Raynaud’s phenomenon is a common condition that affects the blood supply to the fingers and toes (but can include the tip of the nose, lips and ears)
Raynaud’s is usually triggered by cold temperatures or anxiety. The condition occurs because the blood vessels go into spasm, which blocks the flow of blood.
This causes the affected area to initially become white, then blue and then red, once the blood flow returns. Numbness, pain, and pins and needles may accompany the colour changes. The symptoms of Raynaud’s can last from a few minutes to several hours.
Primary Raynaud’s (PRP) means that it occurs in isolation and is not associated with another disease – this is the common variety and affects up to 5% of the population. It is more common in young women. Secondary Raynaud’s (SRP) is the type that occurs with other disease like Rheumatoid arthritis, SLE (systemic lupus erythematosis) or scleroderma. Raynaud’s often one of the earliest manifestations in patients with autoimmune rheumatic disease.
The clinician must perform a comprehensive clinical assessment with investigations to distinguish between primary and secondary Raynaud’s, as both the prognosis and treatment of these may differ significantly. The autoantibody blood test is very important. SRP is often more severe and may require intensive drug treatment.
First-line treatment for Raynaud’s is a calcium channel blocker (for example nifedipine) other agents that can be used include angiotensin-II receptor antagonists (for example losartan) and selective serotonin receptor antagonists (for example fluoxetine) Phosphodiesterase type 5 inhibitors for example viagra) are increasingly being used to treat connective tissue disease-associated Raynaud’s (SRP)
Intravenous prostanoid therapy (iloprost) should be considered in severe Raynaud’s and digital ischaemic complications.
Botulinum toxin injection and digital sympathectomy have also been used in patients with connective tissue disease – associated Raynaud’s; however, further research is needed in this area.
Non Drug treatment
Keep warm (thermals)
Avoid sudden temperature changes
Avoid vibrating tools
Avoid migraine headache drugs
Avoid beta blockers
Avoid weight reducing drugs