What is Raynaud's Disease?

Raynaud's disease is a condition that affects the blood supply to the fingers, toes and occasionally the ears and nose. During a Raynaud's attack, the blood vessels constrict (narrow) and the blood supply to these areas is reduced. This results in several skin colour changes which are often accompanied by a throbbing or burning sensation, cold, and numbness. The exact cause of Raynaud's disease remains unknown. However, current research is coming closer to determining a probable cause.

What are the symptoms of Raynaud's Disease?

During a typical Raynaud's attack the affected area may first become white (pallor) as the blood supply is reduced, then blue (cyanosis) as the oxygen supply to the area is depleted, followed by bright red (rubor) as the blood returns to the area (reactive hyperemia). Raynaud's disease, by definition, involves three color changes. However, they do not always occur in the same order for all people all of the time nor do all three changes always occur in a given attack.

What causes a Raynaud's attack?

Raynaud's episodes can be triggered by cold, either by touching cold objects or by being in a cold environment. Emotions such as stress and anxiety may also play a role. The severity of attacks will vary from episode to episode, as well as from patient to patient. Attacks typically last a few minutes.

Who gets Raynaud's Disease?

Raynaud's disease occurs more frequently in women than in men. Although it can occur at any age it usually begins between the ages of 15 and 40. It is estimated that 4 - 5% of the population is affected.

How is Raynaud's categorized?

Raynaud's is divided into two categories:

Primary Raynaud's or Raynaud's disease, occurs when an individual has only the above mentioned colour changes along with the typical symptoms of pain or numbness. There is no other medical problem which may be causing the Raynaud's episodes.

Secondary Raynaud's or Raynaud's phenomenon, occurs when the Raynaud's episodes are secondary to another medical condition. In other words, the individual with Raynaud's has another medical condition which is causing the attacks. Or, Raynaud's is only one of the symptoms associated with the other disease. Although this form is less common than primary Raynaud's, it is a more complex and serious disorder. Some examples of other underlying diseases associated with Raynaud's are: connective tissue diseases, scleroderma, rheumatoid arthritis, lupus, vibration white finger, occlusive arterial disease, thoracic outlet syndrome, carpel tunnel syndrome.

How is Raynaud's Disease Diagnosed?

Primary Raynaud's disease is diagnosed following the Allen Brown criteria:

	At least two of the three color changes occurring during attacks which are provoked by cold and or stress.
	Episodes have been occurring periodically for at least two years.
	Attacks occurring in both hands.
	There is no other identifiable cause for the Raynaud's episodes.

Additional testing which a physician might do to help with the diagnosis:

	Antinuclear antibody blood test (usually negative in Raynaud's disease).
	Examine the nailfold capillaries which should be in a normal pattern.

What is the treatment for Raynaud's Disease?

There is no known cure for this condition, therefore, effective treatments are essential. Most cases of primary Raynaud's can be controlled with proper medical care.

What you can do:

Many people are able to find relief by simply adjusting their lifestyle. For example:

	Protect yourself from the cold.
	Avoid excessive emotional stress.
	Do not use vibrating tools.

What a doctor might do

For more severe cases that require medication, your doctor might prescribe drugs which keep your blood vessels from narrowing and help them dilate (expand), such as nifedipine, diltiazem, or nitroglycerin. Some of these medications may have side effects which you should discuss with your physician before taking.

Non-medication treatment

Biofeedback has been demonstrated to be safe and effective for some individuals. This is a technique designed to help a person gain control over involuntary body functions, such as skin temperature, heart rate, or blood pressure. Biofeedback training is necessary and several methods are available.

Surgery

In rare instances, a sympathectomy may be performed. This operation cuts the nerves that may also be affecting the blood vessels to the fingers. This procedure is usually not necessary and may only work for a short period of time.

Surgical and Other Invasive Treatment

If medical measures are not sufficient, surgery or balloon angioplasty may be advised. There are 2 major types of operations: revascularization, in which the blocked arteries are bypassed with either healthy blood vessels taken from elsewhere in the body (usually a vein in the leg) or synthetic material; or endartectomy, which involves opening portions of the diseased artery and removing the atherosclerotic deposits.

Balloon angioplasty, in which a catheter with a balloon tip is inserted into an artery and inflated to compress the fatty deposits, is most successful for people with small segments of blockage. However, the area becomes quickly reclogged in about 30 percent of all cases, requiring repeated treatment within a year or two.

Still another technique, laser ablation, which is being used experimentally in major medical centers, entails using a laser instead of a balloon to open the blocked blood vessel. The procedure is similar to balloon angioplasty; the laser catheter has a metal or fiber-optic probe at its tip. The heated probe then ablates, or removes, the fatty deposits layer by layer. Laser surgery has several advantages over conventional surgery: It is faster, entails a shorter hospital stay, and does not require inserting a bypass graft.