What is Raynaud’s? They do say that a picture is worth a thousand words.
In a previous article about scleroderma, I alluded to something called Raynaud’s phenomenon. Tis the season of the Raynaud flare, so I thought this post would be especially relevant.
This phenomenon is super common. Some studies estimate that it occurs in 3 to 4% of the population but it’s probably a lot more than that. In colder climates its is present in up to 30% of the population. It’s more common in women, in younger people, and it tends to run in families.
Raynaud’s is a vasospastic disorder. Basically the blood vessels clamp up when exposed to the cold, when there is a sudden change in temperature, or sometimes when you are extremely stressed out. No joke! Cigarette smoking is also a known cause. Typically, the finger goes white, then dusky, and when the blood comes back, bright red. If the change in color involves the palm, this is not Raynaud’s.
Raynaud’s can be associated with many conditions. And they’re not all autoimmune.
- Autoimmune – scleroderma, lupus, rheumatoid arthritis, Sjogren’s syndrome, myositis
- Vibration injury – riveters, rock drillers, etc.
- Frost bite
- Medications and chemicals – beta blockers, cocaine, chemo
- Arterial diseases – carpal tunnel, clots, pressure from a crutch
- Hormonal diseases – low thyroid, pheochromocytoma
- Hyperviscosity syndromes – paraproteinemia, polycythemia, cryoglobulinemia
- Infections – Lyme, hepatitis, endocarditis
- Cancers – ovarian cancer, lymphoma, leukemia
And then there’s the most common cause… just cause. Idiopathic primary Raynaud’s. Typically, this occurs in women during their teens or 20’s. There are a lot more causes but these are some of the common and… not so common ones.
Primary Raynaud’s vs. Secondary Raynaud’s
When Raynaud’s is idiopathic, this means that it is NOT caused my any underlying condition. This is primary Raynaud’s. When there IS an underlying condition, we are dealing with secondary Raynaud’s.
In primary Raynaud’s, the blood vessels are structurally normal. In secondary Raynaud’s, the structure of the blood vessels can deform because of the underlying cause.
Secondary Raynaud’s can cause finger ulcers, pitting, fissuring, and gangrene. People tend to have an ANA and or antibodies. In addition sometimes the doctor can actually see that the blood vessels above your nails look distorted using a pocket microscope. While, you don’t see any of these things with primary Raynaud’s.
Can people with primary Raynaud’s develop secondary Raynaud’s
The simple answer is YES. About 1% of patients with primary Raynaud’s develop some form of autoimmune disease yearly. There are a few risk factors that increase that risk.
- Having any specific antibody like anticentromere antibodies
- Abnormal blood vessels above your nails
- Having a ANA with a nucleolar pattern
- First flare after the age of 40 years
- Male gender
- Finger ulcers, pits, gangrene
If you have any or a few of these, it’s important to see a rheumatologist periodically to make sure that you aren’t developing an autoimmune disease. Early diagnosis is key.
How do you treat Raynaud’s?
Keep your hands and feet warm and, keep your core temperature warm. Easier said than done. I know, I grew up in Canada! The trick is layering, mittens, scarves, and warm socks. Need to remove your gloves to answer your phone? Don’t. Either wear touchscreen friendly gloves or convert them. I recently discovered nanotips. It does the job. Note, this is NOT an affiliate marketing link. Basically, try to avoid triggers like the cold, stress, or any chemicals that could cause it in the first place. Known chemicals include cigarettes, decongestants, diet pills… stimulant drugs. Some heart medications may also worsen Raynaud’s. Before making any changes, talk to your doctor.
Fish oil to treat Raynaud’s
When it comes to conventional medications, you do have a few options. Provided you are not allergic to fish, omega-3 fatty acid supplementation could be beneficial. One of my teachers/colleagues, conducted a double-blind, controlled, prospective study looking at fish oil supplementation in patients with both primary and secondary Raynaud’s phenomenon back in the 80’s. Basically, 3 grams of fish oil daily improves tolerance to cold exposure and delays the onset of vasospasm in patients with primary Raynaud’s. This effect was not seen in people with secondary Raynaud’s.
Medications for Raynaud’s
Finally, doctors sometimes prescribe medications like calcium channel blockers: amlodipine and nifedipine. These are generally considered first-line and help about 35% of people. Calcium channel blockers like verapamil and nicardipine are essentially useless. Other medications include prazosin, sildenafil, and talalafil. All of these can decrease your blood pressure. For those with normal or low blood pressure, fluoxetine is a possibility. Although this is an anti-depressent, it’s thought that the increase in serotonin dilates the blood vessels thereby alleviating Raynaud’s. Sometimes topicals are effective: nifedpine and nitroglycerine. But again, sometimes they can cause a drop in blood pressure. Again, this does not constitute medical advice. Please talk to your doctor before making any change.
What about finger or toe threatening situations
Sometimes Raynaud’s is particularly severe and refractory to medications. This tends to happen with people suffering from scleroderma. Sometimes, you can see gangrene because the decrease in blood flow is so severe. Obviously, you don’t want it to get to that point. In these situations, hospitalization often times is necessary. Consequently doctors use medications like epoprostenol or iloprost to aggressively open up those blood vessels. Surgical intervention may also be necessary: sympathectomy. It can be performed at the cervical, lumbar, wrist, or digital (finger) levels. These interventions are reserved for very severe cases.
What’s the prognosis
For primary Raynaud’s prognosis is excellent. Simply a nuisance for the most part. However, in high risk people, it’s important to see a rheumatologist on an annual basis to see if anything changes. Thankfully, in about 10% of people the attacks disappear completely with time.
In contrast, things are little more complicated with secondary Raynaud’s. It really depends on the underlying problem. Remember this is treatable. Not curable, but treatable.
I hope this has been informative and enlightening. Remember, bundle up and stay warm this winter!
References
Rheumatology Secrets, 3rd Edition
DiGiacomb RA, Kremer JM, Shah DM. Fish-oil dietary supplementation in patients with Raynaud’s phenomenon: a double-blind, controlled, prospective study. Am J Med. 1989 Feb;86(2):158-64.