Raynaud’s disease- Causes and Symptoms

December 08 04:07 2021 by admin Print This Article

Raynaud’s disease (pronounced – ‘Raynose’ disease) is a unique condition that causes fingers and toes to go numb as a reaction to cold temperatures. While not a life-threatening condition, it can affect the quality of life. And if left untreated for long, can cause complications that result in gangrene and amputation of the affected parts of the body. That is why, it’s important to know about Raynaud’s disease so that timely treatment can be given. Treatment of Raynaud’s disease depends on the severity of the disease.

Types of Raynaud’s

 Raynaud’s disease is a generic name for 2 types of the condition:

• Primary Raynaud’s, also called Raynaud’s disease (RD): This is the most common type and has no underlying conditions. It just happens as a result of cold weather or temperature. Its more common in the age-group of 15 to 30 years. The condition is also not very serious and resolves on its own without treatment. However, you should still consult a doctor who is the best judge on the condition.
• Secondary Raynaud’s, also called Raynaud’s phenomenon: This form is less common but more serious. It is caused by an underlying problem. Signs and symptoms of this type show up around 40 years of age or later. This definitely requires treatment and there are various options.

How does this condition work? 

In a normal, healthy individual, the body reacts to cold climates and temperatures in a specific way. Body heat must be conserved so that the brain and internal organs do not go into a hypothermic shock due to the cold. This is done by ensuring the extremities of the body – fingers and toes, more specifically their skin, receive lesser supply of blood than usual, which is done by narrowing the blood vessels supplying blood to them. Once the ambient temperature improves, or the person has taken measures to keep him/her warm, the blood supply returns to normal. Nerves that are attached to these blood vessels give them the signals to contract or expand accordingly. This is what happens in primary Raynaud’s. The episode may last for 15 minutes.

In secondary Raynaud’s, the same events described above happen, however, the contraction of the blood vessels lasts longer than 15 minutes which in the long run cause complications such as ulcers on the skin and gangrene in worst cases. These complications do not have any cure. Gangrene if left untreated can lead to amputation of the affected fingers and toes.

Causes of Secondary Raynaud’s

• Connective tissue diseases: Scleroderma, Lupus, rheumatoid arthritis and Sjogren’s syndrome are all connective tissue or auto-immune disorders that can trigger Raynaud’s disease.
• Artery diseases: Atherosclerosis is a condition in which plaque builds up in blood vessels, reducing blood flow. When this happens in arteries of the heart, it can trigger a heart-attack. When the same happens in the arteries that feed the hands and legs, it can trigger Raynaud’s disease. Buerger’s disease is an inflammation of blood vessels in the hands and feet; while pulmonary hypertension is a type of high blood pressure in the arteries of lungs. These conditions can also trigger Raynaud’s.
• Carpal tunnel syndrome: CTS is a condition in which a major nerve that brings signals to the hand is stressed, causing numbness, pain, and hypersensitivity to cold, eventually triggering Raynaud’s in some patients.
• Repetitive actions or vibration: Typing on the computer keyboard or playing the piano for long stretches of times can cause overuse injury. Technicians who use power tools that vibrate, like jackhammers, also undergo overuse injury. And overuse injury is a perfect trigger for Raynaud’s.
• Smoking. Smoking causes narrowing down of blood vessels and hence restricted blood flow in different parts of the body. When this happens in the arteries that feed the hands and legs, it can trigger Raynaud’s.
• Injuries: Falls, fractures, accidents, surgery and frostbite cause trauma or damage to tissues in the hands or feet. In some people, this can trigger Raynaud’s.
• Certain drugs: Some medicines used for high BP (such as beta-blockers), migraine (ergotamine or sumatriptan), ADHD, chemotherapy and over-the-counter (OTC) medication for cold – can all narrow down blood-vessels and trigger Raynaud’s in some people.

Risk Factors of Raynaud’s disease

According to American disease registries, one in 10 people in the US experience primary Raynaud’s disease at some point of time in life, while 1 in 100 people have secondary Raynaud’s. Although no data is available for India, one can expect similar figures. In addition to the risk factors outlined above for secondary Raynaud’s, it’s found that women are 9 times more likely than men to develop Raynaud’s. There is no clear reason for this. For that matter, it’s still not clear why some people develop Raynaud’s while some do not, although they may have the same set of risk factors.

Symptoms of Raynaud’s disease

• The affected areas, which are the fingers and toes would first turn white (called pallor), then later turn blue (called cyanosis). Once the area has received some warmth due to the change in weather or some measures being taken to keep warm, the blood flow returns to normal. The area turns red (called rubour), has a tingling sensation and some swelling too. Some people even experience a painful, throbbing sensation.
• Breastfeeding women may also experience Raynaud’s phenomenon that is localized to the nipples and marked by severe throbbing. The throbbing is similar to that felt due to Candida albicans, a fungal infection, which is why it’s sometimes misdiagnosed.

Keeping the hands and feet warm and protected from cuts, bruises and injuries go a long way in preventing Raynaud’s.

Diagnosis and Treatment of Raynaud’s disease

• The doctor will first discuss with you about your personal medical history, family medical history, diet, lifestyle, profession and hobbies. These will help isolate the triggers that have caused the condition.
• Next, the doctor needs to understand whether its Primary or Secondary Raynaud’s. For this, he/she will conduct a capillaroscopy. In this, a microscope is used to examine the skin under the finger-nails and/or toe-nails to look for enlarged or malformed blood vessels.
• Next a blood-test is done. The presence of antinuclear antibodies and the rate of erythrocyte sedimentation may indicate auto-immune disorders or any condition that causes inflammation.

Treatment – Mild cases

• The person must be kept warm as much as possible. He/she must wear warm clothes such as sweaters, jackets, caps, gloves and socks, during cold weather. He/she should avoid entering suddenly from a warm room to an air-conditioned room. He/she should avoid cold-rooms and walk-in refrigerators. The person should wear gloves or mitts while removing or keeping something in the refrigerator.
• Since stress is also one of the triggers, Stress Management must be done using relaxation techniques such as yoga, meditation and indulging in hobbies.

Treatment – moderate to severe cases

• The following medications are used for such patients: Alpha-1 blockers which prevent constriction of blood vessels, Dihydropyridine calcium channel blockers which relax smaller blood vessels of the feet and hands, Topical nitroglycerin ointment which improve blood flow and reduce BP, and vasodilators which dilate the blood vessels and alleviate the symptoms.

Treatment – severe cases

• Sympathectomy: As described earlier, nerves in the hands and feet send signals to the blood vessels to dilate or contract. These are called sympathetic nerve fibers. A surgical procedure called sympathectomy is done where these nerve fibers attached to the blood vessels are stripped away from the blood-vessels. That will reduce the frequency of RD attacks.
• Chemical injections: Here, instead of stripping away the nerve fibers, their action is blocked by injecting local anesthetics or Botox at the site.

Outlook

If you or any of your dear ones are showing the above symptoms, do not ignore the same. Consult a reputed hospital. A vascular surgeon there will conduct the required tests on you and once the condition is confirmed, put you on a course of treatment for quick recovery and rehabilitation.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801