serious cases

When blood circulation is blocked and there is a risk of gangrene , hospitalization may be necessary. This allows for tighter clinical follow-up and, if necessary, intravenous administration of more potent vasodilator medication. In advanced gangrene, amputation may become necessary.

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