Raynaud’s phenomenon (RP) is digital ischemia that occurs on exposure to cold and/or as a result of emotional stress. The various causes of RP include rheumatic disorders [systemic scleroderma (85%), SLE (35%), dermatomyositis (30%), Sjögren’s syndrome rheumatoid arthritis, polyarteritis nodosa], diseases with abnormal blood proteins (cryoproteins, cold agglutinins, macroglobulins), drugs (β-adrenergic blockers, nicotine), arterial diseases (arteriosclerosis obliterans, thromboangiitis obliterans), and carpal tunnel syndrome. When no etiology is found for RP, the term Raynaud’s disease (RD) is used. It is primarily RD that is summarized below.
Causes of Raynaud’s Disease
The vasomotor tone is regulated by the sympathetic nervous system. The centers for vasomotor tone are located in the brain, the spinal cord, and the peripheral nerves. Vasodilatation occurs only on withdrawal of the sympathetic activity. It is conjectured that there may be a “local fault” in which blood vessels are abnormally sensitive to cold.
Symptoms of Raynaud’s Disease
- Toes or fingers that change color upon pressure.
- Numb, prickly feeling or stinging pain upon warming or relief of stress.
- Toes or fingers that change color when exposed to the cold.
- The affected skin may look slightly swollen.
Diagnosis
The vascular changes in RP are characteristic; when no other disease is discovered, the diagnosis is RD.
Treatment
Systemic Therapy Drug therapy such as reserpine and nifedipine should be used only in patients who have severe RD.
Avoid exposure to the cold, and when cold cannot be avoided, dress warmly. If you smoke, stop smoking, as it further constricts the blood vessels.
Prevention
Education regarding the use of loose-fitting clothing, and avoiding cold and pressure on the fingers. Giving up smoking is mandatory.
References