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Questions and Answers about Raynaud's Phenomenon
What Is Raynaud's Phenomenon?
Raynaud's phenomenon is a disorder that affects the blood
vessels in the fingers, toes, ears, and nose. This disorder is characterized
by episodic attacks, called vasospastic attacks, that cause the blood
vessels in the digits (fingers and toes) to constrict (narrow). Raynaud's
phenomenon can occur on its own, or it can be secondary to another condition
such as scleroderma or lupus.
Although estimates vary, recent surveys show that Raynaud's
phenomenon may affect 5 to 10 percent of the general population in the
United States. Women are more likely than men to have the disorder.
Raynaud's phenomenon appears to be more common in people who live in
colder climates. However, people with the disorder who live in milder
climates may have more attacks during periods of colder weather.
What Happens During an Attack?
For most people, an attack is usually triggered by exposure
to cold or emotional stress. In general, attacks affect the fingers
or toes but may affect the nose, lips, or ear lobes.
Reduced Blood Supply to the Extremities
When a person is exposed to cold, the body's normal response
is to slow the loss of heat and preserve its core temperature. To maintain
this temperature, the blood vessels that control blood flow to the skin
surface move blood from arteries near the surface to veins deeper in
the body. For people who have Raynaud's phenomenon, this normal body
response is intensified by the sudden spasmodic contractions of the
small blood vessels (arterioles) that supply blood to the fingers and
toes. The arteries of the fingers and toes may also collapse. As a result,
the blood supply to the extremities is greatly decreased, causing a
reaction that includes skin discoloration and other changes.
Changes in Skin Color and Sensation
Once the attack begins, a person may experience three
phases of skin color changes (white, blue, and red) in the fingers or
toes. The order of the changes of color is not the same for all people,
and not everyone has all three colors. Pallor (whiteness) may occur
in response to spasm of the arterioles and the resulting collapse of
the digital arteries. Cyanosis (blueness) may appear because the fingers
or toes are not getting enough oxygen-rich blood. The fingers or toes
may also feel cold and numb. Finally, as the arterioles dilate (relax)
and blood returns to the digits, rubor (redness) may occur. As the attack
ends, throbbing and tingling may occur in the fingers and toes. An attack
can last from less than a minute to several hours.
How Is Raynaud's Phenomenon Classified?
Doctors classify Raynaud's phenomenon as either the primary
or the secondary form. In medical literature, "primary Raynaud's phenomenon"
may also be called Raynaud's disease, idiopathic Raynaud's phenomenon,
or primary Raynaud's syndrome. The terms idiopathic and primary both
mean that the cause is unknown.
Primary Raynaud's Phenomenon
Most people who have Raynaud's phenomenon have the primary
form (the milder version). A person who has primary Raynaud's phenomenon
has no underlying disease or associated medical problems. More women
than men are affected, and approximately 75 percent of all cases are
diagnosed in women who are between 15 and 40 years old.
People who have only vasospastic attacks for several years,
without involvement of other body systems or organs, rarely have or
will develop a secondary disease (that is, a connective tissue disorder
such as scleroderma) later. Several researchers who studied people who
appeared to have primary Raynaud's phenomenon over long periods of time
found that less than 9 percent of these people developed a secondary
Secondary Raynaud's Phenomenon
Although secondary Raynaud's phenomenon is less common
than the primary form, it is often a more complex and serious disorder.
Secondary means that patients have an underlying disease or condition
that causes Raynaud's phenomenon. Connective tissue diseases are the
most common cause of secondary Raynaud's phenomenon. Some of these diseases
reduce blood flow to the digits by causing blood vessel walls to thicken
and the vessels to constrict too easily. Raynaud's phenomenon is seen
in approximately 85 to 95 percent of patients with scleroderma and mixed
connective tissue disease, and it is present in about one-third of patients
with systemic lupus erythematosus. Raynaud's phenomenon also can occur
in patients who have other connective tissue diseases, including Sjögren's
syndrome, dermatomyositis, and polymyositis.
Possible causes of secondary Raynaud's phenomenon, other
than connective tissue diseases, are carpal tunnel syndrome and obstructive
arterial disease (blood vessel disease). Some drugs, including beta-blockers
(used to treat high blood pressure), ergotamine preparations (used for
migraine headaches), certain agents used in cancer chemotherapy, and
drugs that cause vasoconstriction (such as some over-the-counter cold
medications and narcotics), are linked to Raynaud's phenomenon.
People in certain occupations may be more vulnerable to
secondary Raynaud's phenomenon. Some workers in the plastics industry
(who are exposed to vinyl chloride) develop a scleroderma-like illness,
of which Raynaud's phenomenon can be a part. Workers who operate vibrating
tools can develop a type of Raynaud's phenomenon called vibration-induced
People with secondary Raynaud's phenomenon often experience
associated medical problems. The more serious problems are skin ulcers
(sores) or gangrene (tissue death) in the fingers or toes. Painful ulcers
and gangrene are fairly common and can be difficult to treat. In addition,
a person may experience heartburn or difficulty in swallowing. These
two problems are caused by weakness in the muscle of the esophagus (the
tube that takes food and liquids from the mouth to the stomach) that
can occur in people with connective tissue diseases.
How Does a Doctor Diagnose Raynaud's
If a doctor suspects Raynaud's phenomenon, he or she will
ask the patient for a detailed medical history. The doctor will then
examine the patient to rule out other medical problems. The patient
might have a vasospastic attack during the office visit, which makes
it easier for the doctor to diagnose Raynaud's phenomenon. Most doctors
find it fairly easy to diagnose Raynaud's phenomenon but more difficult
to identify the form of the disorder.
Nailfold capillaroscopy (study of capillaries under a
microscope) can help the doctor distinguish between primary and secondary
Raynaud's phenomenon. During this test, the doctor puts a drop of oil
on the patient's nailfolds, the skin at the base of the fingernail.
The doctor then examines the nailfolds under a microscope to look for
abnormalities of the tiny blood vessels called capillaries. If the capillaries
are enlarged or deformed, the patient may have a connective tissue disease.
The doctor may also order two particular blood tests,
an antinuclear antibody test (ANA) and an erythrocyte sedimentation
rate (ESR). The ANA test determines whether the body is producing special
proteins (antibodies) often found in people who have connective tissue
diseases or other autoimmune disorders. The ESR test is a measure of
inflammation in the body and tests how fast red blood cells settle out
of unclotted blood. Inflammation in the body causes an elevated ESR.
Diagnostic Criteria for Raynaud's Phenomenon
Primary Raynaud's Phenomenon
- Periodic vasospastic attacks of pallor or cyanosis (some doctors
include the additional criterion of the presence of these attacks
for at least 2 years)
- Normal nailfold capillary pattern
- Negative antinuclear antibody test
- Normal erythrocyte sedimentation rate
- Absence of pitting scars or ulcers of the skin, or gangrene
(tissue death) in the fingers or toes
Secondary Raynaud's Phenomenon
- Periodic vasospastic attacks of pallor and cyanosis
- Abnormal nailfold capillary pattern
- Positive antinuclear antibody test
- Abnormal erythrocyte sedimentation rate
- Presence of pitting scars or ulcers of the skin, or gangrene
in the fingers or toes
What Is the Treatment for Raynaud's
The aims of treatment are to reduce the number and severity
of attacks and to prevent tissue damage and loss in the fingers and
toes. Most doctors are conservative in treating patients with primary
and secondary Raynaud's phenomenon; that is, they recommend nondrug
treatments and self-help measures first. Doctors may prescribe medications
for some patients, usually those with secondary Raynaud's phenomenon.
In addition, patients are treated for any underlying disease or condition
that causes secondary Raynaud's phenomenon.
Nondrug Treatments and Self-Help Measures
Several nondrug treatments and self-help measures can
decrease the severity of Raynaud's attacks and promote overall well-being.
- Take action during an attack--An attack should not be ignored.
Its length and severity can be lessened by a few simple actions. The
first and most important action is to warm the hands or feet. In cold
weather, people should go indoors. Running warm water over the fingers
or toes or soaking them in a bowl of warm water will warm them. Taking
time to relax will further help to end the attack. If a stressful
situation triggers the attack, a person can help stop the attack by
getting out of the stressful situation and relaxing. People who are
trained in biofeedback can use this technique along with warming the
hands or feet in water to help lessen the attack.
- Keep warm--It is important not only to keep the extremities
warm but also to avoid chilling any part of the body. In cold weather,
people with Raynaud's phenomenon must pay particular attention to
dressing. Several layers of loose clothing, socks, hats, and gloves
or mittens are recommended. A hat is important because a great deal
of body heat is lost through the scalp. Feet should be kept dry and
warm. Some people find it helpful to wear mittens and socks to bed
during winter. Chemical warmers, such as small heating pouches that
can be placed in pockets, mittens, boots, or shoes, can give added
protection during long periods outdoors. People who have secondary
Raynaud's phenomenon should talk to their doctors before exercising
outdoors in cold weather.
People with Raynaud's phenomenon should also be aware that air conditioning
can trigger attacks. Turning down the air conditioning or wearing
a sweater may help prevent attacks. Some people find it helpful to
use insulated drinking glasses and to put on gloves before handling
frozen or refrigerated foods.
- Quit smoking--The nicotine in cigarettes causes the skin
temperature to drop, which may lead to an attack.
- Control stress--Because stress and emotional upsets may trigger
an attack, particularly for people who have primary Raynaud's phenomenon,
learning to recognize and avoid stressful situations may help control
the number of attacks. Many people have found that relaxation or biofeedback
training can help decrease the number and severity of attacks. Biofeedback
training teaches people to bring the temperature of their fingers
under voluntary control. Local hospitals and other community organizations,
such as schools, often offer programs in stress management.
- Exercise--Many doctors encourage patients who have Raynaud's
phenomenon, particularly the primary form, to exercise regularly.
Most people find that exercise promotes overall well-being, increases
energy level, helps control weight, and promotes restful sleep. Patients
with Raynaud's phenomenon should talk to their doctors before starting
an exercise program.
- See a doctor--People with Raynaud's phenomenon should see
their doctors if they are worried or frightened about attacks or if
they have questions about caring for themselves. They should always
see their doctors if attacks occur only on one side of the body (one
hand or one foot) and any time an attack results in sores or ulcers
on the fingers or toes.
Treatment With Medications
People with secondary Raynaud's phenomenon are more likely
than those with the primary form to be treated with medications. Many
doctors believe that the most effective and safest drugs are calcium-channel
blockers, which relax smooth muscle and dilate the small blood vessels.
These drugs decrease the frequency and severity of attacks in about
two-thirds of patients who have primary and secondary Raynaud's phenomenon.
These drugs also can help heal skin ulcers on the fingers or toes.
Other patients have found relief with drugs called alpha
blockers that counteract the actions of norepinephrine, a hormone that
constricts blood vessels. Some doctors prescribe a nonspecific vasodilator
(drug that relaxes blood vessels), such as nitroglycerine paste, which
is applied to the fingers, to help heal skin ulcers. Patients should
keep in mind that the treatment for Raynaud's phenomenon is not always
successful. Often, patients with the secondary form will not respond
as well to treatment as those with the primary form of the disorder.
Patients may find that one drug works better than another.
Some people may experience side effects that require stopping the medication.
For other people, a drug may become less effective over time. Women
of childbearing age should know that the medications used to treat Raynaud's
phenomenon may affect the growing fetus. Therefore, women who are pregnant
or are trying to become pregnant should avoid taking these medications
- Take action during an attack
- Keep warm
- Don't smoke
- Control stress
- Exercise regularly
- See a doctor if questions or concerns develop
What Research Is Being Conducted To
Help People Who Have Raynaud's Phenomenon?
Researchers are studying ways to better diagnose Raynaud's
phenomenon and predict and monitor its course and association with other
diseases. They are also evaluating the use of new drugs to improve blood
flow in Raynaud's phenomenon; for example, the prostaglandins iloprost
and alprostadil, the high blood pressure drug losartan, and a substance
applied to the skin that generates the blood vessel dilating gas nitric
oxide. Basic investigators are studying the molecular mechanisms behind
Raynaud's phenomenon, the anatomy of blood vessels, and possible genetic
associations. Some researchers are studying the use of biofeedback to
control attacks. Researchers in scleroderma and other connective tissue
diseases are also investigating Raynaud's phenomenon in relation to
Where Can People Get More Information
About Raynaud's Phenomenon?
National Institute of Arthritis and Musculoskeletal
Skin Diseases Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
The clearinghouse provides information about various forms
of arthritis and rheumatic disease and bone, muscle, and skin diseases.
It distributes patient and professional education materials and refers
people to other sources of information. Additional information and updates
can also be found on the NIAMS Web site.
National Heart, Lung, and Blood Institute Information
National Institutes of Health
P.O. Box 30105
Bethesda, MD 20824-0105
The National Heart, Lung, and Blood Institute (NHLBI)
provides leadership for a national program in diseases of the heart,
blood vessels, lung, and blood; blood resources; and sleep disorders.
The NHLBI Information Center develops and maintains information on numerous
topics to respond to inquiries on specific diseases related to the heart,
lungs, and blood.
American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
This professional organization of rheumatologists (doctors
specializing in arthritis and related conditions such as Raynaud's phenomenon)
and associated health professionals is involved in research, education,
and patient care. It provides referrals to rheumatologists and other
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or 800-283-7800 (free of charge)
or call your local chapter (listed in the telephone directory)
This is the main voluntary organization devoted to all
forms of arthritis. The foundation publishes a free pamphlet on Raynaud's
phenomenon and also provides physician referrals.
Lupus Foundation of America
1330 Piccard Drive, Suite 200
Rockville, MD 20850-4303
Phone: 301-670-9292 or 800-558-0121 (free of charge)
This is the main voluntary organization devoted to lupus.
The LFA offers information and referral services, health fairs, newsletters,
publications, seminars, support group meetings, hospital visits, and
telephone help lines.
National Sjögren's Syndrome Association
5815 North Black Canyon Highway, Suite 103
Phoenix, AZ 85015
Phone: 602-433-9844 or 800-395-6772 (free of charge)
This association promotes public awareness of Sjögren's
syndrome and encourages research into the cause and cure of the disorder.
It also conducts educational and research programs.
12 Kent Way, Suite 101
Byfield, MA 01922
Phone: 800-722-HOPE (4673) (free of charge)
This voluntary organization publishes information on scleroderma,
including a booklet for scleroderma patients with Raynaud's phenomenon.
It also offers patient education seminars, support groups, physician
referrals, and information hotlines.
Sjögren's Syndrome Foundation
366 North Broadway
Jericho, NY 11753
Phone: 516-933-6365 or 800-475-6473 (free of charge)
This organization is devoted to Sjögren's syndrome. It
publishes free pamphlets and a newsletter for members that provides
up-to-date information. It provides clinic and physician referrals.
The NIAMS gratefully acknowledges the assistance of Paul
Plotz, M.D., NIAMS, NIH; Phillip J. Clements, M.D., of the University
of California, Los Angeles; Jay D. Coffman, M.D., of the Boston University
Medical Center; and Frederick M. Wigley, M.D., of The Johns Hopkins
University School of Medicine in the preparation and review of this
The mission of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes
of Health (NIH), is to support research into the causes, treatment,
and prevention of arthritis and musculoskeletal and skin diseases, the
training of basic and clinical scientists to carry out this research,
and the dissemination of information on research progress in these diseases.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse is a public service sponsored by the NIAMS
that provides health information and information sources. Additional
information can be found on the NIAMS Web site at http://www.niams.nih.gov/.
Publication Date May 2001
NIH Publication No. 01-4911