Raynaud's Phenomenon & Raynaud's Disease

What is Raynaud's syndrome?

Your body had the ability to control circulation throughout the body without your thinking about it.  If you go for a run, the blood is shunted towards your muscles.  If you eat a big meal, the blood is shunted towards your gut.  And when it's cold outside, your body shunts the blood away from the fingers and toes, in order to keep the organs inside the body warm. 

The nervous system that controls these sorts of involuntary actions is known as the "autonomic nervous system".

In some people, however, the body's internal thermostat is a little too hypersensitive, so that the blood is shunted away from the fingers and toes with even modest amounts of cold.  This condition is known as Raynaud's disease, named after the French physician who first described the condition 1889.  

Is Raynaud's syndrome the same as Raynaud's phenomenon and Raynaud's disease?   

The terminology is a bit confusing, with many physicians throwing around the terms as being synonymous and others reserving each term to mean variations of the same process.  For example, Raynaud's Disease is often used to indicate some systemic problems (like connective tissue disease, dysfunction of the esophagus, atherosclerosis, tarsal tunnel, Rheumatoid arthritis, Lupus, etc.) associated with the Raynaud's syndrome. 

Who gets Raynaud's syndrome?

There are several factors in determining who might be susceptible: 

• Women outnumber men 8 to 2.
• Those 10-45 years of age get this more frequently. 
• Individuals of northern European heritage seem to get this condition more than others.
• It is more frequent in certain family lines.  
• Those living in a cold environment get this more frequently than those living in warm areas. 
• Previous exposure to frostbite increases the odds of getting Raynaud's syndrome.
• Emotional factors also seem to play a role. 

What does it look like?

Raynaud's syndrome is seen most frequently in the fingers alone (60%), but it is seen in the toes about 40% of the time.  When the toes are involved, it rarely develops there first. 

It typically appears as a whitish or bluish discoloration of the affected the digit.  The digit feels cold to the touch and when the skin is blanched (pressed hard enough to remove the blood in the digit), the bluish color returns sluggishly.   When the episode resolves, the skin may appear reddish in color. 

How is it diagnosed?

Usually by history and physical exam alone, though lab work (thermograpy, capillary microscopy and a positive Anti-Nuclear Antibody (ANA) blood test, e.g..) 

How is it treated? 

A variety of things may help: 

• Avoid the cold.  Bundle up the feet and hands, and don't touch a cold steering wheel, bags of ice, or other cold items.  
• Don't smoke (which worsens the condition).
• Don't ingest caffeine (which also worsens the condition).
• Keep the skin well lubricated.

Medications that may help include:

• Niacin (which acts as a vasodilator to open up the circulation in the fingers and toes) is an over-the-counter drug that may help, though it can give the patient a temporary "flushed" feeling, like they're skin is burning up, and it seems to affect the face and neck more than the fingers and toes. 
• Other vasodilators like Nitroglycerine is available by prescription.
• Calcium channel blockers like Nifedipine (by prescription).
• ACE inhibitors like Captopril (by prescription).
• Surgery (rarely necessary) is directed to inhibit the autonomic nervous system function that controls the vasospasm.