Raynaud's Disease

By: TheGreenLabCoat

Working in Family Medicine, you see several chronic diseases on a daily basis: diabetes mellitus 2, hypertension, and osteoporosis - Or as one of our elderly patients jokingly refers to them, “all these old people diseases.” Recently during a new patient visit, I noticed that this patient’s fingers were a different color from the rest of her hand; fleshy, pink hands but with almost paper white fingers. At first I thought it might have been a skin discoloration that naturally occurs in some people, but through the course of the visit her hand gradually turned blue, and then a bright shade of red. I couldn’t help but to ask the patient, “Are you aware that your fingers have been changing colors since you sat down in here?” The patient waved her unusually colorful hand in the air, stating “Oh honey, I have Raynaud’s, it's fine. I was just holding my soda.” Not knowing exactly what she meant at the time, I decided to educate myself on the subject: What is Raynaud’s?

Raynaud’s Disease, named after Maurice Raynaud in 1862, is a disorder of the blood vessels that causes them to overreact, predominantly in the hands and feet. Our body has an internal thermostat with many locations of thermometers. When we are cold, the sensors in our body tell us “Hey, we need to keep the heat up so that all of our organs continue to function.” It sends out a signal that binds to receptors on our blood vessels, instructing them to secrete vasoconstriction hormones. When this happens, our blood vessels constrict, kind of like shutting all the windows around the house to keep the heat in. In this situation there is less blood going to our extremities, keeping the core of our bodies warmer. People who have Raynaud’s disease are unable to regulate the appropriate blood flow when exposed to cold temperatures. Their blood vessels spasm, which can cause pain, numbness, and tingling. Color changes in fingers are the most observable symptoms when an attack is happening. Emotional distress may also be a trigger of this phenomenon.

Though the exact cause of Raynaud’s is still unknown, scientists have been able to separate this disease into two major classifications: Primary Raynaud’s Phenomenon (PRP) and Secondary Raynaud’s (SR). PRP is the most common type in most people. Development can occur at any age but happens most frequently between the ages of 15 - 30, and it typically affects women more often than men. If a family member has PRP, there is a 33% chance that their offspring will develop the disease as well.

Secondary Raynaud’s (SR) has been associated with rheumatic disorders such as Lupus and scleroderma. Depending on severity of SR, it could be life threatening due to the hardening of blood vessels which down the road could be a contributing factor of heart issues such as ischemia or plaque buildup in the arteries.

Neural abnormalities, hormonal and genetic factors, and smoking all have been noted as potential causes of this disease. A few blood tests and observing capillaries of the fingernails under a microscope are the common methods of diagnosing Raynaud’s Disease. There currently are no medications to cure Raynaud’s. Outcomes for patients with PRP are usually very good. No reported mortality and little morbidity. In very rare cases, ischemia of the affected body part can result in necrosis.

Following the guidelines below can help prevent an attack:

●        Keep warm - Manually regulating body temperature can help to prevent an attack. For instance, avoid moving from a hot summer day to a cold air conditioned room. Wearing mittens and socks to bed during winter, or changing out of wet clothing items a rainy day are both good preventative measures.

●        Do not smoke - Nicotine in cigarettes causes the body temperature to lower, which may trigger an attack.

●        Control stress - Emotional well being can prevent an attack. Relaxation methods such as meditation has been reported useful.

●        Avoid stimulating medications, foods - Vasoconstrictor medications such as narcotics, beta blockers (blood pressure medication) OTC cold medication, and caffeine.

As for SR, there is no FDA-approved medication specifically, but this type of Raynaud’s is usually treated with calcium channel blockers such as amlodipine (norvasc) and felodipine which work by relaxing the smooth muscle and dilating the small blood vessels.

When my patient returns to the clinic, hopefully just for a routine check up, I will be able to have a conversation with her about this disease and not look like a deer caught in headlights. I might be able to learn a few pointers from her to potentially offer future patients with this disease some information.

References

Peer-Reviewed

Herrick, A. L. (2005, May 01). Pathogenesis of Raynaud’s phenomenon. Retrieved February 12, 2016, from http://rheumatology.oxfordjournals.org/content/44/5/587.full.pdf html

Wigley, F. M., MD. (2002, September 26). Raynaud's Phenomenon. Retrieved February 12, 2016, from http://www.nejm.org/doi/full/10.1056/nejmcp013013

Non-Peer-Reviewed

Hansen-Dispenza, H., MD, & Lisse, J. R., MD,FACP. (2015, November 17). Raynaud Phenomenon. Retrieved February 12, 2016, from http://emedicine.medscape.com/article/331197-overview

Mayo Clinic Staff. (2015, March 04). Diseases and Conditions Raynaud's disease. Retrieved February 12, 2016, from http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/definition/con-20022916

Raynaud’s Phenomenon by Dr. Nicolas Gumpert is licensed under CC BY 2.0