RAYNAUD'S PHENOMENON

WHAT IS RAYNAUD'S PHENOMENON?

Raynaud's (ray-NODES) phenomenon is a condition in which poor blood flow 
results in pain and skin color changes in affected parts of the body. 
Those parts of the body most commonly affected include the fingers, 
toes, ears, or tip of the nose. Raynaud's phenomenon usually occurs in 
several episodes, with each episode lasting a few minutes to an hour or 
more. Symptoms generally don't occur between episodes.

When this condition occurs by itself, it is called primary Raynaud's
 phenomenon. When it occurs along with other diseases, such as 
scleroderma, systemic lupus erythematosus, polymyositis, 
dermatomyositis, Sjogren's syndrome, or overlap syndrome (mixed 
connective tissue disease), it is called secondary Raynaud's phenomenon.

There is no cure for Raynaud's phenomenon, but in most cases it can be 
controlled with proper medical care.

WHAT HAPPENS IN RAYNAUD'S PHENOMENON?

Attacks of Raynaud's phenomenon usually occur only once in a while and 
usually don't cause permanent damage. Some people, however, may have 
frequent and severe attacks.

During an attack of Raynaud's phenomenon, the blood vessels in the 
affected areas - usually the fingers and/or toes - become narrower for a 
short time. This prevents the blood from flowing freely to the affected 
area. As this happens, you may notice the following signs:
Change of skin color in that area. First, it may turn white because
there is little blood in that area. It then may turn blue because the 
blood remains stagnant in the blood vessels due to improper flow. 
Finally, it may turn red or purple as the blood begins flowing again. 
Sometimes your skin may turn only white or blue. Numbness and/or
coldness in that area as the blood flow slows. Pain may occur during 
episodes. Swelling, tingling, aching, warmth, and/or throbbing in that
area as the blood begins flowing again. 

Without treatment, secondary Raynaud's phenomenon can damage the 
affected part of the body. When blood does not flow adequately to the 
tissues, sores (called ulcers) may develop. If these sores are not 
treated, they may become infected and may take a long time to heal.

This kind of damage rarely happens in primary Raynaud's phenomenon. 
Therefore, it is important to find out what type of Raynaud's phenomenon 
you have.

WHAT CAUSES RAYNAUD'S PHENOMENON?

Doctors aren't sure exactly what causes Raynaud's phenomenon. They do 
know, however, that attacks often are triggered by cold temperatures and 
sometimes by emotional stress, such as nervousness or excitement. Using 
hand-held vibrating tools also can lead to Raynaud's phenomenon.

WHO GETS RAYNAUD'S PHENOMENON?

This condition can begin at any age, but it usually begins between ages 
15 and 40. It occurs in three to five percent of the population and is 
much more common in women than in men.

HOW IS IT DIAGNOSED?

To diagnose your condition, your doctor may:
ask questions about your symptoms (as already mentioned, Raynaud's
phenomenon may occur as a symptom of other illnesses) take blood
samples to test for other illnesses that may have similar symptoms test
your fingers to see if they change color in response to cold show you
pictures of hands taken during an attack of Raynaud's phenomenon to make 
sure that color The goal of treatment is to prevent attacks and prevent 
tissue damage if an attack does occur. This is done mainly by protecting 
yourself from the cold, by avoiding excessive emotional stress, and not 
using vibrating tools. In some cases medicine also may be used. Surgery 
usually is unnecessary. changes you've observed are not a strong, yet 
normal response to cold. This also will help distinguish Raynaud's pheno
menon from a condition called acrocyanosis, meaning blue extremities.
examine your fingers under a special microscope to look for abnormal 
blood vessels 

WHAT IS THE TREATMENT?

To avoid attacks of Raynaud's phenomenon, make sure you are adequately 
protected from the cold.

COLD PROTECTION

To avoid attacks of Raynaud's phenomenon, you should keep your entire 
body warm at all times. Follow these tips to keep from getting too cold:

Dress warmly, especially during cold

weather and during changes of season.
Wear layers of loose-fitting clothes. Wear a hat in cold weather,
since much body heat is lost through the scalp. Cover your face and
ears with a scarf. Wear loose-fitting boots and shoes that won't cut
off your blood supply. Wear heavy socks or layers of socks. Wear thick
mittens - they're warmer than gloves. Always keep a sweater or jacket
with you, even during the summer. You may need it in cold, 
air-conditioned buildings. 

Use flannel sheets, layers of blankets, or an electric blanket on a low 
setting. Before you get into bed, turn on your electric blanket to warm 
the sheets. If your hands and feet get cold when you sleep, wear mittens 
and socks to bed.

Keep the rooms you use most often at a comfortable temperature.

Start running your bath or shower water ahead of time so you don't touch 
cold water. Keep the bathroom door closed. The steam will warm the room.

Enlist help from family and friends. In the winter, for example, let 
someone else get the newspaper from outside or start the car on a cold 
day. Avoid reaching into the freezer or doing tasks that require putting 
your hands into cold water.

Wear thick gloves or mittens to reach into a freezer at home or at the 
grocery store.

Use insulated containers or wear a glove or mitten to hold cold objects
 such as ice-cold drinks, frozen desserts, or fruit.

Rinse and peel vegetables with warm water instead of cold.

Use warm, not cold, water when rinsing food or washing dishes.

SKIN PROTECTION

Poor blood flow may make your skin dry. It also may cause cuts, cracks, 
or sores to heal more slowly than normal. Follow these tips to protect 
your skin:

Use lotion with lanolin every day on your hands and feet.This keeps your 
skin from chapping or cracking.

Wash with a mild, creamy soap. Clean between your fingers and toes, but 
don't soak them.

Examine your feet and hands daily to check for ulcers. If you develop an 
ulcer, keep it clean and covered. See your doctor right away.

Protect your nails. Use a lotion to keep your cuticles soft. Don't cut 
your cuticles with scissors or use a sharp instrument to push them back. 
Gently push them back with a cotton swab soaked in cuticle remover. 
Carefully cut hangnails and file your nails in a rounded fashion to the 
tips of your fingers.

Wear rubber gloves while washing dishes.

Be aware of activities that put pressure on your fingertips, such as 
using vibrating tools or a manual typewriter or playing the guitar or 
piano. They may cause your blood vessels to narrow, thus triggering an 
attack.

Wear clothes made of natural fibers, such as cotton and wool. These draw 
moisture away from your skin.

OTHER TIPS

Don't smoke. Smoking causes blood vessels to narrow, which decreases the 
blood flow.

Try to avoid emotional stress. When possible, avoid situations that may 
make you too excited, nervous, or frightened. Ask your doctor about 
relaxation techniques that may help you reduce stress. Also, look into 
biofeedback training, which can help you learn to control your body 
temperature. For more information, contact your local Arthritis 
Foundation chapter and request a copy of the brochure Coping with 
Stress.

Be aware of certain drugs that may cause your blood vessels to narrow.
 Some of these drugs are listed in the following table. Always tell your 
doctors that you have Raynaud's phenomenon, and discuss any 
over-the-counter or prescribed medicines with them. For example, even 
over-the-counter cold remedies can aggravate Raynaud's phenomenon. Work 
in partnership with your doctors to determine which drugs are most 
suitable for you.

MEDICATIONS

In severe cases, Raynaud's phenomenon may be treated with drugs that 
keep your blood vessels from narrowing and help them dilate, such as 
nifedipine, diltiazem, or nitroglycerine.
Type of Medicine 
Vasoconstrictor

Beta blocker

Adrenergic stimulator
Use 
Headaches

Angina,
High blood pressure,
Migraine headaches

Colds,
Respiratory symptoms,
Diet aids
Generic Name 
ergotamine

acebutolol, 
labetalol,
metroprolol,
nadolol, propanolol, timolol 

phenylpropanolamine
Brand Names 
Ergomar, Ergostat, Cafergot, Ergotmine

Sectral 
Normodyne, Trandate,
Lopressor 
Cogard Inderal, Inderal LA
, Blocadren

Naldecon, Triaminic, Sudafed, various cold tablets

Some of these medications may have side effects, such as: headache; 
palpitations; lightheadedness or dizziness. skin rash; swelling of the 
face or other parts of the body; dry cough; loss of taste; nausea; 
unusual tiredness; or others. Contact your doctor right away if you have 
difficulty breathing; fever or chills; or swelling of the face, mouth, 
hands, or feet.

Topical medications, such as nitro- glycerine ointment, also may be 
used.

Discuss all medications and their side effects with your doctor.

SURGERY

In rare cases, a sympathectomy may be done. This operation cuts the 
nerves that may be making the narrowing of the blood vessels worse. This 
procedure usually is not necessary and may only work for a short time.

WHAT SHOULD I DO IF I HAVE AN ATTACK?

If you have an attack, stay calm and follow these steps:

1. Gently warm your fingers or toes as soon as you can. Placing your 
hands under your armpits often helps.

2. Wiggle your fingers or toes. Move or walk around to try to keep your 
blood flowing freely.

3. When your hands start feeling cold, hold them above your head. Then 
swing them around as if you're throwing a softball.

4. Run WARM - not hot - water over your fingers or toes until their 
normal color returns. Do not use a hot water bottle or heating pad, 
because they may damage your skin.