Brief overview
- Symptoms: Attack-like circulatory disturbances in the fingers and sometimes the toes with discoloration of the affected areas from pale to blue to red, in some cases with insensations, numbness and pain.
- Causes and risk factors: Possible causes are disorders of the blood vessels, nerve activity or hormone balance as well as other underlying diseases; important triggers are stress and cold.
- Treatment: Stress reduction, heat, calcium blockers, blood circulation-enhancing drugs and ointments, in particularly severe cases surgical interventions
- Prognosis: Depending on the cause, as long as there is no other underlying disease, usually good.
- Diagnosis: Diagnosis is based on characteristic symptoms and various tests. Further examinations may be necessary to differentiate it from other diseases.
- Prevention: The disease cannot be prevented, but it is advisable for those affected to avoid the known risk factors as much as possible.
Raynaud’s syndrome (Raynaud’s disease) is a circulatory disorder caused by vascular spasms. The spasms occur in attacks mostly in the fingers, less frequently in the toes and other parts of the body. They cause blood vessels to contract and obstruct blood flow to the affected area of the body.
Therefore, a typical symptom of Raynaud’s syndrome is that the fingers (usually with the exception of the thumb) or the toes initially turn pale and later blue during an attack. Because of the onset of pallor, the condition is also known as white finger disease or cadaver finger disease. Many affected persons suffer from insensations and numbness, and pain is also common.
If the spasms persist over a longer period of time in rare cases, the vessels are permanently damaged. In some cases, the tissue sometimes dies – necroses form. However, such damage usually occurs only as complications of secondary Raynaud’s syndrome.
If Raynaud’s syndrome is the result of scleroderma, a hereditary disease of the connective tissue, the skin of the hands, arms or face is also thickened and taut.
Causes and risk factors
Raynaud’s syndrome is caused by very severe and sudden constrictions of the vessels, especially in the fingers and hands, which disappear after some time. The attacks occur especially in cold temperatures and under stress. The cause of this phenomenon is an imbalance of vasodilator and vasoconstrictor factors.
In most people, the cause of Raynaud’s syndrome remains unexplained. In this case, doctors speak of a primary or idiopathic Raynaud’s syndrome. Young women in particular are affected, and there is often a familial predisposition. In the course of life, the attacks usually become less frequent and weaker. Primary Raynaud’s syndrome often occurs more frequently in a family. Smoking in particular promotes the circulatory disorder.
In contrast to primary Raynaud’s syndrome with an unclear cause, secondary Raynaud’s syndrome is the result of a variety of different diseases. These include for example
- rheumatological diseases
- autoimmune diseases, especially connective tissue diseases such as scleroderma or lupus erythematosus
- Diseases of the nerves (for example multiple sclerosis)
- Vascular diseases such as arteriosclerosis
- Diseases of the hematopoietic system
- Cancer diseases
- Carpal tunnel syndrome (pinched nerves in the wrist)
Some medications (contraceptives, cytostatics, interferon, beta blockers, ergotamine preparations and dopaminergic substances) or drugs (cocaine, designer drugs) also cause Raynaud’s syndrome in some cases. People who come into contact with certain chemicals in their jobs (for example, polyvinyl chloride) or who work for long periods of time with vibrating machinery such as jackhammers or power saws also belong to the risk group.
Treatment
Raynaud’s syndrome therapy is initially based on general measures. It is crucial to avoid triggers of the attacks, i.e. above all stress and cold. To reduce the frequency of attacks, it may help to avoid cold drinks and foods. When handling cold or frozen foods, it is advisable to wear gloves.
Stress reduction
An essential contribution to an improvement of the symptoms is stress reduction. Learning a relaxation technique such as autogenic training or progressive muscle relaxation is helpful. Sports also help to reduce stress.
Wound care
People with Raynaud’s syndrome should have wounds in the affected areas treated intensively and professionally, as they may heal poorly and thus persist for a long time.
What to do in case of a Raynaud’s attack?
If an attack is imminent, affected persons should wash their hands with warm water. It is also advisable to move and massage the hands so that the vessels quickly dilate again. Sometimes it also helps to put your hands under your armpits to warm them up.
Medication
If the general measures are not sufficient, there is an option to take medication against Raynaud’s syndrome. The administration of medication is particularly useful if the tissue is already damaged and it is therefore especially important to ensure good blood circulation on a permanent basis.
The most important group of drugs for Raynaud’s syndrome are calcium blockers (calcium antagonists). Nitroglycerin, a vasodilator, is also used as an ointment. However, both agents cause undesirable side effects in some people. For example, calcium antagonists cause the fingers to swell in some cases, while a nitro ointment occasionally causes headaches.
A number of other drug groups are available for very severe Raynaud’s syndrome, but not all are specifically approved for Raynaud’s syndrome therapy. The use of these drugs is controversial. This is especially true for antidepressants.
Operations
If Raynaud’s syndrome occurs in connection with work, a change of job or even profession may be necessary.
Course of the disease and prognosis
Primary Raynaud’s syndrome mainly affects women between 20 and 40 years of age. Overall, women are affected about five times more often than men. An estimated three percent of the population exhibit the typical symptoms of primary Raynaud’s syndrome. Although primary Raynaud’s syndrome is disturbing and unpleasant, it is harmless and usually has little effect on quality of life. As a rule, the symptoms improve over time.
In particularly severe cases, areas of tissue may also die. However, since new vessels form relatively quickly in cases of vascular damage, amputation, for example of the affected fingers, is very rarely necessary in Raynaud’s syndrome.
What is Raynaud’s syndrome?
Raynaud’s syndrome is a vascular disease caused by vascular spasms (vasospasms). The spasms occur in attacks, usually in the fingers, and less commonly in the toes and other parts of the body. This reduces the blood supply to the affected body region – they become pale and cold, which is why it is also referred to as cadaver finger or white finger disease. The cramps are usually triggered by cold and psychological stress.
Primary Raynaud’s syndrome mainly affects women between the ages of 20 and 40. Overall, women are affected about five times more often than men. An estimated three percent of the population exhibit the typical symptoms of primary Raynaud’s syndrome.
The first point of contact for Raynaud’s syndrome is the family doctor, who may refer the patient to a rheumatologist. As a rule, a detailed description of the symptoms is sufficient to establish the diagnosis of Raynaud’s syndrome.
The medical consultation provides important information about the type and cause of Raynaud’s syndrome. During the interview, the doctor will ask the following questions, among others:
- Is there sudden discoloration of the hands, possibly associated with pain?
- Do the symptoms occur symmetrically on both hands?
- Do the symptoms occur frequently under stress or in cold weather?
- Are there any changes in the skin or nails?
- Are there any known previous diseases?
- Are there similar cases in the family?
The Allen test is used to examine the arteries that supply blood to the hand. The physician compresses one of the two arteries in turn and checks whether the artery that is open in each case supplies the hand with sufficient blood. If the hand becomes pale during compression, the artery that is not squeezed is probably occluded.
By means of a cold provocation test, the physician determines whether cold is a possible trigger of an attack. To do this, the affected person immerses his or her hands in ice water for about three minutes. This test is controversial, however, because the attacks cannot be reliably triggered in this way.
If Raynaud’s syndrome is suspected, it is also important to inspect the hands. The physician looks for wounds and tissue damage such as dead areas on the fingertips, so-called rat bite or fingertip necrosis. In addition, the physician looks for changes in the nail.
Diagnosis of primary Raynaud’s syndrome
- Both hands are affected.
- The attacks occur mainly during cold or stress.
- Tissue damage is present.
- Symptoms have been present for over two years without an underlying disease being identified.
- Further examinations are unremarkable.
A primary form of Raynaud’s syndrome is also indicated if the affected person is young (under 30) and female or also suffers from migraine or a special form of heart disease (Prinzmetal’s angina). Both diseases are based on spasms of certain blood vessels.
Diagnosis of secondary Raynaud’s syndrome
The criteria that indicate the presence of secondary Raynaud’s syndrome are:
- Only one hand is affected.
- The tissue in the affected regions is damaged.
In order to reliably differentiate Raynaud’s syndrome from other diseases with partly similar symptoms, a number of further examinations are possible.
Capillary microscopy
During a capillary microscopy, the physician examines the smallest vessels (capillaries) of the hands. This can be used, for example, to determine scleroderma as the cause of secondary Raynaud’s syndrome. This disease is associated with giant capillaries, vascular-free regions and minor bleeding.
Blood tests
Blood tests reveal other conditions that sometimes result in secondary Raynaud’s syndrome. For example, blood counts, inflammation levels, and the detection of certain antibodies are important. These include so-called ANA and anti-DNA antibodies, which are typical for the rare immune disease lupus erythematosus.
Imaging procedures
It is important to rule out other conditions that present with symptoms similar to those of Raynaud’s syndrome. These include blood clots (embolisms) and peripheral arterial occlusive disease (pAVK), in which blood vessels become blocked. In addition, so-called isolated acrocyanosis is accompanied by a painless blue discoloration of the hands. An at first sight disturbing but harmless condition are spontaneous bruises on the finger (the so-called spontaneous finger hematoma).
