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DESCRIPTION
Raynaud's can occur as a primary or secondary condition. As a primary condition, it is not associated with any other disease and is often referred to as Raynaud's disease. If Raynaud's symptoms are associated with another health condition, it is referred to as Raynaud's Phenomenon. Primary Raynaud's is more common than secondary Raynaud's and usually less severe.
RAYNAUD'S DISEASE
Raynaud's disease is a vascular disorder that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. It was named after Maurice Raynaud (1834-1881), a French physician who first described it in 1862. Raynaud's disease is a disorder in which the blood vessels to the fingers and toes (digits) become abnormally closed off (constricted). The fingers and toes of individuals with Raynaud's disease change color from white to blue to red, often causing them to feel numb. Raynaud's disease is sometimes seen with autoimmune diseases, such as rheumatoid arthritis, scleroderma, and lupus, where the body's immune system turns against itself, causing various symptoms. Other causes of Raynaud's disease include repeated trauma/vibration, abnormalities in the structure of blood vessels, and drug injection into one type of blood vessel (arteries).
RAYNAUD'S PHENOMENON
Raynaud's phenomenon (RP), in medicine, is an arthritis-related, vasospastic circulatory disorder causing discoloration of the hands, fingers, feet, toes, and occasionally other extremities. RP is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. Emotional stress and cold are classic triggers of the phenomenon, and the discoloration follows a characteristic pattern in time: white, blue and red.
The hands, and sometimes the feet are hypersensitive to cold temperatures. When the skin is exposed to cold, discoloration occurs because an abnormal spasm of the blood vessels (the small arteries) that supply the fingers and toes with oxygenated blood. This spasming causes the blood vessels to become abnormally closed off (constrict) resulting in a diminished oxygenated blood supply to the local tissues and a noticeable color change in the affected tissues.
Initially, the digit(s) involved turn white because of the diminished blood supply. The digit(s) then turn blue because of prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local "flushing" phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), most often upon exposure to cold temperature, is characteristic of RP. This condition can also cause nails to become brittle with longitudinal ridges.
Raynaud's phenomenon most frequently affects women, especially in the second, third, or fourth decades of life. People can have Raynaud's phenomenon alone or as a part of other rheumatic diseases. When it occurs alone, it is referred to as "Raynaud's disease" or primary Raynaud's phenomenon. When it accompanies other diseases, it is called secondary Raynaud's phenomenon.
RP comprises both Raynaud's disease (primary Raynaud's), where the phenomenon is idiopathic, and Raynaud's syndrome (secondary Raynaud's), where it is caused by some other instigating factor. Measurement of hand-temperature gradients is one tool used to distinguish between the primary and secondary forms. It is possible for the primary form to progress to the secondary form.
The condition causes painful, pale, cold extremities. This can often be distressing to those who are not diagnosed, and sometimes it can be obstructive. If someone with Raynaud's is placed in too cold a climate, it could potentially become dangerous.
Unilateral Raynaud's, or that which is present only in the hands or feet, is almost certainly secondary, as primary Raynaud's is a systemic condition. However, a patient's feet may be affected without him or her realizing it. In pregnancy, this sign normally disappears due to increased surface blood flow.
Over time, the condition may result in a general shrinkage of the affected area. Ultimately, ulcers may form, damaging the tissues and resulting in chronic infection under and around the fingernails and toenails. In severe cases, gangrene may result from prolonged and persistent contraction of the arteries.
ABOUT GANGRENE
Gangrene is a condition in which body tissues die, and ultimately decay, as a result of inadequate oxygen supply. It can affect any body part, but most frequently affects extremities such as the toes, feet, fingers, hands, and arms. Gangrene of the internal organs is especially dangerous.
MoonDragon's Health & Wellness: Gangrene
FREQUENT SIGNS & SYMPTOMS
Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood-vessel spasm. Most patients with mild disease only notice skin discoloration upon cold exposure.
The vasospasm which occurs during a Raynaud's attack usually lasts 15 minutes but can range from just one minute to several hours. Pain, swelling, tingling, throbbing, numbness, and discoloration can all occur in the affected area. Fingers and toes are the most common site of Raynaud's phenomenon. In Raynaud's disease (primary), both hands and both feet are commonly affected. Besides fingers and toes, Raynaud's can affect the ears, nose, lips, knees, and nipples.
DISCOLORATION
Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. The symptoms include several cyclic color changes:
- When exposed to cold temperatures, the blood supply to the fingertips, toes, nose, and earlobes of Raynaud's disease patients is reduced and the skin turns pale or white (called pallor) and becomes cold and numb.
- When the oxygen supply is depleted, the skin color turns blue (called cyanosis).
- These events are episodic and when the episode subsides, or the area is warmed, blood returns to the area and the skin color turns red (rubor) and then back to normal, often accompanied by swelling and tingling.
These symptoms are thought to be due to reactive hyperemias of the areas deprived of blood flow. All three color changes are present in classic Raynaud's disease. However, some patients do not see all of the color changes in all outbreaks of this condition.
Figure A shows the normal digital arteries with normal blood flow to the fingers. The inset images show cross-sections of a normal artery.
Figure B shows white discoloration of the fingertips caused by blocked blood flow.
Figure C shows narrowed digital arteries, causing blocked blood flow and purple discoloration of the fingertips. The inset images show cross-sections of a narrowed artery blocking the flow of blood.
OTHER SYMPTOMS & COMPLICATIONS
Symptoms of RP depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration upon cold exposure. They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal. When the blood-vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen and can cause pain in the involved digit(s). Rarely, poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Severe Raynaud's disease can result in skin ulcers. This complication is more common in people who have both scleroderma and Raynaud's disease. Ulcerated digits can become infected. With continued lack of oxygen, gangrene of the digits can occur.
Less common areas of the body that can be affected by RP include the nose, ears, and tongue. While these areas rarely develop ulcers, they can be associated with a sensation of numbness and pain.
People with Raynaud's disease may have more noticeable small blood vessels (capillaries) into their fingers and toes where the nail plate meets the skin of the finger (proximal nail fold), particularly in people who also have an autoimmune disease.
Patients with secondary RP can also have symptoms related to their underlying diseases. RP is the initial symptom of 70 percent of patients with scleroderma, a skin and joint disease. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.
It is normal for the body to keep its vital inner organs warm by limiting blood flow to the arms, legs, fingers, and toes. The body naturally does this in response to a long period of cold. This response can cause frostbite. In people with Raynaud's, the response to cold is quicker and stronger. The response can be triggered by mild or short-lived changes in temperature, such as:
- Taking something out of the freezer.
- Temperatures that dip below 60°F.
- In people with Raynaud's, blood flow is more strongly reduced in response to cold temperatures than in people without the disorder. When Raynaud's is severe (which is uncommon), exposure to cold for as little as 20 minutes can cause major tissue damage.
The blood vessels of people with Raynaud's also physically overreact to stressful emotions. It is normal during times of psychological stress for the body to release hormones that narrow its blood vessels. But for people with Raynaud's, this squeezing of blood vessels is stronger. This results in less blood reaching fingers, toes, and sometimes other extremities.
Attacks usually last about 15 minutes. They can last less than a minute or as long as several hours. Attacks can occur daily or weekly. Sometimes attacks affect only one or two fingers or toes. Different areas may be affected at different times. Attacks can cause sores or tissue death (gangrene) in people with severe secondary Raynaud's. However, severe Raynaud's is very uncommon.
CAUSES
The causes of primary and secondary Raynaud's phenomenon is unknown and is not completely understood, although abnormal nerve control of blood-vessel diameter causing constriction of blood vessels and nerve sensitivity to cold and excessive stress are suspected of being involved and as being contributing factors. Some researchers are also studying if genetics is related to Raynaud's phenomenon. When no cause can be found, the disorder is called primary Raynaud's. When a cause can be found, the disorder is called secondary Raynaud's.
Raynaud's phenomenon occurs because of vasospasm of blood vessels temporarily limiting blood flow to affected tissues. The characteristic color changes of the digits are in part related to initial blood-vessel narrowing due to spasm of the tiny muscles in the wall of the vessels, followed by sudden opening (dilation), as described above. The small arteries of the digits can have microscopic thickness of their inner lining, which also leads to abnormal narrowing of the blood vessels.
CONDITIONS ASSOCIATED WITH RAYNAUD'S PHENOMENON
Secondary Raynaud's phenomenon has been linked to many different medical or workplace conditions such as:
- Diseases that damage blood vessels or the nerves that control the function of blood vessels in the hands and feet.
- Repetitive actions that damage the nerves that control blood vessels in the hands and feet.
- Exposure to certain chemicals.
- Use of medicines that narrow blood vessels or affect blood pressure.
Conditions and factors which cause secondary Raynaud's phenomenon include:
- Scleroderma. About 9 out of 10 people with scleroderma have Raynaud's.
- Rheumatoid arthritis.
- Systemic lupus erythematosus. About 1 out of 3 people with lupus have Raynaud's.
- Hypothyroidism hormone imbalance and thyroid problems.
- Carcinoid. Carcinoid tumors are non-cancerous (benign) or cancerous (malignant) growths that sometimes produce excessive amounts of hormone-like substances, resulting in the carcinoid syndrome.
- Rarely with cancers.
- Sjogren's syndrome.
- Atherosclerosis.
- Pulmonary hypertension (high blood pressure in the arteries of the lungs.
- Mixed connective tissue disease.
- Dermatomyositis.
- Polymyositis.
- Buerger's disease.
- Tissue trauma from frostbite or injury to hands or feet from surgery or other causes.
- Repetitive stress and actions, such as using vibrating tools, typing or playing the piano for long periods of time.
- Exposure to certain chemicals at work can cause a scleroderma-like illness that is linked to Raynaud's.
- Smoking. Nicotine in cigarette smoke also can make you more prone to developing Raynaud's.
Several medicines are linked to secondary Raynaud's, including:
- Migraine headache medicines that contain ergotamine.
- Beta blockers used for blood pressure problems, such as propranolo (Inderal). Propranolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). Propranolol is used to treat tremors, angina (chest pain) and hypertension (high blood pressure).
- Estrogens without additional progesterone.
- Certain cancer medications, such as bleomycin (Bleoxane) used in cancer treatment.
- Some over-the-counter (OTC) cold or allergy remedies.
PREVALENCE OF RAYNAUD'S PHENOMENON
The National Institute of Arthritis and Musculoskeletal and Skin Conditions estimates that 5 to 10 percent of the United States population is affected by Raynaud's phenomenon. Seventy-five percent of primary Raynaud's cases involve women 15 to 40 years old. 85 to 95 percent of people with scleroderma or MCTD also have Raynaud's phenomenon. One third of lupus patients have Raynaud's symptoms.
POINTS OF INTEREST ABOUT RAYNAUD'S PHENOMENON
- Keeping warm is the key to managing Raynaud's phenomenon, even if that means wearing gloves when you are inside the house.
- Running warm water over affected cold areas can offer relief.
- Remaining calm is essential.
- Raynaud's can begin at any age.
DISEASE VS PHENOMENON
It is important to distinguish Raynaud's disease from Raynaud's phenomenon. In order to diagnose these two forms of Raynaud, your health care provider may look for signs of arthritis or vasculitis and conduct a number of laboratory tests. See more about diagnosis under the Treatment section below.
Primary Raynaud's (Disease): Raynaud's disease (or "Primary Raynaud's") is diagnosed if the symptoms occur only by themselves and are not accompanied by other diseases. Primary Raynaud's often develops in young women in their teens and young adulthood. This form of Raynaud's is thought to be at least partly hereditary, although specific genes have not yet been identified. Some refer to Primary Raynaud's disease as being allergic to the cold.
Secondary Raynaud's (Phenomenon): Raynaud's phenomenon (or "Secondary Raynaud's") occurs secondary to many different causes:
- The most common causes are connective tissue disorders such as systemic lupus erythematosus, scleroderma/systemic sclerosis/CREST syndrome, arthritis and many others.
- Other disorders that can be causes include carpal tunnel syndrome and obstructive arterial disease.
- Medications that can be causes include beta-blockers and ergotamine.
- In contrast to the disease form, this form of Raynaud can progress to necrosis or gangrene of the fingertips.
- Patients with secondary RP can also have symptoms related to their underlying diseases. RP is the initial symptom of 70 percent of patients with scleroderma, a skin and joint disease. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.
RISKS
About 3 out of 4 cases of primary Raynaud's occur in younger to middle-aged women between the ages of 15 and 40 years, although the reason is unknown. When it affects men, it is usually seen in middle age or later in life. A Framingham study found the incidence in men was 5.8 percent and 9.6 percent of women suffered from it.
Raynaud's disease is seen in 20 percent of people with lupus.
People in colder climates are also more likely to develop Raynaud's than people in warmer areas.
There is a familial component to primary Raynaud's, and presentation is typically before two.
Smoking worsens frequency and intensity of attacks.
There is also a hormonal component associated with RP.
Sufferers are more likely to have migraine and angina than controls.
Secondary Raynaud's has a number of associations:
- Connective Tissue Disorders
- Scleroderma.
- Systemic lupus erythematosus.
- Rheumatoid arthritis.
- Sjogren's syndrome.
- Dermatomyositis.
- Polymyositis.
- Eating Disorders
- Anorexia nervosa.
- Obstructive Disorders
- Atherosclerosis.
- Buerger's disease.
- Subclavian aneurysms.
- Thoracic outlet syndrome.
- Drugs
- Beta-blockers.
- Cytotoxic drugs - particularly chemotherapeutics and most especially bleomycin.
- Cyclosporin.
- Ergotamine.
- Sulfasalazine.
- Occupation
- Jobs involving vibration, particularly drilling.
- Exposure to vinyl chloride, mercury.
- Exposure to the cold (e.g. by working packing frozen food).
- Others
- Hypothyroidism.
- Cryoglobulinemia.
- Malignancy.
- Reflex sympathetic dystrophy.
It is important to realize that Raynaud's can herald these diseases by periods of more than 20 years in some cases, making it effectively their first presenting symptom. This can be the case in the CREST syndrome, of which Raynaud's is a part.
PREVENTION
Patients with Raynaud's disease are advised to keep warm by wearing gloves and socks. They should also avoid stress, medicines that can constrict blood vessels such as decongestants and touching cold objects. Patients are also advised to avoid foods and activities that may constrict blood vessels such as drinking caffeinated drinks and smoking. Avoiding artificially cold environments, such as refrigerated or highly air conditioned spaces, can also help prevent episodes from occurring.
DIAGNOSIS & TREATMENT
PATHOPHYSIOLOGY
Raynaud disease is an exaggeration of vasomotor responses to cold or emotional stress. More specifically, it is a hyperactivation of the sympathetic system causing extreme vasoconstriction of the peripheral blood vessels, leading to tissue hypoxia. Chronic, recurrent cases of Raynaud phenomenon can result in atrophy of the skin, subcutaneous tissues, and muscle. It can also rarely cause ulceration and ischemic gangrene.
DIAGNOSIS
Health care providers use the patient's history of symptoms, a physical exam, and diagnostic tests to rule out other conditions that might act like Raynaud's. A careful patient history will often reveal whether the condition is primary or secondary. Once this has been established, investigations are largely to identify or exclude possible secondary causes.
A physical examination by your health care provider will look for physical symptoms related to Raynaud's phenomenon such as blueness or pallor to the skin and skin ulcers.
COLD STIMULATION TEST
To help diagnose Raynaud's, a health care provider may do a cold simulation test. In patients with the characteristic sequence of skin-color changes of the digits upon cold exposure, diagnosing RP is not difficult. This test can trigger an attack that is typical of the disorder. They also may do tests for inflammatory disorders that damage blood vessels or nerves. Having these conditions along with Raynaud's symptoms makes it more likely that a patient has secondary Raynaud's disease.
In the cold simulation test, temperature sensors are taped to the fingers of the hand. The hand is then briefly exposed to the cold, usually by dunking it in ice water. If the patient likely has Raynaud's, it will take more than the normal time for the finger temperature to return to what it was at the start of the test.Digital Artery Pressure: Pressures are measured in the digital arteries before and after cooling the hands. A drop of 15mmHg or more is diagnostic.
NAILFOLD CAPILLAROSCOPY
Doppler Ultrasound: A doppler ultrasound may be used to assess flow.
Health care providers also may do a test called a nailfold capillaroscopy. Sometimes, certain patterns in the tiny blood vessels (capillaries) adjacent to the fingernails of patients with RP can be seen using a magnifying viewing instrument. Abnormal nail-fold capillary patterns can suggest the possibility of an associated rheumatic condition. For this test, the practitioner puts a drop of oil on the skin at the base of the fingernail and then looks at it under a microscope. If the practitioner sees abnormal looking blood vessels, this suggests an inflammatory disorder such as scleroderma.
BLOOD TESTS
There is, however, no single blood test to help the health care provider to confirm the diagnosis. The practitioner can order certain blood tests (for example, sedimentation rate, rheumatoid factor, antinuclear antibody, thyroid hormone levels, and protein levels) to exclude associated rheumatic diseases and thyroid disorders. Typically patients with Raynaud's phenomenon that is a manifestation of a rheumatic disease have elevated blood sedimentation rates and antinuclear antibodies. Furthermore, capillary nail fold abnormalities can frequently be found as described above.Complete Blood Count (CBC): This test can reveal a normocytic anemia suggesting the anemia of chronic disease or renal failure.
Urea & Electrolytes: This test can reveal renal impairment.
Thyroid Function Tests: This can reveal hypothyroidism.
Erythrocyte Sedimentation Rate (Sedrate or ESR), C-Reactive Protein (CRP) & Antinuclear Antibody Test (ANA): These routinely used tests looks for antibodies for rheumatoid factor and may reveal causative illness or a generalized inflammatory process or to rule out other arthritis-related conditions.
ESR & CRP TESTS
The ESR is an easy, inexpensive, non-specific test that has been used for many years to help diagnose conditions associated with acute and chronic inflammation, including infections, cancers, and autoimmune diseases. ESR is said to be non-specific because increases do not tell the practitioner exactly where the inflammation is in your body or what is causing it, and also because it can be affected by other conditions besides inflammation. For this reason, ESR is typically used in conjunction with other tests.
ESR is helpful in diagnosing two specific inflammatory diseases, temporal arteritis and polymyalgia rheumatica. A high ESR is one of the main test results used to support the diagnosis. It is also used to monitor disease activity and response to therapy in both of these diseases.
A health care provider usually orders an ESR test (along with others) to evaluate a patient who has symptoms that suggest polymyalgia rheumatica or temporal arteritis, such as headaches, neck or shoulder pain, pelvic pain, anemia, unexplained weight loss, and joint stiffness. There are many other conditions that can result in a temporary or sustained elevation in the ESR.
Since ESR is a non-specific marker of inflammation and is affected by other factors, the results must be used along with the health care provider's other clinical findings, the patient's health history, and results from other appropriate laboratory tests. If the ESR and clinical findings match, the practitioner may be able to confirm or rule out a suspected diagnosis. A single elevated ESR, without any symptoms of a specific disease, will usually not give the health care provider enough information to make a medical decision.
Before doing an extensive workup looking for disease, a health care provider may want to repeat the ESR test after a period of several weeks or months. If a health care provider already knows the patient has a disease like temporal arteritis (where changes in the ESR mirror those in the disease process), she may order the ESR at regular intervals to assist in monitoring the course of the disease. In the case of Hodgkin's disease, for example, a sustained elevation in ESR may be a predictor of an early relapse following chemotherapy.
ESR Test Results - A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. It is strongly recommended that you discuss your test results with your health care provider. Health care providers do not base their decisions solely on ESR results. You can have a normal result and still have a problem. Moderately elevated ESR occurs with inflammation, but also with anemia, infection, pregnancy, and old age. A very high ESR usually has an obvious cause, such as a marked increase in globulins that can be due to a severe infection. The practitioner will use other follow-up tests, such as cultures, depending on the patient's symptoms. Persons with multiple myeloma or Waldenstrom's macroglobulinemia (tumors that make large amounts of immunoglobulins) typically have very high ESRs even if they do not have inflammation. As noted before, polymyalgia rheumatica and temporal arteritis may also have very high ESRs. A rising ESR can mean an increase in inflammation or a poor response to a therapy; a decreasing ESR can mean a good response. Although a low ESR is not usually important, it can be seen with polycythemia, with extreme leukocytosis, and with some protein abnormalities. Some changes in red cell shape (such as sickle cells in sickle cell anemia) also lower the ESR.
ESR and C-reactive protein (CRP) are both markers of inflammation. Generally, ESR does not change as rapidly as does CRP, either at the start of inflammation or as it goes away. CRP is not affected by as many other factors as is ESR, making it a better marker of inflammation. However, because ESR is an easily performed test, many health care providers still use ESR as an initial test when they think a patient has inflammation.
If the ESR is elevated, it is typically a result of globulins or fibrinogens. Your health care provider may then order a fibrinogen level (a clotting protein that is another marker of inflammation) and a serum protein electrophoresis to determine which of these (or both) is causing the elevated ESR. Females tend to have higher ESR, and menstruation and pregnancy can cause temporary elevations.
In a pediatric setting, the ESR test is used for the diagnosis and monitoring of children with rheumatoid arthritis or Kawasaki's Disease.
Drugs such as dextran, methyldopa (Aldomet), oral contraceptives, penicillamine procainamide, theophylline, and vitamin A can increase ESR, while aspirin, cortisone, and quinine may decrease it.
ANA TEST
The ANA test is ordered to help screen for autoimmune disorders and is most often used as one of the tests to diagnose systemic lupus erythematosus (SLE). Depending on the patient's symptoms and the suspected diagnosis, ANA may be ordered along with one or more other autoantibody tests. Other laboratory tests associated with presence of inflammation, such as erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) may also be ordered. ANA may be followed by additional tests that are considered subsets of the general ANA test and that are used in conjunction with the patient's clinical history to help rule out a diagnosis of other autoimmune disorders.
The ANA test is ordered when a patient shows signs and symptoms that are associated with SLE or another autoimmune disorder. It may also be ordered when a patient has been diagnosed with an autoimmune disorder and the health care provider suspects that the patient may have developed an additional autoimmune disorder. Patients with autoimmune disorders can have a wide variety of symptoms such as low-grade fever, joint pain, fatigue, and/or unexplained rashes that may change over time.
ANA Test Results - ANA tests are performed using different assays (indirect immunofluorescence microscopy or by enzyme-linked immunoabsorbant assay - ELISA) and results are reported as a titer with a particular type of immunofluroscence pattern (when positive). Low-level titers are considered negative, while increased titers, such as 1:320, are positive and indicate an elevated concentration of antinuclear antibodies. ANA shows up on indirect immunofluorescence as fluorescent patterns in cells that are fixed to a slide that is evaluated under a microscope. Different patterns are associated with a variety of autoimmune disorders. Some of the more common patterns include:
- Homogenous (Diffuse): Associated with SLE and mixed connective tissue disease.
- Speckled: Associated with SLE, Sjogren's syndrome, scleroderma, polymyositis, rheumatoid arthritis, and mixed connective tissue disease.
- Nucleolar: Associated with scleroderma and polymyositis.
- Outline Pattern (Peripheral): Associated with SLE.
An example of a positive result might be: "Positive at 1:320 dilution with a homogenous pattern." A positive ANA test result may suggest an autoimmune disease, but further specific testing is required to assist in making a final diagnosis. ANA test results can be positive in people without any known autoimmune disease. While this is not common, the frequency of a false positive ANA result increases as people get older. Also, ANA may become positive before signs and symptoms of an autoimmune disease develop, so it may take time to tell the meaning of a positive ANA in a person who does not have symptoms. Most positive ANA results do not have significance, so health care providers should reassure their patients but should also still be vigilant for development of signs and symptoms that might suggest an autoimmune disease. About 95 percent of SLE patients have a positive ANA test result. If a patient also has symptoms of SLE, such as arthritis, a rash, and autoimmune thrombocytopenia, then he probably has SLE. In cases such as these, a positive ANA result can be useful to support SLE diagnosis. Two subset tests for specific types of autoantibodies, such as anti-dsDNA and anti-SM, may be ordered to help confirm that the condition is SLE.
A positive ANA can also mean that the patient has drug-induced lupus. This condition is associated with the development of autoantibodies to histones, which are water soluble proteins rich in the amino acids lysine and arginine. An anti-histone test may be ordered to support the diagnosis of drug-induced lupus.
Other conditions in which a positive ANA test result may be seen include:
- Sjogren's Syndrome: Between 40-70 percent of patients with this condition have a positive ANA test result. While this finding supports the diagnosis, a negative result does not rule it out. The health care provider may want to test for two subsets of ANA: Anti-SS-A (Ro) and Anti-SS-B (La). The frequency of autoantibodies to SSA in patients with Sjogren's can be 90 percent or greater.
- Scleroderma: About 60-90 percent of patients with scleroderma have a positive ANA finding. In patients who may have this condition, ANA subset tests can help distinguished two forms of the disease, limited versus diffuse. The diffuse form is more severe. Limited disease is most closely associated with the anticentromere pattern of ANA staining (and the anticentromere test), while the diffuse form is associated with autoantibodies to the anti-Scl-70.
- A positive result on the ANA also may show up in patients with Raynaud's disease, rheumatoid arthritis, dermatomyositis, mixed connective tissue disease, and other autoimmune conditions.
A practitioner must rely on test results, clinical symptoms, and the patient's history for diagnosis. Because symptoms may come and go, it may take months or years to show a pattern that might suggest SLE or any of the other autoimmune diseases. A negative ANA result makes SLE an unlikely diagnosis. It usually is not necessary to immediately repeat a negative ANA test; however, due to the episodic nature of autoimmune diseases, it may be worthwhile to repeat the ANA test at a future date. Aside from rare cases, further autoantibody (subset) testing is not necessary if a patient has a negative ANA result.
Some drugs and infections as well as other conditions mentioned above can give a false positive result for the ANA test. About 3-5 percent of Caucasians may be positive for ANA and it may reach as high as 10-37 percent in healthy individuals over the age of 65. Some medications may bring on a condition that includes SLE symptoms, called drug-induced lupus. When the drugs are stopped, the symptoms usually go away. Although many medications have been reported to cause drug-induced lupus, those most closely associated with this syndrome include hydralazine, isoniazid, procainamide, and several anticonvulsants.
OTHER TESTS
The health care provider can also perform certain maneuvers with the patient's extremities to exclude pinched blood vessels that can produce symptoms that mimic RP, such as in thoracic outlet syndrome.
Specialists may be called in for consultation on your case. A rheumatologist is a health care practitioner who specializes in treating disorders of the joints, bones, and muscles. Often, a rheumatologist diagnoses and treats patients with Raynaud's, but internists and family practice practitioners also are able to diagnose and treat Raynaud's.
CONVENTIONAL MEDICAL TREATMENT
There is no cure for primary or secondary Raynaud's, but many measures can reduce the number or intensity of attacks. Conventional medical treatment of Raynaud's phenomenon is focused on prevention - preventing future Raynaud's attacks and preventing permanent tissue damage. Treatment of Raynaud's phenomenon involves protection of the digits, medications, and life style changes such as avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands. Treatment can include:
- Keeping warm and protecting against exposure to cold.
- Stress management.
- Relaxation techniques.
- Stop smoking, if you are a smoker.
- Exercise to increase circulation.
- Treatment for the disease or condition that may help cause secondary Raynaud's.
- Surgery for tissue damage that some people with secondary Raynaud's develop, but rarely needed.
MEDICATIONS & DRUG THERAPY
Medications used to treat Raynaud's symptoms include calcium channel blockers, catecholamine deceptors, vasodilators, and smooth muscle relaxers. Most of the medicines used to treat people with Raynaud's are given to improve blood flow to the extremities.
Patients with persistent or bothersome symptoms may be helped by taking oral medications that open (dilate) blood vessels. Drug treatment is normally with a calcium channel blocker (calcium antagonists), frequently nifedipine to prevent arterioconstriction and to treat hypertension. Like all drugs, this can have side effects. It has the usual common side effects of headache, flushing, and ankle edema; but normally result in not needing to stop the drug. Calcium channel-blockers help limit the number and severity of attacks in about 2 out of 3 patients with Raynaud's. These medicines include calcium channel-blockers, such as:
- Nifedipine (Procardia, Adalat, Procardia).
- Nicardipine (Cardene).
- Amlodipine (Norvasc).
- Diltiazem (Cardizem, Dilacor).
- Felodipine (Plendil).
- Isradipine (Dynacirc, Prescal).
Angiotensin II receptor antagonists used in blood pressure treatment (often Losartan) and others, such as methyldopa (Aldomet) and prazocin (Minipress) may be used in treatment of Raynaud's to reduce the frequency and severity of attacks, possibly better than nifedipine. Recent research and evidence has shown that the blood-pressure drug losartan (Cozaar, Hyzaar) can reduce the severity of episodes of RP possibly more than nifedipine.
Alpha-1 adrenergic blockers such as prazosin (Minipress, Vasoflex, Hypovase) can be used to control Raynaud's vasospasms under supervision of a health care provider. In a study published in the November 8, 2005 issue of Circulation, sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilatory therapy. The authors, led by Dr Roland Fries (Gotthard-Schettler-Klinik, Bad Schönborn, Germany), report: "In the present study, capillary blood flow was severely impaired and sometimes hardly detectable in patients with Raynaud's phenomenon. Sildenafil led to a more than 400 percent increase of flow velocity."
Medications that "thin" the blood, such as low doses of aspirin or dipyridamole (Persantine), are sometimes helpful.
Some patients with persistent symptoms can benefit by adding a medication called pentoxifylline (Trental) which makes the red blood cells more pliable, thereby improving circulation.
Oral medications may be prescribed, such as epoprostenol (a prostaglandin) or a drug that affects the nerves (selective serotonin reuptake inhibitor), such as fluoxetine. Fluoxetine, a selective serotonin reuptake inhibitor and antidepressant medication, may reduce the frequency and severity of episodes.
Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the tips of the digits should be monitored closely by the doctor. These can become infected. Gently applied finger splints are used to protect ulcerated areas. Skin creams or ointments that open the blood vessels are sometimes used on the sides of severely affected digits to allow increased blood supply and help heal skin sores. Topical nitroglycerin paste, which helps to dilate blood vessels, may be used as needed to treat or prevent active Raynaud's disease. Apply the paste carefully as it can lead to low blood pressure (hypotension) if used on large areas.
LIFESTYLE CHANGES
Patients with Raynaud's phenomenon who have no symptoms other than the color changes of extremities may require only measures to prevent complications. Prevention measures are important in primary and secondary RP regardless of the severity. Most of the lifestyle changes that help people with Raynaud's aim to avoid the triggers of attacks. These triggers include cold, emotional stress, and certain medicines, chemicals, or actions.
To protect the body from cold, people can:
- Wear a hat, gloves, scarf, and a coat with snug cuffs during cold weather.
- Wear gloves or mittens when taking food out of the refrigerator or freezer.
- Turn down air conditioning, or dress warmly while in an air conditioned space.
- Warm up the car before driving in cold weather.
To avoid emotional triggers, people can steer clear of stressful situations if possible. Relaxation techniques also can be helpful under stress.
To avoid workplace or recreational triggers, people can:
- Limit use of vibrating tools.
- Wear proper protective gear if they work with industrial chemicals.
- Limit frequent and repeated actions of the hands, such as typing or playing the piano.
A number of medicines can trigger attacks. See the provided links for other treatment options besides using attack triggering drugs for a health problem. People with Raynaud's should avoid:
- Medications that can aggravate symptoms of RP by leading to increased blood-vessel spasm (narrowing the blood vessels) include over-the-counter cold, allergy and weight-control preparations, such as pseudoephedrine (Actifed, Chlor-Trimeton, Cotylenol, and Sudafed).
- Beta blockers, medicines used for high blood pressure and heart disease, can also worsen RP. These include atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), and propranolol.
- Birth control pills, which affect blood flow. Discuss with your health care provider other contraception options you may have available that do not use hormones to prevent pregnancy.
- Headache medicines that contain ergotamine (often used to treat migraines).
Mild cases of Raynaud's can be addressed by biofeedback or a technique to help control involuntary body functions such as skin temperature and help to decrease the severity and frequency of RP in some patients.
Other helpful lifestyle changes for people with Raynaud's are those that boost blood flow in the body. These include exercising regularly and quitting smoking. Direct and indirect (passive) smoking should be avoided by patients with RP. The chemicals in tobacco smoke can cause blood-vessel constriction and lead to atherosclerosis (hardening of the arteries), which can further impair oxygen supply to the extremities.
When attacks do occur, people with Raynaud's can take several steps to limit the length and strength of the attacks. These steps include:
- Simple initial care involves keeping the body warm, especially the extremities. Warm clothing in colder environments is essential.
- Cotton gloves can be helpful while searching the freezer.
- Room temperatures should not be too cool.
- Rubber gloves protect the hands and prevent cooling while washing dishes.
- Barefoot walking should be minimized.
- Compression of the blood vessels by tight-fitting wrist bands, rings, or footwear should be avoided.
- Moving to a warmer spot, such as indoors during cold weather or relocating to a warmer climate.
- Warming the hands or feet. Hands can be placed under the armpits, and feet or hands can be soaked in warm water. Heatbands and hand warmers may be used on the wrists to warm the blood flowing to the hands.
- Wiggling or massaging the fingers and toes.
- Moving the arms in circles or shaking arms or feet.
- Relaxing and getting out of or removing yourself from stressful situations that trigger the attacks.
Those with RP should guard their hands and feet from direct trauma and wounds. Any wounds or infections should be treated early to prevent more serious infections. Anyone with Raynaud's who develops sores on their fingers or toes or elsewhere on their body should see a health care provider right away to prevent tissue loss.
SURGICAL INTERVENTION
More serious cases require medical intervention due to the risks of gangrene and possible digital amputation. Microvascular surgery of the affected areas is a possible therapy.
The rare patient who develops sores or tissue death (gangrene) needs more aggressive treatment. Such treatment includes antibiotics and surgery to cut out damaged tissue. People with severe, worsening Raynaud's may have surgery or shots to block the action of nerves in the hands and feet that control blood flow in the skin. This surgery often gets rid of symptoms for 1-2 years. Patients may need shots more than once.
Severe cases of Raynaud's phenomenon can lead to gangrene and the loss of digits. In rare cases of severe disease, nerve surgery called "sympathectomy" is sometimes considered. In this procedure, to prevent blood-vessel spasm, the nerves that signal (stimulate) the constriction of the blood vessels (sympathetic nerves) are surgically interrupted (surgically cut). Usually, this is performed during an operation that is localized to the sides of the base of the fingers at the hand. Through small incisions the tiny nerves around the blood vessels are stripped away. This procedure is referred to as a digital sympathectomy.
In intractable cases, sympathectomy and infusions of prostaglandins, e.g. prostacyclin, may be tried, with amputation in exceptionally severe cases.
RESEARCH
Researchers have reported finding a substantial genetic (inherited) contribution both to the symptoms of Raynaud's phenomenon and to the associated blood-vessel changes of patients with Raynaud's phenomenon.
Other researchers are studying nitric oxide and its potential relationship to Raynaud's phenomenon. A gel is being studied which might promote local production of nitric oxide in involved digits. The local nitric oxide, it seems, may open the blood vessels and improve the impaired circulation.
LIVING WITH RAYNAUD'S DISEASE
Primary and secondary Raynaud's are conditions that may be lifelong. Most people with primary Raynaud's respond to simple lifestyle changes or medicines. Such treatment is not always as successful in secondary Raynaud's. If you have secondary Raynaud's, you may find that in time your medicines are less effective and your attacks become more frequent and/or more severe. Switching to a new treatment may help relieve or prevent your symptoms. Be sure to seek a health care provider's care if you develop sores on your fingers or toes or elsewhere on the body. Follow the lifestyle suggestions recommended above to help prevent and reduce the frequency and intensity of attacks. Follow a healthy nutritional program as recommended below.
PROGNOSIS
For most people, primary Raynaud's is more of a bother or an annoyance than a serious illness and it can usually be managed with minor lifestyle changes. Secondary Raynaud's can be more difficult to manage, but several treatments may help prevent or relieve symptoms. Among the most important treatments for secondary Raynaud's is treating of the underlying condition.
HELPFUL RELATED LINKS
NIAMS: Questions and Answers About Raynaud's Phenomenon
Arthritis Foundation: Raynaud's Phenomenon
Vascular Disease Foundation: Raynaud's Disease: What Is It?
Mayo Clinic: Raynaud's Disease
Cedars-Sinai Health System: Raynaud's Phenomenon
The Arthritis Foundation
P.O. Box 19000
Atlanta, Georgia 30326
www.arthritis.org
HERBAL & HOLISTIC RECOMMENDATIONS
ALTERNATIVE HEALTH RECOMMENDATIONS
Avoidance of any environmental triggers, e.g. cold, vibration, etc. (although emotional stress is a recognized trigger, it tends to be impossible to consciously avoid).
Warm clothing for the extremities such as mittens or HeatBands.
Hormone regulation and assessment of the type of hormonal contraception used, if any. Contraception which is low in estrogen is preferable, and the progesterone only pill is often prescribed.
Smoking cessation.
Avoid stress and practice relaxation techniques.
Two separate gels combined on the fingertip (somewhat like two-part epoxy, they cannot be combined before use because they will react) increased blood flow in the fingertips by about three times. One gel contained 5 percent sodium nitrite and the other contained 5 percent ascorbic acid. The milliliter of combined gel covered an area of approximate 3 cm2. The gel is wiped off after a few seconds.
Biofeedback, which is a treatment technique in which people are trained to improve their health by using signals from their own bodies, is another therapy for Raynaud's disease.
NUTRITION RECOMMENDATIONS
Eat a diet composed of 50 percent raw foods.
Avoid fatty and fried foods.
Avoid caffeine. This stimulant constricts the blood vessels.
See the dietary and nutrition recommendations found in the Nutrition links below for more information and consult with a health care provider and/or a nutritional therapist to help you treat any underlying disorders.
EMERGENCY MEASURES
If white finger (Raynaud's), occurs unexpectedly and a source of warm water is available allow tepid to slightly warm water to run over the affected digits while gently massaging the area. Continue this process until the white area turns pink or a normal healthy color.
If triggered by exposure in a cold environment, and no warm water is available, place the affected digits in a warm body cavity - arm pit, crotch, or even in the mouth. Keep the affected area warm at least until the whiteness returns to pink or a healthy color, avoid continued exposure to the cold.
HERBS
The extract of the Ginkgo Biloba leaves may reduce frequency of Raynaud's attacks.
Butcher's Broom, Cayenne (capsicum), Ginkgo Biloba and Pau D'Arco can be used separately or in combination to improve circulation and strengthen blood vessels.
Hyssop may prove helpful for problems affecting the circulation.
FOR CHRONIC INFECTION UNDER & AROUND THE FINGERNAILS OR TOENAILS
If you have problems developing abscesses for lack of proper circulation, Goldenseal made into a poultice can be directly applied to the abscess. Or apply alcohol-free Goldenseal Extract to sterile gauze and place the gauze over the abscess and to treat infection problems.
CAUTION! Do not take Goldenseal internally on a daily basis for more than one week at a time, and DO NOT USE IT DURING PREGNANCY. If you have a history of cardiovascular disease, diabetes, or glaucoma, use it only under a health care provider's supervision.
Goldenseal Root Tincture, 100% Organic, 2 fl. oz.
Echinacea Goldenseal Tincture, Nature's Way, Alcohol Free, 1 fl. oz.
A poultice that combines Lobelia and Slippery Elm bark is soothing and fights infection.
Milk Thistle, taken in capsule form, is good for the liver and aids in cleansing the bloodstream.
Tea Tree Oil, applied externally, is a potent natural antiseptic that kills infectious organisms without harming healthy cells. Mix 1 part tea tree oil with 4 parts water and apply the mixture with a cotton ball 3 times daily. It will destroy bacteria, hasten healing, and prevent infection from spreading.
NUTRITIONAL SUPPLEMENT RECOMMENDATIONS
The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
RAYNAUD'S DISEASE / RAYNAUD'S PHENOMENON SUPPLEMENTS & PRODUCTS
Information, supplements and products for Raynaud's Disease, a circulatory disorder that causes the fingers, toes and other extremities to be overly sensitive to cold. Also included are supplements and products helpful for treating infection and gangrene, which can result due to chronic vessel constriction and tissue damage.
Black Cohosh Extract, Standardized, Nature's Way, 40 mg, 120 VCaps
Black Cohosh extract is the most popular herbal supplement in Europe for women experiencing change of life (peri-menopause) symptoms due to hormonal fluctuations.Black Seed Theramune Ultimate With Garlic, 100 Caps
Promotes healthy circulation, useful for arthritis and cardiovascular & respiratory support. It also supports digestion and is a natural remedy for ulcers. Garlic is known to lower cholesterol naturally.Burdock Root (Arctium Lappa) Powder, 4 oz. Bulk
Burdock Root is traditionally used for skin disorders associated with adolescence. It is also one of the most effective herbs for cleaning the blood without the side effect of nausea.Butcher's Broom, 100% Organic, 2 fl. oz.
Butcher's Broom is a laxative and diuretic and it is also used to improve circulation problems, hemorrhoids, varicose veins, arteriosclerosis, and blood clots.Butcher's Broom Root, Nature's Way, 470 mg, 100 Caps
Popular in Europe for improving circulation in the legs, Butcher's Broom Root contains a mixture of steroidal saponins which produce a vasoconstrictive effect.Cayenne Pepper Supplement, Nature's Way, 450 mg, 180 Caps
Cayenne Pepper Supplement is a blood warming herb that has an invigorating effect on several body systems.Chlorofresh, Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels
Chlorofresh, Chlorophyll Supplement, is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence.Chlorofresh Liquid, Natural, Nature's Way, 16 fl. oz.
Chlorofresh is a special liquid chlorophyll complex, derived from premium alfalfa leaves. Chlorofresh is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence.Choline & Inositol, 100% Natural, Nature's Way, 250 mg/250 mg, 100 Caps
Nature's Way Choline Inositol is 100 percent natural crystalline inositol and choline bound to tartaric acid for superior absorption.Comfrey Leaf Herb Skin Poultice, 2.5 oz.
Comfrey leaf contains allantoin, which promotes the growth of connective tissue, bone, cartilage, and is easily absorbed through the skin.Comfrey Leaf Powder, 100% Organic, 4 oz. Bulk
One of the most well-known healing plants, especially for its ability to heal tissue and bone.Coenzyme Q10: All-Around Nutrient for All-Around Health! Latest Research as a Heart Strengthener, Energy Promoter, Aging Fighter, and Much More.
This Book discusses an amazing antioxidant that helps patients with heart failure, hypertension, coronary artery disease, high cholesterol levels and other diseases.CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps
A coenzyme for several key steps in the production of energy within each cell, and an antioxidant important in its clinical effects. It is these two properties make CoQ10 one of the best supplements available today.CoQ10 With Vitamin E, NOW Foods, 200 mg, 90 Lozenges
This new orange flavored chewable CoQ10 is formulated with 100 IU of Vitamin E in a base of non-genetically engineered Soy Lecithin.DMG Supplement N,N Dimethyl Glycine, NOW Foods, 125 mg, 100 Caps
NOW Foods DMG Supplement is a methylated amino acid found in all cells. DMG is an antioxidant and methyl donor that has a number of beneficial effects. It has shown to have potential in increasing immune response to the flu and salmonella.Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Garlic oil is often used to soothe the ear and as an antibiotic but most often used as a food and herb and also to lower serum cholesterol and blood pressure and to improve circulation as well as possibly inhibiting the growth of ulcer causing bacteria.Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 VCaps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb.Ginkgold, Ginkgo Biloba Extract, Standardized, Vegetarian, Nature's Way, 60 mg, 150 Tabs
Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.Hawthorn Berry Tincture (Heart Herb), 100% Organic, 2 fl. oz.
Throughout Europe, Hawthorn berry is recognized as a safe and effective treatment for the early stages of congestive heart failure (CHF).Hydrogen Peroxide & Ozone By Conrad LeBeau
Reveals documented details of the use of hydrogen peroxide as a successful treatment for many disorders, including arthritis, cancer, and AIDS.Hyssop Herb, Nature's Way, 445 mg, 100 Caps
Hyssop herb regulates blood pressure, purifies the blood & promotes circulation, excellent aid for the eyes, hoarseness, lungs, mucous buildup, nervous disorders and skin problems.Lecithin Concentrate, Nature's Way, 400 mg, 100 Softgels
Nature's Way Lecithin Supplement is 100% natural from soy oil and it contains no artificial ingredients or preservatives.Marshmallow Root (Althaea Officinalis) Powder, 4 oz. Bulk
The German Commission E approved the internal use of marshmallow root for irritation of the oral and pharyngeal mucosa and associated dry cough, and for mild inflammation of the gastric mucosa.Niacin Supplement, Vitamin B-3, 100% Natural, Nature's way, 100 mg, 100 Caps
Niacin or vitamin B-3, is necessary for normal breakdown of fats and fatty acids and the release of energy from carbohydrates. It is also an excellent vasodilator and may be useful in maintaining proper cholesterol levels.Olive Leaf Extract, Standardized, Nature's Way, 500 mg, 60 Caps
Nature's Way Standardized Olive Leaf extract is a technically advanced herbal product. Standardization assures specific measurable levels of important compounds that provide beneficial activity in the body.Silica Complex, 8% Extract, Silica Supplement, NOW Foods, 500 mg, 90 Tabs.
NOW Foods Silica Supplement is a vegetarian supplement that will help build strong and healthy hair, skin and nails.Stabilized Oxygen OxyDrops, Liquid Electrolytes, Sodium Chloride Solution, 4 fl. oz.
WaterOz stabilized oxygen is the highest quality, strongest and most stable of all the liquid electrolytes of oxygen available on the market.Vitamin E, Natural D-Alpha Tocopherol, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
Herbal Remedies: Raynaud's Disease Information
Herbal Remedies: Raynaud's Disease / Raynaud's Phenomenon Supplements, Information & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You notice symptoms suspicious for Raynaud's disease. Further testing may be needed to see if you might have another medical condition that is causing your symptoms.
KEY POINTS
Raynaud's is a rare disorder that affects blood flow to the fingers and toes, and rarely affects other areas such as the nose, ears, nipples, and lips.
When Raynaud's occurs without any known cause, it is called primary Raynaud's. When a cause can be identified, the disease is called secondary Raynaud's.
People with Raynaud's have attacks in response to cold or emotional stress. During these attacks, their fingers, toes, or other extremities temporarily pale and/or become bluish due to a lack of blood flow. As blood flow returns, the area turns red. The affected areas also may throb or feel cold, numb, or tingly.
Raynaud's is usually diagnosed based on a history of symptoms, the exclusion of other conditions, and certain diagnostic tests.
Common causes of secondary Raynaud's include other disorders, medicines, chemicals, or work conditions that affect blood flow to the extremities.
Primary Raynaud's often can be managed with minor lifestyle changes. Secondary Raynaud's may require changing or stopping certain medicines, treating any underlying conditions, and having surgery (in severe cases).
People with severe secondary Raynaud's may develop sores or tissue death (gangrene) in the extremities. This is uncommon.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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