What is Raynaud's Phenomenon?

Raynaud's Phenomenon is a condition where blood circulation in the hands and feet is dramatically reduced, causing blanching and bluish discoloration of the fingers and toes. Typically, one ore more fingers turn white, when you are exposed to the cold or touch a cold object. If Raynaud's phenomenon occurs for a sustained period, without a cause, then it is referred to as Raynaud's disease. Nearly 50% of the people having Raynaud's phenomenon have Raynaud's disease. In others, there is a cause for this phenomenon, which can be corrected medically.

Causes, Incidence and Risk factors

A. G. Maurice Raynaud was the French doctor who discovered this phenomenon in the late 1800's. He believed that the blanching and discoloration of blood vessels are a result of the exaggerated action of adrenalin, a neurotransmitter that controls the constriction of blood vessels in the fingers and toes. His proposal is widely accepted as a cause for Raynaud's phenomenon, although other reasons have also been discovered.

Women are 5 times more susceptible to this phenomenon than men. The age group affected is between 20-40 years. It affects the fingers more than the toes. Initially, only the fingertips may be involved, but the condition slowly progresses to involve the entire finger and the whole hand.

Raynaud's phenomenon is common in occupations where intricate and intensive hand movements are required like pianists and typists. It is also common in people using vibratory equipments like chain saws or jack hammers.

Raynaud's phenomenon is common in conditions that cause arterial occlusion like systemic sclerosis, diseases causing inflammation of the small arteries and in people with excessive blood cholesterol. Some blood disorders and endocrine disorders can also manifest themselves as Raynaud's phenomenon. Electric shock and frostbite can also induce Raynaud's phenomenon. It is common for this phenomenon to occur in those with migraine headaches and people with recurrent episodes of chest pain, suggesting a common link between those conditions. As said before, in 50% of the individuals no cause can be found. They are said to have Raynaud's disease.

Signs and Symptoms

Raynaud's phenomenon is commonly recognized when the hands and feet are cooled and warmed. For example, as the hands or feet are exposed to cold, the fingers and toes turn white in color (blanching of digits) and then blue as blood flow is restricted. As the hands and feet are warmed, the fingers and toes turn red before returning to their normal color. This re-warming produces a throbbing pain in the affected digits.

• Fingers and toes feel cold
• Headache
• Chest pain
• Excessive sweating of the hands
• Thickening and tightening of the fingers

Risk Factors:

• Smoking
• Repetitive vibrations or traumas
• Rheumatoid arthritis
• Lupus Erythematosus
• Scleroderma
• Arthrosclerosis
• Arterial disease
• Buerger's disease

Screening and Diagnosis

The results of a clinical examination are usually normal. There are no abnormalities in the pulse or blood vessels of the fingers and toes. An angiography can be done to make sure there are no arterial occlusions, but is usually not required. A physician may want to perform a cold stimulation test, which involves subjecting the affected hand or feet to a cold object or environment and then re-warming the extremities.

Treatment

The use of drugs is reserved only for severe cases. Generally medications are only used to treat the symptoms of Raynaud's phenomenon, such as constriction of the blood vessels. This will not relieve the underlying condition. Calcium channel blocking agents and adrenalin receptor antagonists are the commonly used drugs. Long term therapy is required and you can expect side effects like hypotension, nasal stuffiness, lethargy and even depression.

Complications:

If Raynaud's phenomenon is not treated as soon as it is noticed, the following complications can occur:

• Loss of sensation during blanching episodes, followed later by complete loss of sensation
• Development of Ulcers
• Gangrene of toes and fingers
• Amputation to remove gangrene

Prevention

Raynaud's phenomenon can be easily prevented. The initiating factor is exposure to cold. It is best to:

• Wear warm clothes and avoid unnecessary exposure to cold
• Protect the trunk, head and feet with warm clothing
• Stop smoking
• Wear gloves or mittens in a cold climates
• Re-warm immediately if you notice blanching or discoloration
• Take precautions while re-warming, avoid burning yourself. Use lukewarm water and immerse exposed parts in the water until normal color is restored.

References

1. Harrison's Principles of Internal medicine, 15th edition. Chapter 248. Vascular Diseases of the extremities.