Polymyalgia rheumatica, or PMR, is inflammation of the shoulders and hips that causes pain and stiffness, often after sleep or rest. It is most often found in people over 50 years of age. PMR can be treated with low doses of corticosteroid medication.…
- Raynaud's phenomenon is when the blood flow to the fingers is limited, usually because of cold conditions or stress.
- It is most common in young women.
- It can occur as an independent condition (primary Raynaud's) or as a complication of an existing medical condition (secondary Raynaud's).
- Prevention is the best tool for treating Raynaud's phenomenon. It is best that you identify what triggers your symptoms and take care to avoid these triggers.
What is Raynaud's phenomenon?
The body's normal response to cold exposure is to reduce the blood flow to the extremities. Raynaud's phenomenon is a disorder in which the body over-reacts to cold conditions. Small muscles in the arteries that supply the fingers and other extremities to suddenly constrict. This temporarily cuts off the blood supply to these areas.
In some people, Raynaud's can also be caused by stress or emotional upset.
In most cases, Raynaud's phenomenon has no underlying cause. This is also known as primary Raynaud's disease.
When it occurs because of an underlying medical condition, this is known as secondary Raynaud's phenomenon. This is more likely to develop after 30 years of age, and can be more serious.
A wide range of factors have been linked to an increased risk of Raynaud's phenomenon.
Underlying medical conditions can include:
- Autoimmune conditions such as lupus, scleroderma, rheumatoid arthritis and Sjogren's syndrome;
- Diseases of the blood vessels such as atherosclerosis, vasculitis, Buerger's disease and primary pulmonary hypertension;
- Carpal tunnel syndrome;
- Some cancers, such as ovarian cancer, and;
- Some infections, such as hepatitis B and hepatitis C.
Injuries that can increase the risk include:
- Overuse injuries from activities such as typing, piano playing or using crutches;
- Previous injuries, such as a fracture, surgery or frostbite, and;
- Industrial injuries due to the use of heavy, vibrating machinery such as chainsaws and drills.
Medications and substances that can increase the risk include:
- Antihypertensive medications such as beta-blockers (including metaprolol and propanol);
- Chemicals such as nicotine in cigarettes;
- Some migraine medications such as ergotamine and sumatriptan;
- Medications for attention deficit hyperactivity disorder (ADHD), such as methylphenidate;
- Some nasal decongestants such as ephedrine and phenylephrine;
- The combined oral contraceptive pill and estrogen replacement therapy, and;
- Some chemotherapy medications such as bleomycin.
For primary Raynaud's disease, risk factors include:
- Being aged between 15-30 years old, although Raynaud's can develop at any point in life;
- Being female - women are at an increased risk;
- Cold, wet weather and climate, and;
- Having a family history of primary Raynaud's disease.
For secondary Raynaud's disease, risk factors include:
- Having an underlying medical condition associated with Raynaud's disease;
- Some medications (as noted above in 'Causes'), and;
- Using heavy vibrating equipment.
Signs and symptoms
Most commonly, Raynaud's phenomenon affects the fingers, with symptoms usually starting in one finger before appearing in the others.
Other parts of the body that are more rarely affected include the toes, ears, nose, nipples, face, lips and tongue.
The skin of the affected areas generally changes color over the course of an 'attack' of Raynaud's phenomenon. Initially, the area goes white as blood flow reduces to the area and then the skin can turn blue or purple. Finally, as blood flow returns, usually after 15-20 minutes, the skin becomes red.
As blood flow returns, other symptoms in the affected areas include:
- Discomfort or pain, which can be severe;
- Sensations such as tingling or pins and needles, and;
Methods for diagnosis
To diagnose Raynaud's phenomenon, your doctor will perform a physical examination and ask you questions about your symptoms.
It is important to rule out other causes for the symptoms and identify any underlying causes for Raynaud's phenomenon, and tests may be recommended for this reason.
Tests that can help to identify autoimmune disorders include:
Types of treatment
The most effective way to manage Raynaud's phenomenon is to take steps to prevent attacks from occurring.
Learning what triggers your attacks is a good first step. For some people, an attack may occur only during cold weather, while for others it may be exposure to relatively small changes in temperature, such as when entering an air-conditioned building when it is hot outside, or handling frozen items out of the freezer.
Steps to avoid triggers include:
- Wearing warm clothing, particularly gloves, mittens and thick socks;
- Avoiding situations where temperatures change rapidly;
- Taking care when handling cold items;
- Managing stress and emotional upset;
- Avoiding medications that can trigger an attack;
- Avoiding cigarette smoke (both through smoking and passive exposure to smoke), and;
- Avoiding activities that can damage the fingers and trigger attacks.
The link between caffeine and Raynaud's phenomenon is not clear. Some experts recommend avoiding coffee, while others do not. If you find that drinking coffee appears to trigger attacks, you may wish to avoid it.
Managing Raynaud's attacks
To encourage the blood vessels to open up and blood flow to return to the affected areas, it is best to try to warm them gradually.
- Bathe them in warm water;
- Use body heat (such as putting an affected hand in your armpit), and;
- Rotate your arms like windmills, or rub your hands together to help encourage blood flow.
If the symptoms of Raynaud's phenomenon cannot be managed well with the measures above, medications may be recommended.
If these are not effective, other medications may be substituted, or added to help open up the arteries. These can include:
- Sildenafil, known commonly as Viagra® or by other trade names;
- Nitroglycerin, applied to the skin as an ointment or gel, and;
- Losartan, a particular blood pressure medication.
It is not clear whether psychological treatment is effective for treating Raynaud's attacks. If stress or emotional upset trigger Raynaud's attacks, counselling or using relaxation techniques may be helpful.
More intensive treatment
For people with severe symptoms, or complications such as ulcers, more intensive treatment may be required. This usually only occurs in people who have serious underlying medical conditions such as scleroderma.
More intensive treatments include:
- Intravenous (IV) infusions of a prostanoid such as iloprost;
- Sympathectomy - blocking of the nerves that can stimulate a Raynaud's attack with injections such as botulinum toxin (Botox®), or surgery, and;
- Other medications such as anticoagulants and antibiotics, if necessary.
Complementary and alternative medicines
A range of complementary therapies such as acupuncture, biofeedback, wearing therapeutic gloves, or various herbs such as Ginkgo biloba, have been suggested for treating Raynaud's phenomenon, but there is currently not enough evidence to support the effectiveness of any of these therapies.
Primary Raynaud's disease is normally a minor complaint; complications are extremely rare.
In severe secondary Raynaud's disease, if blood flow cannot be restored to the affected area (usually the fingers or toes) this can lead to ulceration and gangrene.
If this cannot be managed with more intensive treatments, amputation of the affected area may be necessary.
Most people who have Raynaud's attacks have the less serious primary form that can be managed well by avoiding triggers. In some cases, the symptoms will improve over time, with women often finding that symptoms noticeably reduce with menopause. However, some people have lifelong symptoms.
Secondary Raynaud's disease can be much more serious and may require more intensive treatment. It can lead to ulceration and, in very severe cases, may require amputation.
If you have Raynaud's attacks, learning about your triggers and avoiding them can help to reduce your symptoms.