Raynaud’s phenomenon

Raynaud's phenomenon is usually set off by cold, anxiety or stress. The blood vessels go into a temporary spasm, and that blocks the flow of blood.

The affected area turns white, then blue, and then red as the blood flow comes back. You may also feel numbness, pain, and pins and needles. Symptoms can last anywhere from a few minutes to several hours.

Raynaud's is not a serious threat to your health, but it can be painful and hard to live with. It can affect your ability to move your fingers and hands. Many people go for long periods without any symptoms, and sometimes the condition goes away altogether.

Other parts of the body can be affected too, including the ears, nose, nipples and lips.

What causes Raynaud's phenomenon

The condition comes from over-sensitive blood vessels in the body's extremities. In many cases no cause is found, although it is sometimes linked to other health conditions.

When your body is exposed to cold, your fingers and toes lose heat. The small blood vessels under the skin spasm and slow the blood supply, which helps preserve your body's core temperature. In people with Raynaud's, these sensitive vessels overreact to the cold and become narrower than usual, so the blood flow is cut down sharply.

Even mildly cool weather can bring on symptoms. So can taking something out of the freezer or running your hands under a cold tap. Strong emotions such as stress or anxiety may also trigger them.

Primary Raynaud's

The most common form is primary Raynaud's phenomenon. It occurs by itself, without being tied to another health condition.

It seems to be caused by disruptions in how the nervous system controls the blood vessels, though exactly what causes these disruptions is unclear. There's some evidence that primary Raynaud's may be inherited, as cases have been known to run in families.

Secondary Raynaud's

Sometimes an underlying health condition makes the blood vessels overreact. This is called secondary Raynaud's, so it's worth seeing a doctor to find out whether one of these conditions is behind your symptoms.

Autoimmune conditions

Most cases of secondary Raynaud's are linked to autoimmune conditions, where the immune system attacks healthy tissue. The ones known to be associated with it include:

• scleroderma, a condition that causes hardening and thickening of the skin
• rheumatoid arthritis, which causes joint pain and swelling
• Sjogren's disease, where the immune system attacks the glands that make moisture in the body, such as the tear glands
• lupus, which causes tiredness, joint pain and skin rashes

Around 1 in 10 people with primary Raynaud's go on to develop an autoimmune condition.

Infections

The blood-borne viral infections hepatitis B and hepatitis C can occasionally trigger Raynaud's in some people.

Cancer

Some types of cancer can cause secondary Raynaud's. These are usually cancers that develop inside the blood, bone marrow or immune system, such as:

• acute lymphoblastic leukaemia, a cancer of the white blood cells that mainly affects children
• lymphoma, a cancer that develops inside one or more of the glands that are part of the immune system
• multiple myeloma, a cancer that develops inside bone marrow

Raynaud's phenomenon is usually diagnosed after your doctor reviews your symptoms and runs some blood tests.

Your GP may place your hands in cold water or cool air to see whether this brings on your symptoms. Further testing is usually recommended to work out whether you have primary or secondary Raynaud's, since secondary Raynaud's may need more treatment and, in some cases, referral to a specialist.

Secondary Raynaud's may be suspected if:

• your symptoms only started after you turned 30 (most cases of primary Raynaud's begin between the ages of 20 and 30)
• you get severe pain during an attack of Raynaud's
• only one side of your body is affected

Your GP may also check the tiny blood vessels, called capillaries, found where your nail meets your finger. In people with secondary Raynaud's, these capillaries are often larger and look like red pen marks.

Blood tests

Your GP may also refer you for blood tests to check for other health conditions that could be causing your symptoms. These may include:

• a full blood count, to check for infection or, much less commonly, a blood cancer such as leukaemia
• an antinuclear antibodies (ANA) test, to check for an overactive immune system, which is common in autoimmune conditions such as scleroderma and lupus
• an erythrocyte sedimentation rate test, to check for an autoimmune disorder

Scleroderma & Raynaud's UK (SRUK)

If you've been diagnosed with Raynaud's, Scleroderma & Raynaud's UK (SRUK) may be a helpful resource. It is the UK's leading charity for people affected by the condition.

In many cases you can keep Raynaud's under control yourself. Stay out of the cold, wear gloves, and use relaxation techniques when you feel stressed. Stopping smoking can also improve symptoms, because smoking affects your circulation. If you can't manage your symptoms on your own, a medicine called nifedipine may be recommended.

You can usually treat Raynaud's phenomenon yourself, although medicine is sometimes necessary. If you've been diagnosed with secondary Raynaud's, you may be referred to a specialist in treating the underlying condition. If your secondary Raynaud's may be a side effect of a medicine, you may be asked to stop taking it, to see whether your symptoms get better.

Self-help

This advice applies to both primary and secondary Raynaud's.

• Keep your whole body warm, especially your hands and feet. Wear gloves and warm footwear in cold weather.
• If you smoke, stop. Quitting improves your circulation, which should help your symptoms.
• Exercise regularly, as this helps your circulation and lowers stress. For most people, 150 minutes of vigorous exercise a week is recommended.
• Try to keep your stress levels down. Regular exercise, a healthy diet, and relaxation techniques such as deep breathing or yoga can help. You may find it useful to avoid stimulants such as coffee, tea and cola.

If you find it hard to control feelings of stress, you may need additional treatment, such as counselling.

Medicine

Nifedipine

If your symptoms don't improve, you may be prescribed nifedipine. It is the only medicine licensed to treat Raynaud's phenomenon in the UK. It doesn't cure Raynaud's, but it can help relieve the symptoms.

Nifedipine is a calcium channel blocker, a type of medicine that encourages the blood vessels to widen. Depending on the pattern of your symptoms and how well you respond, you may be asked to take it every day. Or you may only need it as prevention, for example during a sudden cold snap.

Side effects are common and include:

• oedema, which is swelling of parts of the body such as your hands and feet because of a build-up of fluid
• headaches
• heart palpitations
• dizziness
• constipation

Don't drink grapefruit juice while taking nifedipine, as it could make the side effects worse. They should ease as your body gets used to the medicine, but tell your doctor if you find them particularly troublesome. There are other calcium channel blockers that may suit you better.

Other medicines

Other medicines have been used to treat Raynaud's, but their use is controversial because there is limited evidence that they work in most people. Some people have still claimed to benefit. These medicines include:

• fluoxetine, which was widely used in the treatment of depression
• sildenafil, which is used to treat erectile dysfunction (inability to get or maintain an erection)

These medicines are not licensed for treating Raynaud's in the UK, but you may be prescribed them if it's thought the possible benefit outweighs the possible risks.

Surgery

Surgery for Raynaud's is rare. It's usually only recommended when symptoms are so severe that the affected body part, such as your fingers, could lose its blood supply and begin to die.

A type of surgery called sympathectomy is sometimes used. It involves cutting the nerves that cause the affected blood vessels to spasm. The results are often only temporary, and you may need further treatment, and possibly more surgery, after a few years.

Secondary Raynaud's phenomenon can severely restrict the blood supply, so it carries a higher risk of complications. These include ulcers, scarring and, in the most serious cases, tissue death (gangrene). Severe complications are rare, though.

People with Raynaud's phenomenon also have an increased risk of developing other problems, such as scleroderma.

Scleroderma

Around 1 in 16 women and 1 in 50 men with Raynaud's develop a condition called scleroderma, usually between the ages of 25 and 55. In scleroderma, the body produces excessively high levels of collagen. The word is Greek and means hard skin, but the condition can affect other parts of the body too, such as the kidneys, heart and lungs.

Symptoms of scleroderma include:

• puffy and itchy skin
• tight and uncomfortable joints
• small calcium spots and red spots under the skin
• trouble swallowing, known as dysphagia
• diarrhoea, bloating or constipation

There's no cure for scleroderma, but there are ways of overcoming the problems it may cause. Medicines, for example, can reverse or slow down the processes that cause damage around the body.

Ulcers and gangrene

In severe cases of Raynaud's, the blood supply to an affected body part can become badly reduced. Without a constant supply of blood, the tissue in that part will begin to die. This is rare and normally only happens in secondary Raynaud's.

The first sign is an open sore, known as an ulcer, on the surface of the body part. If you suspect a skin ulcer, see your doctor for advice.

Left untreated, the tissue can die. This is called gangrene (specifically, dry gangrene). Dry gangrene normally starts with a red line on the skin that marks the edge of the affected tissue. The tissue becomes cold and numb, and it can be painful as it dies. Many people, particularly the elderly, feel nothing at all.

The affected area changes colour from red, to brown, to black. The dead tissue then shrivels up, separates from the healthy tissue and falls off.

These complications normally mean admission to hospital, where you'll be given medicine to thin your blood, which should help to restore blood flow. If you don't respond to treatment, you may need surgery to unblock or repair damaged blood vessels.