Raynaud’s Phenomenon: Cold Hands, Warm Heart?

By Nancy K. Crevier

Springtime has people looking forward to no more weather that bites the nose and nips the toes. Coats are packed away and the only gloves that swath the hands are latex-tipped gardening gloves. Unless, of course, Raynaud’s phenomenon is diagnosed.

Sufferers of Raynaud’s phenomenon know that it does not necessarily matter if the thermometer registers 10 degrees or 100 degrees. They can still fall victim to an attack that leaves their fingers and toes dead white and numb. Just removing a tray of ice from the freezer can precipitate an attack, as can a dip in a too cool swimming pool. For some, a stressful situation can mean the onset of an attack.

Normally, when the body is chilled, it reacts to preserve the core temperature by drawing blood away from the extremities. Raynaud’s phenomenon is a disorder in which the blood vessels of the extremities — toes, fingers, nose, lips, or ear lobes — overreact to cold, rapidly constricting small blood vessels and arteries. The skin turns white and sometimes blue, as blood flow is suddenly decreased. The digits feel cold to the touch and lose feeling. A Raynaud’s attack can last a few minutes or several hours. As blood slowly returns, the pale, afflicted part of the body turns bright red and may sting or tingle.

It is an unpleasant sensation and one that affects approximately seven percent of healthy, young women in America, said rheumatologist Dr David Trock of Danbury Hospital. “That’s a pretty high number,” he said. Roughly 80 percent of the patients Dr Trock sees for Raynaud’s phenomenon are women between the ages of 13 and 50.

Why more women than men are prone to Raynaud’s is unclear. Several European studies conducted in the 1990s, however, suggested a connection between female sex hormones and Raynaud’s phenomenon.

Rheumatologists, who specialize in disorders of the blood, blood vessels, and connective tissues, frequently see patients with symptoms of Raynaud’s.

The majority of people diagnosed with Raynaud’s phenomenon will be diagnosed with primary Raynaud’s, Dr Trock said. In this instance, the spastic blood vessel attacks can occur for years with no indication of any underlying medical cause and rarely does it develop into anything more than an odd and annoying inconvenience.

However, secondary Raynaud’s phenomenon, said Dr Trock, may indicate a more serious illness. “With secondary Raynaud’s, there is often a related, underlying connective tissue disease and an abnormality in architecture of the blood vessels,” he said. Connective tissue disorders, lupus, Sjogren’s syndrome, carpal tunnel syndrome, and polymyositis are a few of the diseases that present themselves as Raynaud’s. Secondary Raynaud’s phenomenon can also be a symptom of a drug reaction.

“Secondary Raynaud’s has more serious implications. Scleraderma [a chronic connective tissue disease classified as an autoimmune rheumatic disease], for instance, can cause hardening of internal as well as external organ tissues,” he said. Because it is not possible to distinguish easily between primary and secondary, seeking a professional’s opinion is advised when symptoms of Raynaud’s phenomenon occur.

“There are three things I do to distinguish between primary and secondary Raynaud’s,” Dr Trock said. “The first thing I do is check the history of the patient. Then I will perform capillary microscopy and look at the small blood vessels at the nail bed to see if the blood vessels there are normal or not.” Blood vessels in primary Raynaud’s will not be enlarged or deformed. If the rheumatologist feels further diagnostic action is required, he will order blood tests to determine autoimmune or connective tissue disease disorders.

Unless an underlying medical problem is diagnosed, treatment for Raynaud’s phenomenon rarely requires drugs. However, Dr Trock does find that patients with primary Raynaud’s who are bothered especially in the winter months can benefit from vasodilators like Procardia or Norvasc, calcium channel blockers that dilate the blood vessels.

Those with secondary Raynaud’s may find drug intervention helpful when sclera derma is at the root of the Raynaud’s attack.

“If a patient has severe sclera derma and is having painful attack, I may prescribe Viagra to break the attack,” Dr Trock said. “It is a powerful vasodilator.”

Usually, treatment is aimed at relieving the immediate symptoms and shortening the episode.

Most importantly, the affected digits should be warmed as soon as an attack occurs. Running warm water over toes and fingers or soaking them in warm water is recommended. “A water temperature that is about 100 degrees should be fine,” said Dr Trock. Make sure the entire body is kept warm, as well.

Dress appropriately in cold weather and take precautions year around in situations that can bring on a Raynaud’s attack. For Raynaud’s phenomenon sufferers, winter means layers of loose clothing, warm mittens (rather than gloves), and hats and socks to prevent the loss of body heat.

When it is air conditioning and not nature that puts a chill in the air, sweaters can offset a body chill before it leads to a full-blown bout of Raynaud’s. Insulated cup holders will keep fingers warm. If necessary, consider donning gloves before removing icy items from a freezer or refrigerator.

Smoking, because it already causes skin temperature to lower, should be avoided and regular exercise is beneficial for overall well-being.

Learning to relax, said Dr Trock, can be particularly helpful when stress can be pinpointed as a precipitator of a Raynaud’s attack.

The good news is that Raynaud’s attacks do occur less commonly when the weather warms. And warmer weather is on the way.