Raynaud's Disease: Causes, Symptoms and

Treatments
Written by Tim Newman
Knowledge center
Last updated: Wed 9 March 2016 Last updated: Wed 9 Mar 2016
email
4446Share13

Raynaud's disease is a condition that causes pain in the extremities in response to

cold temperatures. Blood vessels, most commonly in the fingers, almost completely
shut down. Digits turn from white to blue and, finally, as the blood returns, they flush
red.

According to the Raynaud's Association, 5-10% of Americans have the disorder, but only 1
in 5 seek treatment. Females are an estimated nine times more likely to be affected than
males.

Contents of this article:

What is Raynaud's disease?

Symptoms of Raynaud's disease

Causes of Raynaud's disease

Possible pathways of Raynaud's disease

Tests and diagnosis of Raynaud's disease

Treatments for Raynaud's disease

Fast facts on Raynaud's disease

Here are some key points about Raynaud's disease. More detail and supporting information
is in the main article.

Raynaud's disease involves peripheral blood vessels overreacting to cold.

The disease affects up to 5-10% of Americans.

There are a number of competing theories as to how Raynaud's disease affects

people but it is generally accepted to be mediated by a combination of mechanisms.

Cases of Raynaud's disease are split into two distinct types - primary and secondary.

Maurice Raynaud first described the disease in 1862.

Females and people living in colder climates are more often affected.

Capillaroscopies can help diagnose Raynaud's disease.

What is Raynaud's disease?

Raynaud's disease causes blood vessels in the hands or feet to overreact to the cold, potentially
causing numbness and pain.

The basis of Raynaud's disease is a hyperactivation of the sympathetic nervous system

(part of the autonomic nervous system that keeps the body in equilibrium) causing extreme
vasoconstriction.
In other words, the blood vessels of the hands or feet overreact to cold stimulus and
momentarily collapse.
Raynaud's is named after the French doctor Maurice Raynaud, who first recognized the
condition in 1862.

In healthy individuals, the circulatory system in the body's extremities, such as the fingers
and toes, reacts to conserve heat in cold conditions.
Small arteries that supply the skin with oxygen narrow to minimize the amount of heat lost
through the exposed skin surface.

For individuals with Raynaud's disease - also called Raynaud's phenomenon or syndrome this reaction is taken further than the standard response. These blood vessels go into total
shutdown.

Symptoms of Raynaud's disease

Raynaud's disease generally strikes in colder weather and appears to affect people who live
in colder climes.
A cold snap triggers a vasospasm (a contraction of the blood vessels) in the fingers or toes.
This contraction causes hypoxia (a deprivation of oxygen). The extremities will feel cold to
the touch and possibly become numb.
Often the affected area will turn white and then, later, blue. Once the area is warmed
through and blood can return, a tingling sensation often accompanies a red flush and
possible swelling. A painful throbbing may also occur.

Toes and fingers are most commonly affected but Raynaud's can affect the nose, lips
and ears. Rarely, the nipples can also be affected, particularly in breastfeeding
mothers. Symptoms of this affliction are similar to Candida albicans infection and,
for this reason, can sometimes be mistreated.

An attack generally takes around 15 minutes to run its course and for the body to return to
normal.

Causes of Raynaud's disease

The exact mechanisms behind the disease are still unclear. As for its triggers, simply
entering a cold region, opening the freezer or putting hands in cold water can set off
symptoms.
For some people, stress can set off an attack without an associated drop in temperature.
There are two types of Raynaud's disease, known as primary and secondary. Primary
Raynaud's is most common and occurs without a secondary medical condition being
present.

Secondary Raynaud's is caused by another underlying medical issue. This condition is less
common and tends to be more serious. Causes of secondary Raynaud's include:

Diseases of the arteries: atherosclerosis (a build-up of plaque in blood vessels) or

Buerger's syndrome (a disorder where blood vessels in the hands and feet become
inflamed) can cause Raynaud's symptoms. Primary pulmonary hypertension has also
been linked to the disease

Diseases of the connective tissue: most people with scleroderma (a disease

leading to hardened skin) exhibit Raynaud's. These symptoms are commonly linked to
lupus, rheumatoid arthritis and Sjogren's syndrome (an autoimmune disease affecting
glands)

Repetition or vibration: people who have repetitive hobbies or jobs, like typing or
playing the guitar or piano, are at risk of Raynaud's symptoms, as are people who are
frequently subjected to vibrational movements, such as jackhammer operators

Carpal tunnel syndrome: this condition puts pressure on nerves innervating the
hand. It also increases susceptibility to Raynaud's symptoms

Certain medications: certain drugs can induce Raynaud's including beta blockers,
migraine medications containing ergotamine or sumatriptan, ADHD medications, some
chemotherapy drugs and even some over-the-counter cold remedies

Exposure to certain substances: smoking narrows blood vessels and is a possible

cause of Raynaud's. Other chemicals, such as vinyl chloride, may also play a role in
some cases

Injuries: Raynaud's has been known to start after, for instance, frostbite, a broken
wrist or surgery in this region.

On top of the risk factors mentioned above, Raynaud's is also known to affect females more
than males, typically with an onset between the ages of 15 and 25 for the primary form and
35 to 40 for the secondary form.

Raynaud's appears to run in families; 1 in 3 people with Raynaud's have a first-degree

relative with the disease.

In general, Raynaud's is not a life-threatening disease. However, if symptoms worsen and

blood supply is substantially reduced for prolonged periods of time, fingers and toes can
become deformed.
If oxygen is completely cut off from the area, skin ulcers and gangrenous tissue can occur.
Both of these complications are difficult to treat and, at worst, call for amputation.

On the next page, we look at tests and diagnosis of Raynaud's disease and the available
treatment options for the condition.

2
NEXT PAGE

http://www.medicalnewstoday.com/articles/176713.php?page=1

Raynaud's Disease: Diagnosis and Treatments

Written by Tim Newman
Knowledge center
Last updated: Wed 9 March 2016 Last updated: Wed 9 Mar 2016
email
4446Share13

(Continued from page 1...)

Possible pathways of Raynaud's disease

Although the exact pathways of Raynaud's disease are not known, ongoing research is
attempting to find solid answers.
The likelihood is that a number of the factors outlined below work in combination. It is also
possible that those combinations differ from individual to individual.
Below are some of the potential mediators that have been postulated over the years:

Vascular mediators

Nitric oxide: nitric oxide is a strong vasodilator and has been found in lower
quantities in people with secondary rather than primary Raynaud's disease

Endothelin-1: this protein is a potent vasoconstrictor, and elevated levels have been
found in people with primary Raynaud's

Serotonin: serotonin, a neurotransmitter, has been found in higher than normal

concentrations in people with Raynaud's

Angiotensin: ACE inhibitors block the production of angiotensin and have been
demonstrated to have some positive effects against Raynaud's.

Neural mediators

Calcitonin gene-related peptide (CGRP): CGRP is a potent vasodilator that is

found to be lacking in people with Raynaud's. Intravenous CGRP alleviates some of the
symptoms
8

Neuropeptide Y: another strong vasoconstrictor

Agents interacting with alpha-adrenoreceptors: alpha blockers have been found

to alleviate symptoms.

Other possibilities

Platelet activation: studies have shown an increase in the activation of platelets in

Raynaud's. Platelets are components of blood that clump together to help prevent
bleeding
10

Fibrinolysis: this is a natural reaction that takes place in the body to reduce clotting;
some studies have shown links between diminished fibrinolysis and Raynaud's

11

Oxidative stress: an increase in free radicals leading to oxidative stress could be

involved in the disease's etiology.

12

Tests and diagnosis of Raynaud's disease

Because of the nature of Raynaud's, diagnosis can be partially met by asking the patient a
series of questions. These questions are likely to include a description of the symptoms and
some general information about diet, habits and hobbies.
The next challenge is to differentiate between secondary and primary versions of the
disease. For this, the doctor may take a sample of the skin at the base of the fingernail and
inspect it under a microscope.
This procedure is called capillaroscopy. The doctor will be looking for malformed or enlarged
capillaries that could be a sign of a secondary illness.
A blood test may be required in order to look for antinuclear antibodies or to measure
erythrocyte sedimentation rate - both can reveal autoimmune problems or diseases of the
connective tissue.

Treatments for Raynaud's disease

People with Raynaud's disease should take care to wrap up before leaving the house on a cold day.

For people with mild forms of Raynaud's disease, simply wrapping up before leaving the
house can be enough to treat most symptoms. If an attack occurs, soaking the hands (or
feet) in warm - not hot - water can ease the symptoms and prevent them from worsening.
If stress is a factor, learning to change the way a patient deals with stress can also be of
benefit.
However, for more long-lasting versions of the illness, medication has been found to be
effective in some cases:

Alpha blockers: norepinephrine constricts blood vessels and alpha blockers

counteract some of norepinephrine's actions. Examples include doxazosin and prazosin

Calcium channel blockers: this class of drugs relax the smaller blood vessels of
the hands and feet. Examples include amlodipine, nifedipine and felodipine

Topical nitroglycerin ointment: nitroglycerin ointment applied to the affected area

appears to relieve the symptoms by improving blood flow and cardiac output and
decreasing blood pressure
13

Vasodilators: as the name suggests, these drugs dilate veins, easing symptoms.
Examples include losartan, sildenafil (Viagra), fluoxetine (Prozac) and prostaglandin.

In extreme cases, there is an option for more invasive procedures:

Nerve surgery (sympathectomy)

The vasodilation that causes Raynaud's is controlled by sympathetic nerves in the affected
areas. It is possible for a surgeon to make small incisions and strip the nerves away from
the blood vessels.
This procedure will often decrease either the frequency or severity of the attacks. However,
the procedure is not always successful.

Chemical injections

Injecting certain chemicals that block sympathetic nerve fibers from carrying out
vasoconstriction can be effective. Local anesthetics or onabotulinumtoxin type A (Botox)
have been found to work well in some cases.
Even when this treatment is successful, the patient often needs to return for repeat
injections as the drug's effects wear off.
The mysteries of Raynaud's will continue to unravel as the years roll on. Research into
novel targets is bound to eventually tease apart the complex interaction between the
mechanisms mentioned above.
http://www.medicalnewstoday.com/articles/176713.php?page=2