Raynaud’s disease – Symptoms and causes

Raynaud’s disease is a medical condition characterized by episodes of smooth muscle spasms in the small arteries of the body’s extremities. It most commonly affects the fingers and toes, causing pain, numbness, and marked discoloration. The disease may arise with or without an underlying cause, and its population prevalence is less than 1% in men but over 20% in women (overall 4.85%).

There are two forms of Raynaud’s disease. Primary Raynaud’s disease occurs spontaneously and doesn’t have an underlying cause, while secondary Raynaud’s disease, known as Raynaud’s phenomenon, is triggered by a wide range of underlying conditions. Both forms of Raynaud’s disease may form part of the CREST syndrome, a multisystem connective tissue disorder.

The symptoms of Raynaud’s disease are caused by overactivity of the sympathetic nervous system, leading to blood vessel constriction and reduced blood flow in the fingers. As these extremities are deprived of oxygen, the main symptoms occur. They include:

Pain

The spontaneous deep and sustained constriction of blood vessels in the fingers causes the pain associated with Raynaud’s phenomenon. Body tissues beyond this point are deprived of oxygen, becoming painful and ulcerated. As the constricted blood vessels relax and blood flow returns, patients also experience intense, throbbing pain.

Skin Discoloration

Raynaud’s disease has a distinctive pattern of skin changes that can help diagnose the condition. As the blood supply reduces, the fingers turn pale or white. In people with darker skin tones, the skin may show a bluish tone. As the blood flow returns, the affected hand flushes a deep red, often accompanied by swelling, before gradually returning to normal.

Numbness

Sudden and severe change in blood flow to the fingers leads to numbness and pins and needles, known as paresthesia. This can make it difficult for people with Raynaud’s disease to use affected fingers while an episode is in progress. Sensory changes can last from a few minutes to several hours, depending on the episode’s severity.

The causes of Raynaud’s disease differ according to whether the condition is primary or secondary Raynaud’s disease.

Primary Raynaud’s Disease Causes

Primary Raynaud’s disease arises spontaneously without an apparent underlying cause, though it may be hereditary. It is most common in young women and is usually triggered by exposure to cold or emotional stressors. Smoking, caffeine consumption, and nonselective beta blockers may aggravate the condition.

Secondary Raynaud’s Disease Causes

The presentation of secondary Raynaud’s disease is always alongside another, often chronic, condition. A thorough medical history and examination may point to the underlying disease process. The leading causes of secondary Raynaud’s disease include:

• Connective tissue disordersThis leading cause of Raynaud’s includes rheumatoid arthritis, scleroderma, Sjögren’s syndrome, and Ehlers-Danlos syndrome. In many cases, Raynaud’s disease is one of the first symptoms of a connective tissue disorder.
• Obstructive disordersConditions like thoracic outlet syndrome, atherosclerosis, and Buerger’s disease cause recurrent inflammation and thrombosis of small blood vessels in the hands and feet, predisposing a patient to Raynaud’s phenomenon.
• Occupational exposuresSustained cold exposure, vibrations from handling machinery or work tools, and exposure to chemicals such as mercury or vinyl chloride are known to cause Raynaud’s.
• PharmaceuticalsDrugs that include cytotoxic drugs, beta blockers, and the immunosuppressant cyclosporine can trigger the onset of Raynaud’s disease.

Health care providers diagnose Raynaud’s disease by taking a full medical history, examining affected parts of the body, and undertaking targeted diagnostic investigations. It’s important to distinguish primary Raynaud’s (Raynaud’s disease) from secondary Raynaud’s (Raynaud’s phenomenon). Here are some of the diagnostic tests a physician may use:

• Full blood countA baseline blood test that may indicate anemia or chronic disease.
• Urea and electrolytesA blood test that analyzes kidney function, which many connective tissue disorders affect.
• Rheumatoid factor and antinuclear antibody testsBlood tests a physician can use to exclude the presence of major autoimmune diseases.
• Doppler ultrasoundA special form of ultrasound that measures blood flow in the hands and other peripheral parts of the body.

There are several approaches to treating and managing Raynaud’s disease. Management of Raynaud’s disease focuses on preventing or alleviating symptoms and treating the underlying causes. Here are some of the most common treatments:

Lifestyle Changes

Lifestyle changes are simple and noninvasive but may prove adequate to keep Raynaud’s symptoms at bay. They are particularly effective in cases of secondary Raynaud’s disease. Your physician may advise you to take the following steps to reduce the frequency and severity of Raynaud’s episodes:

• Wear warm clothing and gloves to insulate your hands from the cold.
• Avoid cold spaces, such as freezer cabinets, or directly handling cold or frozen objects.
• Learn to manage emotional stressors that could trigger an attack.
• Change your working conditions if they involve exposure to chemicals or vibrational triggers.

Medical Management of Raynaud’s Disease

If lifestyle changes do not prevent or control your symptoms, your physician can prescribe medications that help alleviate the constriction of the blood vessels that causes Raynaud’s. Several classes of drugs can achieve this effect, including calcium channel blockers, alpha blockers, and topical nitrates.

Surgical Management of Raynaud’s Disease

Severe cases of Raynaud’s disease that don’t respond to other forms of treatment may require referral to an orthopedic surgeon specializing in the hand and wrist. Skilled surgeons, such as Dr. John T. Knight of The Hand and Wrist Institute in Dallas, Texas, can undertake a delicate procedure called an endoscopic thoracic sympathectomy, which cuts the nerves that trigger the painful vasospasm of Raynaud’s. Other treatments include microvascular surgery and the targeted injection of botulinum toxin.

With appropriate investigation and management, Raynaud’s disease can be managed without long-term loss of hand function. Choosing a hand and wrist specialist, such as Dr. John T. Knight of The Hand and Wrist Institute in Dallas, Texas, ensures that you receive skilled care with judicious use of surgery when needed. If you would like advice or a consultation about Raynaud’s disease, Dr. Knight and his team are available to assist you. Contact The Hand and Wrist Institute today by phone or online.

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