Contents:

Fingers or toes may feel cold in low temperatures — this is a normal reaction of the body to the cold. However, if they suddenly turn pale, become numb or hurt, and such episodes recur, these changes are worth paying attention to.

In this article, we will discuss what Raynaud's disease is, why it occurs and how it manifests. We will also explain how the primary and secondary forms differ, which tests help establish a diagnosis and what can be done to reduce the frequency of attacks.

What Is Raynaud's Disease

Raynaud's disease is a disorder of the regulation of small artery tone in which the arteries narrow excessively in response to cold or emotional stress. As a result, blood supply to the fingers and toes temporarily decreases. This is the name given to the primary form of Raynaud's phenomenon: it occurs without an identified underlying disease, usually has a relatively mild course and does not cause lasting tissue damage.

The disease described by the French physician Maurice Raynaud was named in his honor. Its manifestations are primarily associated with blood vessel spasms rather than permanent blockage of the vessels.

According to National Institute of Arthritis and Musculoskeletal and Skin Diseases, the condition most often affects the fingers and toes. Vascular attacks occur less often in the nose or ears.

Causes and Risk Factors of Raynaud's Disease

The exact cause of the primary form has not been fully established. Its development is linked to an excessive response of blood vessels to cooling and emotional stress. It occurs more often in women and begins between the ages of 15 and 30. A family predisposition also increases the risk. At the same time, cold or stress are factors that trigger an attack, not a proven sole cause of the disease.

An episode may be triggered by:

  • being outdoors in cold weather;
  • contact with cold water or frozen foods;
  • moving suddenly from a warm room into a cool one;
  • being in a stream of cold air from an air conditioner;
  • intense worry or other emotional stress.

Symptoms do not require prolonged exposure to freezing weather. Sometimes brief contact with a cold object or general cooling of the body is enough. Nicotine also narrows blood vessels and may intensify attacks.

If changes in blood supply are associated with another condition, medication or occupational exposures, this is a secondary phenomenon. We will discuss its causes in the section on Raynaud's syndrome.

Symptoms of Raynaud's Disease

Raynaud's disease is characterized by recurring attacks that occur after exposure to cold or stress and gradually pass after warming. They are accompanied by changes in the color and sensation of the fingers or toes. Episodes may last from a few minutes to a few hours. In the primary form, the fingers or toes return to their usual state between attacks, and the symptoms on both hands are often similar.

Symptom intensity may vary even in the same person. It is important to pay attention to the duration of episodes and whether they have become more frequent or more painful.

Why Fingers Turn White

During an attack, fingers turn white because a spasm of small arteries reduces the amount of blood reaching the skin. The pale area often has a distinct border and may involve one or several fingers.

The skin may then take on a bluish color because the oxygen content in the blood of the affected area decreases. When the vessels widen and blood flow returns, the fingers may become red. However, the sequence “white — blue — red” does not occur in everyone.

Doctors at Oxford Medical recommend photographing changes in finger color whenever possible. A photo will help during the consultation if the attack has already passed by the time of the examination.

Other Symptoms of Raynaud's Syndrome

In addition to a change in skin color, a vascular attack may cause:

  • a feeling of cold in the fingers or toes;
  • numbness or reduced sensation;
  • tingling;
  • pain of varying intensity;
  • burning or throbbing as blood flow returns.

Raynaud's disease in the feet primarily affects the toes. Discomfort can make walking more difficult, especially when outdoors in the cold.

These sensations can occur in both the primary and secondary forms. On their own, they do not establish the cause of the condition.

If pain or coldness persists between attacks, other causes must be ruled out, including diseases of the arteries in the limbs. A persistent blood supply problem requires a comprehensive evaluation.

Raynaud's Syndrome

Raynaud's syndrome

Raynaud's syndrome is often used to describe the secondary form of the condition, which develops in the setting of another disease. In this case, vascular attacks are one of its manifestations.

What Is Raynaud's Syndrome

In secondary Raynaud's syndrome, the impaired blood supply to the fingers or toes is linked to an underlying disease that affects the blood vessels or the regulation of their tone. Most often, these are autoimmune connective tissue diseases. Treatment involves controlling vascular attacks and treating the underlying disease.

Causes of secondary Raynaud's syndrome may include:

  • Autoimmune diseases. In particular, systemic lupus erythematosus, Sjögren's syndrome and inflammatory muscle diseases.
  • Consequences of injuries or frostbite. Tissue damage can change how blood vessels respond to cold.
  • Use of certain medications. Some migraine medications, stimulants and certain drugs used to lower blood pressure can cause or worsen vascular spasms.
  • Prolonged exposure to vibration. For example, when working with jackhammers or other vibrating tools.

One of the diseases the doctor considers when secondary Raynaud's is suspected is systemic sclerosis. Vascular attacks sometimes precede its other manifestations. At the same time, the presence of Raynaud's phenomenon does not mean that a person necessarily has or will later develop this disease.

Primary and Secondary Raynaud's Syndrome

The primary form occurs without an identified underlying disease. In the secondary form, vascular symptoms are associated with another condition or an external influence. Additional differences are shown in the table.

Feature Primary form Secondary form
Onset of symptoms More often in adolescence or young adulthood. May occur at an older age.
Symmetry Often affects both hands in a similar way. Marked asymmetry is possible.
Course of attacks Usually relatively mild. Attacks may be longer and more painful.
Nailfold capillaroscopy Usually without changes characteristic of systemic diseases. Characteristic capillary changes may occur, depending on the cause.
Associated symptoms Signs of an underlying systemic disease are absent. Finger swelling, skin thickening, a rash or joint pain may occur.

No single feature confirms the form of the condition. A conclusion is reached based on the combination of symptoms, examination findings and test results.

Raynaud's Syndrome in Children

Manifestations of Raynaud's disease and syndrome more often appear during adolescence, predominantly in girls. They occur less often in young children. Usually, the attacks are not associated with another disease and have a relatively mild course. However, the secondary syndrome can occur in childhood as well, so recurring changes in finger color require a doctor's assessment.

Children do not always have the successive color changes “white — blue — red”: their fingers may only turn pale or blue. Because of this, the symptoms are sometimes mistaken for a normal reaction to cold and are not noticed immediately.

It is important to monitor not only the attacks but also the child's overall well-being. If joint pain, a rash, finger swelling or muscle weakness appears, further testing is needed. If there are signs of a possible secondary form, the child should be monitored by a pediatric rheumatologist.

Diagnosis of Raynaud's Disease

To establish the cause of vascular attacks, a consultation with a rheumatologist is necessary. The doctor asks when the symptoms first appeared, what triggers them and how long they last. During the examination, the doctor assesses the condition of the skin and blood supply to the fingers or toes and considers any associated complaints. This helps determine whether the condition occurs on its own or may be linked to another disease.

Based on the consultation, the following may be ordered:

  • Nailfold capillaroscopy. Examination of the small vessels at the base of the nails helps identify changes characteristic of some connective tissue diseases.
  • Autoantibody tests. In particular, antinuclear antibodies — ANA — are measured to assess a possible autoimmune cause of the symptoms.
  • Tests for markers of inflammation. For example, erythrocyte sedimentation rate — ESR.
  • Thyroid function tests. These are ordered if there is reason to suspect a problem with thyroid function.

There is no single test that confirms Raynaud's disease. The doctor evaluates test results alongside symptoms and examination findings. In particular, a positive ANA result alone does not mean that an autoimmune disease is present.

It is worth bringing previous medical reports, a list of the medications you take and photographs of finger color changes, if you managed to take them, to the consultation.

Doctors at Oxford Medical note that the list of tests depends on the clinical situation. If new symptoms appear or attacks become more frequent or more painful, you should see a specialist again.

How to Treat Raynaud's Syndrome

How to treat Raynaud's syndrome

The aim of treatment is to reduce the frequency and severity of attacks and prevent tissue damage. In mild cases, protection from the cold and changes in habits may be enough. If symptoms remain significant, the doctor prescribes medication to improve blood flow. In the secondary form, the underlying disease is treated at the same time, and wound care is also provided if ulcers develop.

For prevention, it is important to wear warm gloves and socks, avoid sudden temperature changes and protect your hands when handling cold foods. Quitting smoking also helps reduce vascular spasms. Excessive caffeine consumption may trigger symptoms.

Doctors at Oxford Medical recommend keeping a brief record of attacks: note their duration, a possible trigger and what helped ease them. This will help assess whether preventive measures are sufficient and whether the prescribed treatment is working.

If symptoms substantially interfere with daily life, the doctor may prescribe calcium channel blockers, such as nifedipine or amlodipine. They widen blood vessels but can cause dizziness, headache and low blood pressure, so the medication and dose are selected individually. In severe ischemia — a pronounced lack of blood supply — other vasodilators and intravenous treatment in a hospital may be needed.

Which Doctor Treats Raynaud's Disease

A rheumatologist is the relevant specialist. This doctor identifies the form of the condition, assesses a possible connection with autoimmune diseases and selects treatment. A child is seen by a pediatric rheumatologist if necessary. If there are signs of damage to larger vessels, severe ischemia or tissue damage, other specialists are involved in the evaluation and treatment.

If impaired arterial blood flow is suspected or surgery may be needed, a vascular surgeon is required. A consultation with this specialist is not necessary for every person with Raynaud's phenomenon.

Possible Complications of Raynaud's Disease

If the diagnosis is specifically primary Raynaud's disease, ulcers and tissue death are not typical of it. Such complications are possible mainly in severe secondary cases, when blood supply is significantly impaired. Therefore, the appearance of wounds or persistent skin changes requires an urgent examination and a reassessment of the cause of symptoms, even if previous attacks resolved on their own after warming.

Consequences of severe ischemia may include ulcers on the fingertips, infection of the ulcers and necrosis — tissue death.

Seek medical attention without delay if:

  • a finger remains pale or bluish despite warming;
  • pain suddenly becomes worse or constant;
  • an ulcer, an infected wound or a black area of skin appears.

Sudden coldness of a hand or foot with severe pain and loss of sensation may indicate an acute disruption of blood supply. Emergency medical care is needed in this situation.

The information in this article is provided for informational purposes and is not an instruction for self-diagnosis or self-treatment. If symptoms of a disease appear, you should consult a doctor.

Sources: