Last December, I saw a 20-year-old, straight-A pre-med student from a top university for an urgent consult. She had developed transient color changes to her fingertips in both hands that had been going on for a week. She had seen her primary care doctor and vascular surgeon who told her that vascular studies were normal but she may have an autoimmune disease called Raynaud’s.
Raynaud’s is a syndrome that causes color changes to the tips of your fingers or toes. The color changes can happen when the blood flow to the small vessels in your hands and feet are temporarily reduced upon exposure to the cold. The decrease in blood flow results in blanching (whitish color changes), cyanosis (bluish color changes), or reactive hyperemia (reddish color changes) as the affected area rewarms. Some people have all three-color changes, and some experience only one. Raynaud’s can lead to swelling of the fingers as well as pain.
A clear cause for Raynaud’s is still being investigated. However, we do know that the blood vessels in the hand and feet appear to overreact to cold temperatures or stress. Women are more likely to experience Raynaud’s and it is more common in those who live in colder climates. About one-third of people with primary Raynaud’s have a first-degree relative with the disorder. Smoking and medications that affect the blood vessels also increase one’s risk of developing the syndrome.
The diagnosis of Raynaud’s is made through asking questions about your medical history and through a physical examination by your doctor. The condition is present in 5% to 10% of the general population. Raynaud’s is divided into two categories: primary and secondary. Generally we refer to it as primary Raynaud’s unless it is associated with an underlying connective tissue disease, such as rheumatoid arthritis or scleroderma. Typically, primary Raynaud’s does not cause tissue damage. However, secondary Raynaud’s can cause irreversible tissue damage, leading to ulcerations, reduction in the fat pads of the fingers, or scars. Treatment of Raynaud’s depends on the severity of the symptoms and whether there is any other associated disease. We recommend avoiding triggers such as smoking, stress, and caffeine. The initial treatments for Raynaud’s are supportive and preventative, such as wearing gloves or heavy socks and warm shoes. The 20-year-old patient mentioned above started using hand warmers, which resolved her attacks and stabilized her symptoms. Now she is working on managing her stress, since studying for a difficult exam triggered her first flare of Raynaud’s. Sometimes, medications are used to help dilate the blood vessels and promote circulation. In severe cases, procedures such as injection or surgeries are used as treatment options. If you think you may have Raynaud’s, speak to your rheumatologist regarding the diagnosis and treatment.