Raynauds is a disorder of the circulation, leading to colour changes in the extremities (fingers, toes and sometimes the nose) when exposed to temperature changes or stressful situations. The blood vessels supplying the area are very sensitive to changes in temperature and temporarily constrict (close down) too much in the cold, this causes the extremities to become very pale and white, then blue (cyanosed), when the digits are returned to the warmth they can become red, tingling, and uncomfortable.

In 90% of cases it occurs on its own.  This is called Primary Raynaud’s phenomenon and is common, particularly in young women and teenage girls, as many as 10million people in the UK live with this condition. Primary Raynuads is generally managed by your GP.

More rarely it is associated with autoimmune conditions such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis, Scleroderma, or Sjögren’s syndrome. This is called Secondary Raynaud’s phenomenon. Secondary Raynaud’s phenomenon can occur at any age and can precede the associated rheumatic condition by many years. These are the patients we tend to review in our CTD clinic.

Symptoms of a Raynauds attack:

• At first the fingers go white and cool. This happens because the small blood vessels become narrow (constrict) and blood supply is reduced
• The fingers then turn a blue colour. This occurs because the oxygen is used up quickly from the blood in the narrowed blood vessels.
• When the person warms their hands they can turn reddish. This happens because blood vessels open up again (dilate) and the blood flow returns. This may cause tingling, throbbing, numbness and pain.
• In severe secondary Raynaud’s, ulcers can develop in the fingers and toes due to the blood vessels remaining constricted and cutting off the blood supply to small areas of the skin. This can happen if the fingers remain white for longer than 15 minutes.

You may not experience all three phases of an attack. We encourage patients to monitor the white phase of an attack and alert us if this is lasting longer than 15 minutes. You may also experience cold feet.

A diagnosis can be made based on your symptoms. Typically, white, blue and red colour changes are observed in the fingers in response to cold exposure. The doctor may order other tests if they suspect it is secondary Raynaud’s. These tests include investigations to look for other autoimmune diseases such as SLE. In some hospitals a microscope camera can be used to look at the nailbed, this is called capillaroscopy. These can tell if there are abnormal blood vessels suggesting a secondary cause.

There are many self-management techniques we encourage such as keeping warm, stopping smoking, reducing stress, layering up of clothes, wearing gloves when driving, going to the supermarket etc, utilising hand and feet warmers. Our CTD nurse can provide education on self-management and prevention and management of digital ulcers.

Handy Hints on Keeping Warm - Scleroderma & Raynaud's UK (pdf)

In some cases medication is required to manage Raynauds attacks. Most of these work by making the blood vessels wider (dilation). Examples are Nifedipine and Amlodipine. In severe cases, particularly if frequent digital ulcers are occurring we may need to give an intravenous infusion called Iloprost.

Published: 13/10/2022 14:53