RELATED CONDITIONS: RAYNAUD’S
Raynaud’s Phenomenon is the most common early symptom of systemic scleroderma.
Pronounced “ray-NOHZ”, it is present in 95% of people with systemic scleroderma. Although most obvious in the fingers and toes, it can also involve the ears, nose, or tip of the tongue.
In Raynaud’s Phenomenon, blood vessels constrict (narrow) in response to cold, emotional upset, or stress.
Constriction decreases blood circulation, causing a series of changes in skin color. During reduced circulation, the skin will be white, blanched, or pale. As the affected area loses oxygen from decreased blood flow, the color turns blue. When blood flow returns and the area warms up, the skin becomes flushed or red. After the attack subsides and normal circulation returns, the usual skin color is restored. Tingling, numb, and cold sensations may accompany the “blue” and “white” stages. Warmth, burning, or throbbing may accompany the “red” stage. Some patients find Raynaud’s Phenomenon painful.
Those who experience Raynaud’s Phenomenon can take many common-sense measures to prevent attacks.
Minimizing exposure to cold (ex. outdoor weather, air conditioning, reaching into a refrigerator or freezer) and keeping your extremities/body warm is extremely important. Patients should wear mittens or gloves, especially when touching refrigerated or frozen items. In addition, many warming devices are available to protect the hands. Thick socks, hates, ear muffs, and warm clothing made from silk, cotton, wool, or down can help people maintain their body temperature. At home, electric heaters, comforter, and electric blankets can also be used. Keeping the entire body warm helps prevent Raynaud’s Phenomenon attacks. Although avoidance of emotional upset and stress isn’t always possible, various relaxation techniques (self-taught or learned in training courses) have proven effective for some. One example, biofeedback, has been used to increase finger temperature; however, its benefit is still unclear.
Smoking worsens Raynaud’s Phenomenon.
People with scleroderma should avoid smoking. Concurrent carpal tunnel, estrogen, and stimulants may also aggravate the condition. To make sure that you are not taking something that may worsen Raynaud’s Phenomenon, your physician should review all of your current medications.
There are non-pharmacological methods of treating Raynaud’s Phenomenon attacks.
When a Raynaud’s Phenomenon attack does occur, carefully waving the arms in an underhand, circular motion (similar to a softball pitch) may restore blood circulation. Rubbing or massaging the affected area may also work. Other possible options for relieving an attack include a warm bath/shower, heating pads, or hot water bottle on the back.
Diagnosis of Raynaud’s Phenomenon may occur through a capillaroscopy.
In a capillaroscopy, the physician assesses severity by examining the patient’s nailfolds under a microscope. The presence of Raynaud’s Phenomenon should not be proved by provocation testing (ex. placing the hands in ice water).
Physicians prescribe a variety of different medications for Raynaud’s Phenomenon.
Most of these medications work by dilating (opening up) the blood vessels. Common drugs include vasodilators such as prazosin and calcium channel blockers such as aldipine and nifedipine. Drugs that decrease the stickiness of platelets as well as mild blood thinners such as aspirin may ask improve circulation. In addition, medication for pulmonary arterial hypertension (PAH) may also help prevent and treat Raynaud’s Phenomenon attacks.
People without scleroderma can also have Raynaud’s.
This condition also appears in people with lupus, rheumatoid arthritis, and other connective tissue diseases. Many otherwise healthy people experience Raynaud’s Phenomenon without any other illness; this is called Primary Raynaud’s Disease.