Raynaud's Phenomenon

reynaud's phenomenon What is raynaudís phenomenon?

Raynaud's phenomenon occurs when the extremities of the body, usually the fingers and toes, change color and may become painful. It is due to a narrowing of the small blood vessels on exposure to the cold, or to a change in temperature, or to emotional stress. In most cases, the cause is not known. In some cases, it is a symptom of an underlying condition such as scleroderma, lupus, or rheumatoid arthritis. The main treatment is to keep warm. Drugs to open up the blood vessels are used in some cases.

How does it present?

The symptoms develop in fingers when they are exposed to cold in cold whether conditions. The first symptom to develop is fingers turning white and cold, due to narrowing of small blood vessels in fingers. The fingers then go a from white to bluishcolor (or even purple or black in severe cases), this is due to lack of oxygen supply. The fingers then go bright red due to dilatation or opening up of these blood vessels again (dilate) and the return of blood flow causing tingling, throbbing, numbness and pain (which can be severe in some cases). Lot of people with Raynaud's donít have the full classic colour changes, but develop bouts of uncomfortable, pale, cold fingers. Fingers are affected most often, but in some cases the toes are also affected; less commonly other extremities of the body are affected, such as the earlobes, nose, nipples or tongue. Each bout of symptoms can last from minutes to hours.

What are the causes of raynaudís disease?

Primary Raynaudís, is when the cause is not known. In most cases there is no known cause (more than 9 in 10 cases). There is no other underlying disease. Symptoms are triggered more easily in some people than in others and even mildly cool weather, or getting something out of the freezer, can trigger symptoms in some people. Strong emotion may also trigger symptoms in some cases.Usually, all fingers on both hands are affected in primary Raynaud's. It also tends to run in some families. Women are affected much more often than men. It usually first develops before the age of 30. There are no other symptoms apart from those described above, and symptoms go completely after each bout.

Secondary Raynaud's, is when it is due to an underlying cause. Its incidence is less. Various conditions of blood vessels, joints, muscles, nerves or skin can cause secondary Raynaud's. For example, scleroderma, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematous (SLE) and other 'connective tissue' diseases. If you have secondary Raynaud's you will normally have other symptoms in addition to the symptoms of Raynaud's. The Raynaud's is just one feature of the condition. For example, you may also have joint pains, rashes, joint swelling, etc. Often the underlying condition is already present, and you may develop Raynaud's as a complication. Sometimes the symptoms of Raynaud's occur first, and other symptoms of the underlying condition develop weeks, months or even years later. Unlike, primary Raynaudís, just one or two fingers o one hand is affected. Certain medicines may also cause secondary Raynaud's as a side-effect .

Hand-arm vibration syndrome(vibration white finger) is one of the scommon cause of secondary Raynaud's. This is caused by using vibrating tools regularly over a long time. For example, it occurs in some shipyard workers, mine workers, road diggers, etc. It is thought that repeated vibrations over time may damage the small blood vessels or their nerve supply.

What tests are required?

There is no test to confirm the diagnosis of Raynaudís disease; it is confirmed on the basis of typical symptoms that it presents with. Features suggestive of Raynaudís disease include, age more than 30 years, abrupt onset with rapid progression and worsening of symptoms, severe symptoms that may include an ulceration or gangrene of part of a finger or toe, symptoms affecting only one hand or foot, joint pains or arthritis, skin rashes, dry eyes or mouth, muscle weakness or pain, swallowing difficulties, breathlessness, mouth ulcers, previous work with vibrating tools.

Blood tests and other tests may be done if secondary Raynaud's is suspected. Sometimes the diagnosis of an underlying cause is already known (for example, rheumatoid arthritis) and the development of Raynaud's is not a surprising feature.

What complications are required?

Complications with primary Raynauds disease is not known, however, secondaryRaynaudís disease in some people ulcers on affected fingers and toes; scarring of tips of fingers and toes; gangrene (tissue death) of parts of affected fingers and toes.

Things to do to prevent this disease would be to:

  • Stop smoking and consumption of tobacco, as it is known to worsen the symptoms.
  • Medicines used to treat other medical conditions might trigger the condition. Drugs known to do so are : beta-blockers, some anti-migraine medicines, decongestants, and, very occasionally, the contraceptive pill. Don't stop a prescribed drug if you suspect it may be making symptoms worse. See your doctor to discuss possible alternatives.
  • Try cutting out caffeine for a few weeks to see if it helps. Amphetamines and cocaine may also be a trigger.
  • Try to keep warm in cool weather or in cool environments, and avoid touching cold objects.
  • Regular exercise is recommended by many experts. Exercise your hands and feet frequently to improve the circulation.
  • When a bout of symptoms develops, warm the affected hands or feet as soon as possible. Soaking the hands or feet in warm and not hot runningwater, as too hot, would lose its heat and become cool.
What treatment is required?

Drugs given in severe conditions are arterial dilators like, nifedipine, which tends to open up (dilate) the small blood vessels or arteries. They can be taken regularly or just during cold whether spells. It is important to consult your doctor before taking this medication. This drug should avoided in people who are pregnant and breast feeding, who are suffering from myocardial infarction , aortic stenosis, heart failure, peripheral oedema, symptomatic low blood pressure and unstable ungina. Regular blood pressure monitoring is required.

Stress counselling or relaxation techniques help if you have primary Raynaud's and the symptoms are triggered by stress or emotion.'Nerve blocks' or other hospital-based treatments may be tried if you have severe Raynaud's which is not helped by other treatments.

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