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
