Raynaud’s
Raynaud’s is a phenomenon that was discovered by a Parisian physician called Maurice Raynaud in the late nineteenth century. It is a phenomenon that can be experienced as an independent entity (primary) or because of another disease process (secondary). (1)
We know Raynaud’s is a complex condition that is commonly experienced in the hands and feet of patients. We understand the condition to be a complicated combination of abnormalities in the blood vessel walls and the way the brain controls the vessel walls and circulatory factors. (3)
Treatment of Raynaud’s varies depending on whether the condition is primary or secondary. Secondary Raynaud’s is heavily related to the initial disease process that is causing the Raynaud’s phenomenon as a subsequent condition. With primary Raynaud’s, there is a combination of self-management techniques, topical and systemic medication and the possibility of surgery with very severe cases. (4)
Frequently Asked Questions
It is not a rare condition. Overall, approximately 4.85% suffer from the condition in the UK, with 5.74% in women and 4.12% in men. (1) In those who experience Raynaud’s phenomenon, around 10-20% experience it as a secondary symptom to an underlying connective tissue disease. One study of 1500 people that have experienced Raynaud’s showed that 89% of those experienced it as primary, with 11% classified as secondary to an underlying cause. (2)
It is estimated that the condition will affect between 4%–7% in the general and older populations, respectively (2). This number is slightly higher in runners, with approximately 8%-10% being affected. (3)
No. There are multiple management routes. It is important to diagnose either primary or secondary Raynaud’s, and the other underlying condition if it is secondary.
Primary Raynaud’s is most common in young women. Commonly associated with family history and smoking. Secondary Raynaud’s is common and secondary to connective tissue disease, such as lupus. (2)
Pale skin at the end of the fingers, often the thumb is not as affected. A clear line distinguishing affected skin and normal unaffected skin. Followed by numbness or pain in the fingers, with potential blueness on the skin. Finally, the fingers become red and warm. Patients can experience a variation of the phases.(1 & 2)
For primary Raynaud’s, lifestyle management, including quitting smoking, can help. (3) Some topical agents can be applied to the skin on the fingers, as well as systemic agents of the same kind, with surgery being an intervention for severe cases. (4) Secondary Raynaud’s often improves with the treatment of the primary cause.
Raynaud’s is a case of lifestyle management and treatments to avoid and prevent symptoms. Attacks can vary in frequency, duration and severity but correct medication and management can reduce all three.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
There are not many signs of primary Raynaud’s as there is little presentation during the event itself. The symptoms of Raynaud’s follow three interchangeable phases and a patient may not experience all three: (4)
Triggers of primary Raynaud’s include:
It is also possible to develop Raynaud’s as a side-effect of beta-blockers, injury via trauma or vibration and extensive use of the fingers. Secondary Raynaud’s, however, is caused by a wide variety of conditions:
This is not an exhaustive list. These factors could increase the likelihood of someone developing Raynaud’s phenomenon. It does not mean everyone with these risk factors will develop symptoms.
A study looking into Raynaud’s phenomenon found that of 1500 people, 89% presented with primary Raynaud’s with the other 11% having an underlying health condition contributing to their experience of Raynaud’s phenomenon. (2,4)
To diagnose Raynaud’s, there will be a series of investigations to identify an underlying cause as to why the individual is experiencing Raynaud’s phenomenon. In young healthy women, there is unlikely to be any discovery from these findings and therefore primary Raynaud’s will be diagnosed. In other instances, a series of blood tests will be taken to investigate underlying conditions. These will include looking for connective tissue diseases, inflammatory diseases and possible diabetes.
Using these tests, with the personal information a clinician has, will help distinguish between primary and secondary Raynaud’s. Information such as age, gender, family history and other symptoms will be used. Often if an individual is healthy, under 30 and a female, primary Raynaud’s will be diagnosed. If an individual is older than 30 and is experiencing other symptoms, as well as the blood tests showing some altered markers, secondary Raynaud’s will be diagnosed with the view to diagnosing the underlying cause, if this has not been done already.(4)
Self-management is an important step towards learning to live with primary or secondary Raynaud’s. Firstly, as smoking is linked heavily to the triggering of this condition, cessation of smoking will help reduce the frequency, duration and intensity of attacks. If persistent vibration is the cause, then a change of profession/ DIY habits may be a vital step in self-management. Finally, being cautious with the cold weather and taking precautions where it is unavoidable, for example wearing gloves or heated mittens, will help. (2)
Given the nature of this condition, no formal rehabilitation is required in order to manage the symptoms.
In terms of prognosis, primary Raynaud’s patients tend to do very well after diagnosis and learning how to self-manage and vasodilatory (widening of the blood vessels) treatments. There is only a 13% chance of developing further complications with primary Raynaud’s, however, it can go into remission. The majority of cases do become stable and over half improve over time.
With secondary Raynaud’s there is a higher risk of further complications, due to the initial underlying condition causing symptoms. Ulceration, scarring or gangrene occur in 17% of secondary Raynaud’s patients as a result of systematic sclerosis (a rare condition that can cause a patient’s skin to harden).
For primary Raynaud’s, there is very little evidence for topical agents working, however, there is evidence for glyceryl trinitrate being used on the fingers itself which brings about a vasodilation effect with few side effects. Nitro-glycerine applied to affected fingers can also reduce the severity but does not affect the frequency or duration of the attacks. (3)
A last-resort treatment for primary Raynaud’s is surgery. This is only considered for severe and disabling symptoms and can include an arterial reconstruction, peripheral sympathectomy, embolectomy or ulcer debridement. (4)
References
Other Conditions in Feet, Neurological, Long Term Conditions
