Raynaud’s Disease (Raynaud’s phenomenon) is a condition in which low temperatures or strong emotions cause repeated and transient cramps (spasms) of small muscular arteries, precapillary arterioles and arterio-venous shunt, blocking blood flow to the legs, toes and other acral parts of the body. In time Raynaud’s disease can lead to vain problems.
Raynaud’s phenomenon was named after French physician Dr. Maurice Raynaud (1834-1881), who first noticed the change in late 1850 on the fingers of a female patient.
Secondary Raynaud’s phenomenon occurs in 80 to 90% of patients with systemic sclerosis (scleroderma). In patients suffering from this condition, skin defects (ulcers) can occur at the fingertips and gangrene of the toes. Raynaud’s phenomenon also occurs in patients with dermatomyositis, polymyositis and rheumatoid arthritis. Arteriosclerosis can be the cause of the phenomenon in men older than 50 years and in younger men, mostly smokers, the cause is thromboangiitis obliterans. In both cases, the phenomenon occurs in one or two fingers, while Raynaud’s disease occurs in all fingers. The phenomenon may be a consequence of thrombosis or embolism of a blood vessel, or blood-clotting disorders.
Raynaud’s phenomenon may be associated with arterial disease atherosclerosis, Birger’s disease, rheumatoid arthritis, systemic sclerosis and systemic lupus erythematosus and other systemic and autoimmune diseases.
Raynaud’s disease is five times more common in women, usually aged between 20 and 40. It rarely occurs after menopause. A nervous person is more likely to suffer. Most often the disease begins in a few fingers, and then spreads to the other fingers. Changes are always mutual and afflicting the whole finger. It occurs during cold exposure of any part of the body, because the coldness receptors are located over whole body. Often, stress affects the occurrence of the disease. The disease can last years and decades and then go away by itself. Sometimes this happens during pregnancy. The patient’s pulse is normal, and the fingers and feet between spasms are wet and cold.
After exposure to low temperature or cold or after being in contact with cold objects toes become white, as the result of narrowing of the arteries. After that, toes become blue (cyanotic) due to the expansion of capillaries and small veins containing blood with little oxygen. Just then a person feels coldness, stiff fingers and numbness. Change in color is clearly visible. After warming up fingers become red, warm, often pulsing and painful. This is a consequence of the rapid expansion of the arteries during the warming. These three phases (pale, blue and red fingers) are a consequence of changes in diameter of blood vessels.
It is necessary to avoid coldness, to stay warmed up, avoid smoking. Drugs are applied only in the most serious forms of the disease. Calcium channel antagonists (such as Nifedipine) are often applied. They relieve pain and cause spasms to occur less frequently, and reduce the pressure but, they can lead to headaches and the ankles swelling.
Adrenergic blockers are also used (doxazosin), which increase blood flow to the fingers. In patients in whom drugs do not cause improvement a surgical simpatectomia can be applied, which often provides only temporary improvement.