Raynaud’s phenomenon is a disorder in which the small blood vessels in the extremities are over-sensitive to changes in temperature. Usually the fingers and toes, change colour and may become painful. It is due to a narrowing (constriction) of the small blood vessels on exposure to the cold, a change in temperature, or emotional stress. In most cases, the cause is not known.
It affects between 3-20% of the adult population worldwide. While predominantly found in females, the condition can affect children, adolescents and men. Many sufferers have never seen a doctor, as they are unaware that their condition has a name, or that there is anything that can be done to help.

Symptoms
The symptoms of Raynaud’s, whether isolated (primary Raynaud’s Phenomenon) or secondary to another condition, may cause severe pain, discomfort and problems with hand function. For the vast majority of sufferers, Raynaud’s is a benign primary condition which may interfere with patients’ daily activities but does not cause any long term damage to the extremities.
During an attack, the fingers and or toes first become white, and dead looking. They may then turn blue and finally red, with burning when the blood flow is restored. There may be considerable pain, numbness or tingling. These symptoms are due to an intermittent lack of blood in the affected parts, when the arteries normally supplying them spasmodically contract. An attack will often be triggered by touching cold objects or exposure to cold of any kind. Emotions, such as anxiety, may also play a part, as can smoking.

Primary vs Secondary Raynaud’s
Anyone of any age can develop Primary Raynaud’s, which occurs spontaneously without any underlying condition being present. It can be hereditary, in which case it is usually fairly mild. Secondary Raynaud’s is less common, and is associated with underlying diseases such as scleroderma, systemic lupus erythematosus, and rheumatoid arthritis. When associated with scleroderma, patients will often suffer more acute symptoms. In severe cases they may develop persistent finger and toe ulcers and infection, which in very extreme cases may become gangrenous.

How Common is Raynaud’s?
It is common, and about 1 in 20 people develop it. Up to 9 in 10 cases are primary Raynaud’s, which usually first develops in teenagers and young adults, but can develop at any age as well. Secondary Raynaud’s can also develop at any age, in sync with the underlying condition.

Do I need any tests to confirm the diagnosis?
Not in most cases. There is no test that confirms primary Raynaud’s. The diagnosis of primary Raynaud’s is made on the basis of the typical symptoms (described above), and there is no abnormality found that may suggest a secondary cause when a doctor examines you.
Features that may suggest secondary Raynaud’s include:
• Onset of symptoms after 30 years of age.
• Abrupt onset with rapid progression and worsening of symptoms.
• Severe symptoms that may include an ulcer or gangrene of part of a finger or toe.
• Symptoms that only affect one hand or foot, or the symptoms are not the same or as severe on both hands and feet.
• Joint pains or arthritis.
• Skin rashes.
• Dry eyes or mouth.
• Muscle weakness or pain.
• Swallowing difficulties.
• Breathlessness.
• Mouth ulcers.
• Previous work with vibrating tools.
Blood tests and other tests may be done if secondary Raynaud’s is suspected. Sometimes the diagnosis of an underlying cause is already known; for example, rheumatoid arthritis and the development of Raynaud’s is not a surprising feature.

Possible Complications
• Primary Raynaud’s – complications seldom, if ever, occur.
• Secondary Raynaud’s – complications occur in a small number of cases and include ulcers developing on affected fingers and toes; scarring of tips of fingers and toes; tissue death (gangrene) of parts of affected fingers and toes.

Treatment
Many treatments are available for Raynaud’s phenomenon. However, it depends on the severity of the condition. For those with a mild condition, practical measures such as using hand warmers, thermal gloves and hats, help to alleviate symptoms. Be advised though that an even, ambient temperature is as important as keeping warm, because often it is not the absolute temperature, but a small change in the ambient environment, which precipitates an attack. Cold draughty places should therefore be avoided where possible. If the condition is severe, the GP can advise on the different types of drugs available, which include vasodilators – drugs which open up the small blood vessels. Patients often have to try several before they find one that works. Many people with Raynaud’s try natural products such as vitamins, fish oil, evening primrose oil and ginger. These simple measures seem to help some persons, and are popular as they can be purchased without prescriptions.

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