Raynaud's phenomenon

Published by Bupa's Health Information Team, December 2010.

This factsheet is for people who have Raynaud's phenomenon, or who would like information about it.

Raynaud's phenomenon, also known as Raynaud's disease, Raynaud's syndrome or just Raynaud's, is a condition that affects the blood supply to the fingers and toes. It's usually brought on by the cold or emotional stress.

About Raynaud's phenomenon

Raynaud's phenomenon got its name from the French doctor Maurice Raynaud who first described it in 1862. In the UK, it affects about one in six people. Most people develop Raynaud’s phenomenon before the age of 25, but you can get it at any age. It’s more common among women than men.

The symptoms of Raynaud's are usually triggered by cold temperatures or emotional stress. Sometimes, even a slight change in temperature can cause it, so staying warm is important. Touching a cold surface or putting your hand in the fridge can be enough to trigger an ‘episode’. Smoking is also thought to play a part in causing Raynaud’s.

During an episode of Raynaud’s phenomenon, your blood vessels narrow and contract quickly, reducing the blood supply to your fingers and toes. This usually causes them to turn white.

Symptoms of Raynaud's phenomenon

If you have Raynaud’s phenomenon, an episode may start with your fingers or toes becoming pale and feeling cold or numb. Your skin may then begin to turn blue and then finally red. As it turns red you may feel an aching or burning pain, or a tingling ‘pins and needles’ sensation. Your skin may also change to other colours, including purple, yellow, orange, and grey.

Raynaud’s phenomenon tends to affect the middle three fingers more than thumbs and toes. It can also affect your nose, ears, lips, tongue or nipples, but this is rare.

The symptoms of Raynaud’s phenomenon can come and go, and an episode usually only lasts a few minutes.

These symptoms may be caused by problems other than Raynaud’s phenomenon. If you have any of these symptoms, see your doctor for advice.

Complications of Raynaud's phenomenon

Complications of Raynaud’s phenomenon are uncommon.

Severe secondary Raynaud’s can cause ulcers to develop on your fingers, or even gangrene (death and decay of body tissue caused by poor blood supply), but this is rare.

Causes of Raynaud's phenomenon

For most people with Raynaud’s syndrome, there is no known cause. This is known as primary Raynaud's and affects four in five people with the disease. Primary Raynaud’s is often hereditary.

About one in five people with the condition have what is known as secondary Raynaud's phenomenon. This means it is caused by another condition or other factor. Some examples are listed below.

• Connective tissue conditions – including systemic lupus erythematosus, rheumatoid arthritis, and Sjogren’s syndrome.
  
• Conditions affecting your blood – such as leukaemia.
  
• Certain medicines – including beta-blockers, anti-migraine medication and some types of contraceptive pill.
  
• Illegal drugs – including amphetamines, commonly known as speed, and cocaine can cause episodes of Raynaud's.
  
• Exposure to vibration – including occupational use of pneumatic drills, chainsaws, or when you hold materials that are being hammered or shaken (this is known as hand-arm vibration syndrome).
  

Secondary Raynaud's tends to be more severe than primary Raynaud's phenomenon.

Diagnosis of Raynaud's phenomenon

Your GP will ask about your symptoms and examine you. He or she may ask if anyone else in your family has Raynaud’s phenomenon. If your condition is severe, your GP may refer you to a rheumatologist (a doctor who specialises in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues).

If your GP suspects you have secondary Raynaud’s, he or she may ask you to have some blood tests and give a urine sample. These will be sent to a laboratory for testing.

Treatment of Raynaud's phenomenon

The type of treatment you have will depend on whether you have primary or secondary Raynaud’s. For example, if you have primary Raynaud’s, your GP will suggest things you can do to stop triggering an attack. Or, if you have secondary Raynaud's, your GP will first try to treat any underlying causes.

Self-help

Episodes of Raynaud's phenomenon can usually be controlled by making a few changes to your lifestyle. Some examples are listed below.

• Keep your whole body warm, not just your hands and feet – in cold weather, wear woolly socks, gloves and hats, but if it’s particularly cold, stay indoors.
  
• Don't smoke – smoking is known to make the symptoms of Raynaud’s worse.
  
• Exercise regularly and keep active – regular movement and not sitting down for long periods will help to improve your blood circulation and reduce symptoms.
  
• Manage your stress – learning relaxation techniques might help if your condition is brought on by stress.

Medicines

Your GP will usually only suggest treatment with medicines if self-help measures aren’t controlling your symptoms, or if your condition is seriously affecting your work or social life. Your GP will usually prescribe a medicine known as a calcium-channel blocker (eg nifedipine). It works by relaxing the muscles in your blood vessels so that more blood can reach your fingers and toes.

Other types of medicines are sometimes used to treat Raynaud's phenomenon if nifedipine isn't helping, or if there is some reason why you can't take it. Some examples are listed below.

• Angiotensin-receptor blockers (eg losartan). These may be useful if you have primary Raynaud’s phenomenon and scleroderma.
  
• Peripheral vasodilators (eg inositol nicotinate). These dilate blood vessels and are sometimes used for treating Raynaud's.
  
• Selective serotonin reuptake inhibitors (eg fluoxetine) may be used if other medicines haven’t worked.

If you have secondary Raynaud’s, your doctor may give you some glyceryl trinitrate patches to use if you have an episode that comes on suddenly.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Hospital treatment

If you have a very severe episode of Raynaud’s phenomenon, you may be admitted to hospital where you will be given medicines to help increase the blood supply to your fingers. This will help prevent any blood clots forming.

Surgery

Your doctor will usually only suggest surgery if your condition is very serious.

Surgery for Raynaud’s involves cutting the nerves that cause blood vessel narrowing in the part of your body that is affected. For example, you may have a procedure known as a digital sympathectomy to cut one of the nerves in your fingers if one of your fingers is severely affected.

If your legs or feet are severely affected, you may be able to have an operation known as a lumbar sympathectomy. This involves cutting nerves in your back that control blood vessel narrowing in your legs.

Counselling

Your GP may recommend a type of counselling called cognitive behavioural therapy (CBT) for stress if your Raynaud's is triggered by anxiety.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.