Rheumatology
Raynaud Phenomenon
About Raynaud Phenomenon
Raynaud’s is described as Raynaud’s "disease", Raynaud "phenomenon", or Raynaud "syndrome." Although people use these terms interchangeably, they aren’t all the same thing. What’ s going on? It helps to know a little history. Raynaud was a French medical student in the late 1800 ’s who had to write a thesis as a requirement for graduation. He wrote about the color changes he saw in the hands of women waiting for the streetcar on cold winter days.
In true Raynaud’s a person’s fingers will blanch white when they are very cold and there is little or no blood circulating to the fingers. As the hands warm up the blood flow rushes back and the fingers turn red. After this they go back to their normal condition of being bluish and cold, due to poor circulation. Unless the fingers turn all three colors, over a short period of time, it is not Raynaud’s. This same sequence of color changes can be provoked by various emotions in some people (like flushing when embarrassed, anxious or reacting to emotional stress.) It may also occur in the toes when they become cold, and infrequently in the ears and nose, etc.. Other common causes of Raynaud phenomenon include: cigarette smoking leading to poor vessel health, anxiety or panic attacks, some medications, certain types of brain damage, or an injury to local blood vessels or nerves.
Raynaud phenomenon describes the color changes. When they occur without any other medical problem it is called Raynaud’s disease. However, if the color changes occur in someone who has another rheumatic disease then it is called Raynaud’s syndrome. Raynaud’s disease is often an annoying inconvenience, but is usually not medically very important. Raynaud’s syndrome is significant because of whatever disease it is associated with.
Many people are referred to a rheumatologist because of Raynaud’s and it is not initially clear whether they have an underlying rheumatic disease or simply Raynaud’s disease. Almost any rheumatic disorder can be associated with Raynaud’s. Rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and dermatomyositis all may be associated with Raynaud’s. The important thing is for anyone with Raynaud’s to be carefully evaluated to make sure there is no underlying disease. This can be done by taking a good history, doing a detailed physical examination, and by doing appropriate laboratory testing.
Diagnosing Raynaud
Sometimes a child has Raynaud phenomenon for many years before diagnosis of an underlying disease can be made. There are some guidelines that doctors use. If everything is normal there is a less than a 10% risk of a disease becoming evident over time. If there is also a positive ANA, the risk or developing a rheumatic illness in the future rises to about 25%. If there are nail fold capillary changes on exam, the risk is much higher. A few children have pits in the skin of the distal finger tip(s), and they usually do in fact have some form of disease.
Treatment
Treatment is practical, and includes wearing adequate warm clothing. Being prepared for daily temperature changes, use of hats, gloves, and layering of clothing are helpful. This may conflict with current teen styles. During sleep, adequate blankets, and sometimes wearing socks or gloves can be very helpful. Essentially, maintenance of normal core body temperature will reduce many Raynaud’s symptoms. Several medications are also available.
If you think you have Raynaud’s you should be carefully evaluated by an experienced rheumatologist.
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