American Medical Association Family Medical Guide - American Medical Association [635]
Doctors call the disorder Raynaud’s phenomenon when its underlying cause is known. Connective tissue diseases such as scleroderma (see page 922), systemic lupus erythematosus (see page 920), or rheumatoid arthritis (see page 918) often cause Raynaud’s phenomenon. Atherosclerosis (see page 557), a condition in which arteries are narrowed by hardened fatty deposits called plaque, also may cause the disorder. In some cases, Raynaud’s phenomenon occurs as a reaction to drugs that constrict the blood vessels, such as beta blockers (see page 562), some chemotherapy drugs used to treat cancer, and some over-the-counter cold medications and weight-control products. Regular use of vibrating equipment or machinery such as chain saws or pneumatic drills can damage the blood vessels in the hands, causing Raynaud’s phenomenon. The disorder also occurs more frequently in smokers, probably because of circulation problems.
Symptoms
The main symptoms of Raynaud’s disease are color changes in one or more of the affected fingers or toes. As the capillaries begin to constrict, the skin turns white. When blood flow is blocked, the skin turns blue. As the capillaries reopen and blood flow returns to normal, the skin turns red and then gradually returns to its normal color. The fingers or toes may throb and feel cold or numb. Some people may also experience a burning sensation. At first, episodes are infrequent and mild, but they eventually increase in frequency and severity. Prolonged episodes can result in nerve irritation, causing pain in the affected fingers or toes.
In later stages of the disorder, reduced blood flow causes the skin on the affected fingers or toes to tighten and become smooth and shiny. In some cases, small open sores form on the tips of the fingers or toes. The reduced blood supply usually damages muscles and nerves and eventually weakens the fingers and diminishes the sense of touch. When the disorder is persistent or severe, it can result in tissue death (gangrene; see page 601).
Diagnosis
A diagnosis of Raynaud’s disease is based on the characteristic symptoms, a complete health history, and a physical examination. Although diagnostic tests are usually not necessary, the doctor may examine a sample of the nailfolds (the skin at the base of the fingernails) under a microscope to look for abnormalities in the capillaries. He or she may also order blood tests to check for antibodies and to measure the extent of inflammation in the body, both of which are signs of an immune response. The doctor may recommend tests to check for specific underlying diseases or conditions.
Treatment
Treatment for Raynaud’s phenomenon depends on the underlying disease or condition. Treatment for Raynaud’s disease focuses on reducing the frequency and severity of episodes and preventing damage to the tissues of the fingers and toes. Your doctor will probably recommend the following measures to help reduce your symptoms:
• Stay warm and dry. Keep your home comfortably warm year-round. Wear a sweater to avoid becoming chilled indoors. Avoid going barefoot. Put cold beverages in insulated drinking glasses. Wear cotton gloves when handling refrigerated or frozen foods. Avoid going outdoors when the weather is cold. If you go outdoors on a cold day, put on several layers of loose clothing under your coat and wear a scarf, gloves, and warm, comfortable socks and shoes. Keep your hands and feet dry. Wear rubber gloves while washing dishes.
• Manage stress. Find positive ways to cope with or reduce stress in your life. Biofeedback or relaxation techniques (see page 59) such as deep breathing, meditation, or yoga may be helpful. It is also important to get enough sleep every day (see page 57). Try to avoid stressful situations that could