Raynaud Disease

GENERAL INFORMATION:

What is Raynaud disease?

• Raynaud (ray-NOD) disease is a disorder that affects blood circulation, usually in the hands and feet. This disorder causes the arteries (blood vessels) that carry blood to your fingers, toes, ears, or nose to tighten. This is often triggered by cold or emotional stress. The decrease in blood flow causes lack of oxygen and changes in skin color. Over time, ulcers (sores) or gangrene (tissue death) may develop if frequent or severe attacks are not prevented.
  
  
• Raynaud disease can be primary (no underlying diseases) or secondary (with underlying diseases or causes). Primary Raynaud, also known as Raynaud disease, is more common and is often milder than secondary Raynaud. It often affects women and occurs before the age of 30. Secondary Raynaud, is also known as Raynaud phenomenon.

What causes Raynaud disease?

• Primary Raynaud: The cause of primary Raynaud disease is unknown. This form usually affects both hands and feet.
  
  
• Secondary Raynaud:
  
  
  • Causes: The following may cause you to get secondary Raynaud:
    
    
    • Inflammatory and autoimmune diseases: Secondary Raynaud is commonly associated with certain diseases, such as Scleroderma, Lupus, Sjogren's syndrome, rheumatoid arthritis, and carpal tunnel syndrome
      
      
    • Medicines or illegal drugs: Medicines used to treat high blood pressure, headaches, cancer, or colds may cause Raynaud disease. Use of illegal (street) drugs, such as amphetamines or cocaine, and some herbs may also cause Raynaud.
      
      
    • Trauma or injuries: Long-time use of vibrating tools, such as chain saws, grinders, or drills may hurt nerves or blood vessels. Injuries to the hands or feet, such as a wrist fracture (break), surgery, or frostbite may also cause damage.
    
    
  • Risks: The following may increase your risk of getting secondary Raynaud:
    
    
    • Alcoholic and caffeinated drinks: Alcohol is found in beer, wine, liquor, such as vodka and whiskey, or other adult drinks. Beverages containing caffeine, such as some coffees, teas, and sodas, may also increase your risk.
      
      
    • Chemicals: Being around certain chemicals, such as vinyl chloride, a lot may increase your risk of getting Raynaud disease.
      
      
    • Cigarette smoking: Nicotine, a chemical found in cigarettes, may cause small blood vessels to narrow.

What are the signs and symptoms of Raynaud disease? Your fingers or toes may first turn pale when you are exposed to cold or stressful situations. Due to the decrease in blood supply, your fingers or toes may then turn blue and may feel cold and numb. As blood supply returns to your fingers or toes, they become bright red. This may cause tingling, throbbing, or pain. Additional signs and symptoms may be as follows:

• Primary Raynaud: The color changes usually affect both hands or feet in the same way and at the same time. You may develop thick or tight skin and brittle nails. The structure of nail bed capillaries (small blood vessels) looks normal. Signs and symptoms are generally mild with primary Raynaud disease.
  
  
• Secondary Raynaud: The color changes usually do not affect both hands or feet in the same way or at the same time. The structure of nail bed capillaries (small blood vessels) does not look normal. You may develop thick or tight skin and brittle nails. You may develop skin ulcers. If your fingers or toes go without blood for a long time, your skin may turn black and die. Signs and symptoms are generally more severe with secondary Raynaud.

How is Raynaud disease diagnosed? You may have one or more of the following:

• Angiography: This test looks for problems with your arteries in any of your extremities (hands, arms, feet, and legs). Before the x-ray, a dye is put into a thin tube through a small cut in your groin. The groin is the area where your abdomen (stomach) meets your upper leg. The dye helps the arteries show up better on these x-ray pictures. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Arterial doppler: An arterial doppler test is done to check blood flow through an artery. A small metal disc with gel on it is placed on your skin over the artery. You can hear a "whooshing" sound when the blood is flowing through the artery. An "X" may be marked on your skin where caregivers feel or hear the blood flowing best. Caregivers may need to check blood flow more than once.
  
  
• Nail fold capillary test: Your caregiver may put a drop of oil on your nail folds (skin at the base of the fingernail). The capillaries (tiny blood vessels) will then be checked under a microscope for changes that may suggest certain diseases.
  
  
• X-rays: Pictures of the bones, soft tissues, and other parts of your body may be taken. X-rays may show changes that may help caregivers learn if you have other diseases.

How is Raynaud disease treated? Caregivers may tell you to avoid things or situations that may trigger an attack. If your daily activities are affected and symptoms are hard to control, you may need one or more of the following:

• Medicines:
  
  
  • Alpha blockers: These medicines work by stopping a hormone that tightens blood vessels.
    
    
  • Anti-thrombotics: These are medicines that break apart clots and restore blood flow.
    
    
  • Calcium channel blockers: These medicines relax and open up small blood vessels in your hands and feet. They may also help heal skin ulcers on your fingers or toes.
    
    
  • Vasodilators: These medicines relax and widen the walls of the arteries. This may also help heal skin ulcers.
  
  
• Surgery: A surgery called sympathectomy may be done to make some nerves stop working by cutting them. Sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Surgery may also need to be done if affected parts have become gangrenous. Gangrene is a disease of dead tissue that is due to loss of blood supply.

What can I do to care for my skin if I have Raynaud disease?

• Avoid putting too much pressure on your fingertips, such as using a manual typewriter or playing the piano. This kind of pressure may cause your blood vessels to narrow and trigger an attack.
  
  
• Check your feet and hands daily for numb areas, thinning or thickening skin, black spots, cracks, brittle nails, or ulcers. You should also check for signs and symptoms of infection.
  
  
• Keep your skin clean and dry to keep from getting an infection. Use lotion with lanolin on your hands and feet to keep the skin from drying or cracking.

What can I do to prevent a Raynaud disease attack?

• Avoid cold temperatures when possible: You may wear gloves, scarves, or garments during the winter months or before going into cold rooms.
  
  
• Avoid drinking too much alcohol: Different people have different ideas about what too much means. It is important to remember that how often you drink is as important as how much you drink. Talk to your caregiver if you drink alcohol.
  
  
• Avoid food or beverages that have caffeine: You may drink decaffeinated coffee, tea, or soda pop.
  
  
• Avoid medicines that can trigger an attack: Talk to your caregiver first before using medicines that may trigger an attack. These include certain medicines used for treating high blood pressure, headaches, cancer, or colds.
  
  
• Exercise regularly: This prevents narrowing of the blood vessels and increases blood flow in your body.
  
  
• Learn to control stress: Since stress is hard to avoid, try new ways to relax, such as deep breathing, meditation, or biofeedback. Biofeedback is a special way to control how your body reacts to things like stress or pain.
  
  
• Stop smoking: Stay away from cigarette or tobacco smoke. Talk to your caregiver about information on how to stop smoking if you are having trouble quitting.

What should I do during a Raynaud disease attack? When you are exposed to cold or a stressful situation and an attack begins, always stay calm and relaxed.

• Get inside to warm yourself.
  
  
• Wiggle your fingers or toes, or swing your arms around to increase circulation. Massaging the affected parts may also help.
  
  
• Place your hands under your armpits or run warm water over the affected area. Do not place the affected part in direct contact with hot water or a hot water bottle. This will prevent injury to the affected parts, which may not be able to feel that the water is hot.
  
  
• Get yourself out of the stressful situation if possible. Deep breathing, meditating, or biofeedback may help decrease stress.

Where can I find support and more information? Raynaud disease is a life-changing disease for you and your family. Accepting that you have Raynaud disease may be hard. You and those close to you may feel sad, angry, depressed, or frightened. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group of people who have Raynaud disease. Contact the following for more information:

• American College of Rheumatology
  1800 Century Place, Suite 250
  Atlanta, GA 30345
  Phone: 1-404-6333777
  Web Address: http://www.rheumatology.org
  

• National Institute of Arthritis and Musculoskeletal and Skin Disease
  Information Clearinghouse
  National Institutes of Health
  1 AMS Circle
  Bethesda, MD 20892-3675
  Phone: 1-301-495-4484
  Phone: 1-877-226-4267
  Web Address: http://www.niams.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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