Raynaud's phenomenon

About Raynaud's phenomenon

During an episode of Raynaud’s phenomenon, your blood vessels narrow and contract quickly, reducing the blood supply to your fingers and toes. This usually causes them to turn white and feel cold.

The symptoms of Raynaud's are usually triggered by cold temperatures or emotional stress. Sometimes, even a slight change in temperature can cause it, so staying warm is important. Touching a cold surface or putting your hand in the fridge can be enough to trigger an episode. Smoking is also thought to play a part in causing Raynaud’s.

Raynaud's phenomenon got its name from the French doctor Maurice Raynaud who first described it in 1862. In the UK, it affects around 3 in 100 people. Most people develop Raynaud’s phenomenon before the age of 25, but you can get it at any age. It’s more common among women than men.

Types of Raynaud’s phenomenon

There are two types of Raynaud’s phenomenon – primary and secondary. The symptoms are the same, but they have different underlying causes, which can affect the type of treatment you need.

  • Primary Raynaud’s phenomenon has no clear underlying cause, but it may be hereditary.
  • Secondary Raynaud’s phenomenon is related to having an underlying cause, such as scleroderma, systemic lupus erythematosus, or rheumatoid arthritis.

Symptoms of Raynaud's phenomenon

If you have Raynaud’s phenomenon, an episode may start with your fingers or toes becoming pale and feeling cold or numb. Your skin may then begin to turn blue and then finally red. As it turns red you may feel an aching or burning pain, or a tingling ‘pins and needles’ sensation. Your skin may also change to other colours, including purple, yellow, orange and grey.

Raynaud’s phenomenon tends to affect the middle three fingers of your hands more often than your thumbs. It can also affect your nose, ears or tongue, but this is less common.

The symptoms of Raynaud’s phenomenon can come and go, and an episode usually only lasts a few minutes; however, it can go on for hours. Symptoms of secondary Raynaud’s phenomenon tend to be more severe than in primary Raynaud’s.

These symptoms may be caused by problems other than Raynaud’s phenomenon. If you have any of these symptoms, see your GP for advice.

Causes of Raynaud's phenomenon

For most people with Raynaud’s syndrome, there is no clear underlying cause. This is known as primary Raynaud's and is often hereditary. An episode of Raynaud’s can be triggered by the cold, by emotional stress and may be made worse by smoking.

About one in five people with the condition have secondary Raynaud's phenomenon. This means it’s caused by another condition or other factor, some examples of which are listed below.

  • Connective tissue conditions – including systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome and scleroderma.
  • Conditions affecting your blood – such as leukaemia.
  • Certain medicines – including beta-blockers, antimigraine medicines and some types of contraceptive pill.
  • Illegal drugs – including amphetamines (commonly known as speed) and cocaine.
  • Exposure to vibration – including occupational use of pneumatic drills, chainsaws or holding materials that are being hammered or shaken (this is known as hand-arm vibration syndrome).

Secondary Raynaud's symptoms tend to be more severe than primary Raynaud's phenomenon.

Complications of Raynaud's phenomenon

You’re unlikely to have complications in primary Raynaud’s phenomenon because these are extremely rare, but in secondary Raynaud’s it’s possible you may have complications.

About one in five people with secondary Raynaud’s due to scleroderma have problems in their fingers including ulcers or gangrene (death of soft tissue caused by poor blood supply).

Diagnosis of Raynaud's phenomenon

Your GP will ask about your symptoms and may ask if anyone else in your family has Raynaud’s phenomenon. If your condition is severe, or a secondary cause is suspected, your GP may refer you to a rheumatologist (a doctor who specialises in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues).

If your GP suspects you have secondary Raynaud’s, he or she may ask you to have some blood and urine tests. These will be sent to a laboratory for testing.

Treatment of Raynaud's phenomenon

The type of treatment you have will depend on whether you have primary or secondary Raynaud’s. If you have primary Raynaud’s, your GP will suggest things you can do to stop triggering an episode. Or, if you have secondary Raynaud's, your GP or rheumatologist will first try to treat any underlying causes.

Self-help

Episodes of Raynaud's phenomenon can usually be controlled by making a few changes to your lifestyle. Some examples are listed below.

  • Keep your whole body warm, not just your hands and feet – in cold weather, wear woolly socks, gloves and hats, but if it’s particularly cold, stay indoors.
  • Don't smoke – smoking is known to make the symptoms of Raynaud’s worse.
  • Exercise regularly and keep active – regular movement and not sitting down for long periods may help to improve your blood circulation and reduce symptoms.
  • Manage your stress – learning relaxation techniques might help if your condition is brought on by stress.

Medicines

Your GP will usually only suggest treatment with medicines if self-help measures aren’t controlling your symptoms, or if your condition is seriously affecting your work or quality of life. Your GP will usually prescribe a medicine called a calcium-channel blocker (eg nifedipine). It works by relaxing the walls of your blood vessels so that more blood can reach your fingers and toes, which helps prevent episodes.

Other types of medicines are sometimes used to prevent episodes of Raynaud's phenomenon if nifedipine isn't helping, or if there is some reason why you can't take it. These medicines haven’t been licensed for treating Raynaud’s phenomenon and you won’t see the condition listed in the patient information leaflet that comes with your medicines. Your GP can legally prescribe outside the license if he or she feels the medicine will be effective for you. This is called ‘off-label’ use. Some examples are listed below.

  • Angiotensin-receptor blockers (eg losartan).
  • Peripheral vasodilators (eg inositol nicotinate). These dilate (widen) blood vessels and are sometimes used for treating Raynaud's.
  • Selective serotonin reuptake inhibitors (SSRIs), for example, fluoxetine. These may be used if other medicines haven’t worked.

Your GP may give you some glyceryl trinitrate (GTN) patches to use to treat an episode when one happens.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Hospital treatment

If you have a very severe episode of Raynaud’s phenomenon, you may be admitted to hospital where you may be given other medicines, such as iloprost, to help increase the blood supply to your fingers. This will help prevent any blood clots forming.

Surgery

Your GP will usually only suggest surgery if your condition is very serious.

Surgery for Raynaud’s involves cutting the nerves that cause blood vessel narrowing in the part of your body that is affected. For example, you may have a procedure known as a digital sympathectomy to cut one of the nerves in your fingers if one of your fingers is severely affected.

If your toes are severely affected, you may be able to have an operation known as a lumbar sympathectomy. This involves cutting nerves in your back that control blood vessel narrowing in your legs.

Does Raynaud's phenomenon run in families?

Answer

Yes, primary Raynaud's phenomenon may be hereditary.

Explanation

If your parents or other family members have primary Raynaud's phenomenon, you may be more likely to have it yourself. Inherited Raynaud's is often a fairly mild form of the condition.

Are there any alternative therapies that can help treat Raynaud's phenomenon?

Answer

There isn't enough evidence to say. Several alternative therapies and herbal remedies have been suggested for Raynaud's, but the evidence isn't strong enough for doctors to recommend them.

Explanation

Some research has been carried out into acupuncture for treating Raynaud's phenomenon, but the few studies weren't of a good enough quality for any conclusions to be drawn.

Some people claim herbal remedies can help Raynaud's phenomenon, but there is little evidence to show that they are useful. Examples include:

  • vitamin C
  • vitamin E
  • omega-3 oils
  • evening primrose oil
  • ginkgo biloba

Talk to your GP for advice before you try an alternative therapy or take any herbal remedies for your condition.

If I stop smoking, will Raynaud's phenomenon go away?

Answer

Stopping smoking may help to improve your symptoms if you have Raynaud's phenomenon and will benefit your health in general too.

Explanation

Smoking is thought to make the symptoms of Raynaud's phenomenon worse by narrowing the blood vessels to your fingers and toes. This reduces the blood supply and makes them turn white. If you stop smoking, your blood vessels won't become so narrow and this will reduce the symptoms of Raynaud's. Stopping smoking won’t completely stop Raynaud’s phenomenon from happening, but it’s likely to help improve your symptoms. You will also improve your general health.

Can I still drive if I have Raynaud’s phenomenon?

Answer

Yes, you can drive if you have Raynaud’s phenomenon. However, if your symptoms are severe and affect how well your hands and feet work, you may have to take extra measures to warm them before you can control your vehicle properly.

Explanation

Although there are no specific guidelines from the Driver and Vehicle Licensing Agency (DVLA) about driving and Raynaud’s phenomenon, all drivers are required to be in full control of their vehicles, even if they have a health problem. If your symptoms of Raynaud’s are severe enough to affect the function of your hands or feet, driving may be more difficult or even dangerous. You can take steps to help prevent a severe episode of Raynaud’s, including:

  • keeping your whole body warm, not just your hands and feet
  • wearing gloves, warm socks and a hat in cold weather
  • not smoking
  • using a relaxation technique if your symptoms are made worse by stress

When you are going to drive, it may help to:

  • wear suitable driving gloves
  • use a steering wheel cover or heated steering wheel cover
  • keep the heating on in the car
  • keep your fingers and toes moving when your vehicle is stationary and it’s safe to do so, by flexing your hands and feet

In addition, some of the medicines you may be given to treat Raynaud’s phenomenon, such as nifedipine, may affect your ability to drive or operate machinery. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

If you’re in any doubt that you’re in full control of your vehicle, don’t drive.