What is Raynaud’s?

This disorder is named after the French physician Maurice Raynaud, who first described the condition in the 1800s. According to the National Institute for Clinical Excellence (NICE), the prevalence of Raynaud’s varies widely from 0.5% to 21%, depending on the definition used and geographical location, occurring less frequently in warmer climates.

Raynaud’s is a common condition in the UK, thought to affect up to ten million people. Most cases, that is 80%–90% of diagnosed Raynaud’s cases, are primary rather than secondary Raynaud’s.

What is Raynaud’s?

Raynaud’s is a fairly common condition characterised by an exaggerated reaction to cold temperatures. Little is known about the condition; scientists do not know exactly why Raynaud’s develops in some people, but they do understand how attacks happen.

The disease causes an interruption of blood flow to the fingers, toes, nose and/or ears when a spasm occurs in the blood vessels of these areas. Spasms are caused by exposure to cold or emotional stress. Typically, the affected area turns white, then blue, then bright red over the course of the attack.

Raynaud attacks may last from minutes to hours. In severe cases, the area may develop ulcerations and infections, which can lead to gangrene.

The different types of Raynaud’s

Primary Raynaud’s, which is known as Raynaud’s disease, happens without any other illness behind it and the symptoms are often mild. Primary Raynaud’s is more common in women than in men, it typically develops at a younger age, that is in the second or third decade of life, and it is a lifelong condition, although the symptoms tend to remain stable throughout life, not getting any worse with age.

Secondary Raynaud’s, which is known as Raynaud’s syndrome, or Raynaud’s phenomenon, is caused by another autoimmune condition, such as scleroderma. It is often a condition that attacks the body’s connective tissues, like lupus or rheumatoid arthritis does, and although it is less common than these diseases, it is more likely to cause serious health problems. This can include issues such as skin sores and gangrene. These happen when cells and tissue in the toes and fingers die from lack of blood.

What causes Raynaud’s?

The main triggers of a Raynaud’s attack are exposure to the cold and emotional stress. It occurs more commonly in women, and often presents before the age of 30. Raynaud’s means that the small blood vessels in the extremities such as the hands, feet, fingers or toes are oversensitive to even the slightest changes in temperature, to cold conditions, sometimes to emotional stress, to hormone levels or in some cases by using certain vibrating tools.

Raynaud’s is not contagious and cannot be passed on to others; however, there is evidence that primary Raynaud’s may sometimes be an inherited condition, since multiple cases can arise within the same family.

According to NICE the main risk factors identified for primary Raynaud’s were:

• Female gender.
• Positive family history.
• Smoking.
• Migraine.

Most people will never know what caused them to develop Raynaud’s, although it may sometimes be linked to other underlying health conditions and it is another health condition that causes the blood vessels to overreact, leading to Raynaud’s symptoms.

In teenagers, Raynaud’s is very common, often presenting around puberty. Symptoms do seem to improve as they get older and this may be down to treatment, adjustment in lifestyle or hormonal changes, especially in adolescence.

Babies and young children can also develop Raynaud’s, although it is rare. For many young children diagnosed with Raynaud’s, it is little more than a nuisance. But as it isn’t a common disease at this stage in life, it is always best to ask your doctor for further tests to rule out an underlying cause.

If your child suffers with Raynaud’s, make sure you tell your child’s school about their Raynaud’s diagnosis and how attacks can be avoided. Special allowances may need to be made during outdoor activities and PE in cold weather. Also, a young child with Raynaud’s is more susceptible to hot temperatures, so particular care should be taken when bathing; fill a bath with lukewarm water and top it up with warmer water as their body adapts to it.

The majority of cases of secondary Raynaud’s are linked to autoimmune diseases, meaning that the immune system is overactive, causing it to attack healthy tissues within the body.

These might include:

• Scleroderma – This is an autoimmune condition that affects the skin and connective tissue.
• Rheumatoid arthritis – Which causes joint pain and swelling.
• Sjogren’s syndrome – Where the immune system affects the body’s sweat and tear glands.
• Lupus – Which causes tiredness, joint pain and skin rashes.
• Diseases affecting the arteries, including:
  – Atherosclerosis, meaning the build-up of plaques within the blood vessels that feed the heart.
  – Buerger’s disease, a disorder whereby the blood vessels of the hands and feet become inflamed.

Other factors that may contribute to developing Raynaud’s might include:

• Carpal tunnel syndrome – Which involves pressure upon a major nerve to the hand, the median nerve. This causes numbness and pain, which may then make the hand more susceptible to cold temperatures and episodes of Raynaud’s.
• Repetitive action or vibration – Which may arise from typing, playing the piano or doing similar movements for long periods of time. Using vibrating tools such as jackhammers is also known to increase the risk of developing Raynaud’s.
• Smoking is a factor in developing Raynaud’s as this constricts the blood vessels.
• Injuries to the hands or feet, such as a wrist fracture, surgery or frostbite, can all lead to Raynaud’s phenomenon.
• Certain medications including beta blockers used to treat high blood pressure, migraine medications containing ergotamine or sumatriptan, medications for attention-deficit hyperactivity disorder, certain chemotherapy agents, and other drugs that cause blood vessels to narrow have also been linked to Raynaud’s.
• Primary pulmonary hypertension is a type of high blood pressure that can also be linked to Raynaud’s.

Recently there have been concerns that the COVID-19 vaccines may trigger a Raynaud’s attack; however, there is no evidence that this is the case. Although nerves or stress associated with getting the jab may result in triggering a Raynaud’s attack, the vaccine itself has not been shown to pose a threat to the disorder.

Signs and symptoms of Raynaud’s

A Raynaud’s attack can be very uncomfortable, and sometimes quite painful. It can also make everyday tasks, such as buttoning or unzipping clothing, very difficult. Raynaud’s symptoms generally affect the fingers and toes, but all extremities can be involved, including the hands, feet, ears, nose, lips, tongue and nipples.

Raynaud’s symptoms can include:

• A colour change in the extremities such as the hands or feet, often in response to cold conditions.
• Aching, throbbing, cold and/or numbness in the affected areas, such as the fingers and toes.
• Swelling, tingling and/or pain, especially as the circulation returns to the affected areas.

When our bodies are exposed to the cold, a normal response is for the blood vessels to become narrower. When someone has Raynaud’s, this reaction may be much more extreme.

In people who have Raynaud’s, the small blood vessels in the extremities narrow, limiting blood flow for brief periods of time, which is also known as vasospasm, and these extremities are oversensitive to changes in temperature or stress. During such episodes of vasospasm, the skin is deprived of oxygen and might turn pale and take on a bluish colour. When the blood vessels relax and the blood flow resumes, the skin might further turn red.

Signs that you may be suffering from Raynaud’s can include:

• Your fingers or toes may be sensitive to the cold, such as holding an iced drink or air conditioning causing your fingers or toes to hurt.
• Your fingers change colour (white, blue, red and purple) in response to temperature change such as putting your hands in the freezer or in stressful situations.
• You get numbness or pain in the affected area when it changes colour.
• You feel stinging or throbbing when the affected area warms up.
• You have developed sores and/or ulcers on your fingers or toes.

How serious is Raynaud’s disease?

Raynaud’s disease, that is primary Raynaud’s, is not a serious threat to a person’s health, but can be annoying to live with, because it can be difficult for people to use their fingers. People with primary Raynaud’s often go for long periods without any symptoms, and the condition can be manageable so there may be few or no repeat occurrences.

Secondary Raynaud’s can severely restrict the blood supply, so it carries a higher risk of complications, such as ulcers, scarring and even tissue death (gangrene) in the most serious cases. The symptoms of dry gangrene normally begin with a red line on the skin that marks the edges of the affected tissue. The tissue becomes cold and numb, and can be painful as the tissue dies. However, many people, particularly the elderly, experience no sensations. The affected area changes colour from red, to brown, to black. The dead tissue will then shrivel up, separate from the healthy tissue and fall off.

These complications normally require admission to hospital, where a patient will be given medication designed to thin their blood, which should help to restore blood flow. If they fail to respond to treatment, they may need surgery to unblock or repair damaged blood vessels. However, these severe complications are extremely rare.

Treatment and diagnosis for Raynaud’s

A General Practitioner (GP) can usually diagnose Raynaud’s after an examination of your symptoms and by performing some blood tests. To test for Raynaud’s, they may place your hands in cold water or cool air to see if you are showing any of the symptoms of Raynaud’s. The GP may also recommend further testing to find out whether you have primary or secondary Raynaud’s.

Secondary Raynaud’s may require additional treatments and, in some cases, referral to a specialist. If an occupational cause for Raynaud’s is suspected, you should ask for a referral to an occupational medicine specialist or vascular clinician with expertise in this area.

Because primary Raynaud’s is not connected to any underlying health issues, it is usually possible to manage the symptoms without too much disruption to daily life.

Most people are able to treat this themselves by:

• Keeping the whole body warm, especially the hands and feet.
• Wearing gloves and warm footwear in cold weather.
• Wearing lots of layers to keep as warm as possible.
• Keeping warm with the help of hot drinks and food.
• Quitting smoking which will improve circulation and should help to improve symptoms.
• Exercising regularly, as this helps to improve circulation and reduces stress levels.
• Minimising stress levels. Regular exercise, eating a healthy diet, and relaxation techniques, such as deep breathing or activities such as yoga, can help.
• Avoiding stimulants such as nicotine and caffeine, for example coffee, tea etc.
• Avoiding some medications – decongestants with phenylephrine, diet pills, migraine medications with ergotamine, herbal medications with ephedra, and the blood pressure medication clonidine can all narrow your blood vessels.

There are many things you can do to look after your hands and feet particularly if they are affected by Raynaud’s.

These include:

• Soak your hands or run warm water over them when you feel an attack starting.
• Moisturise your feet as often as you can, ideally three or four times a day, being careful not to leave any cream between your toes. Something quite simple such as aqueous cream or E45® are popular choices. These may be bought at the chemist or may be available on prescription.
• Inspect your feet daily – As you moisturise or put on your footwear, take a note of any changes in the skin and if you are concerned seek medical advice.
• Choose footwear that doesn’t rub and allows plenty of room for adequate socks or tights. A thick sole may help protect against the cold, and the use of a thermal insole is recommended if your footwear can accommodate one.

If you have concerns about your foot health, it is worth asking to be referred to the NHS podiatry services for a full podiatric assessment or to seek help from a chiropodist or podiatrist.

Some GPs may prescribe Nifedipine if the symptoms don’t improve through self-help. Nifedipine is the only medicine licensed to treat Raynaud’s in the UK; it doesn’t cure Raynaud’s but can help to relieve the symptoms. Nifedipine is a calcium channel blocker which is a type of medication that encourages the blood vessels to widen.

Depending on the pattern of the symptoms and how well the person responds to treatment, they may be asked to take the medication every day or, alternatively, they may only need to take it as prevention, for example during a sudden snap of cold weather.

Side effects are common with Nifedipine and these include:

• Oedema – Swelling of certain parts of the body, such as your hands and feet, due to a build-up of fluid.
• Headaches.
• Heart palpitations.
• Dizziness.
• Constipation.

People are advised when taking Nifedipine, not to drink grapefruit juice as this could make the side effects worse.

Although not licensed in the UK to specifically treat Raynaud’s, GPs have been known to prescribe alpha-blockers such as Prazosin, or other drugs which include Fluoxetine and Losartan when treating Raynaud’s.

Botox® injections are currently being explored for their application to Raynaud’s. Studies to date are few and small in their samples, but the results are promising. Botox works to block the nerves to prevent the vasospasms involved in Raynaud’s attacks from occurring.

As a treatment, surgery for Raynaud’s is rare and it is normally only recommended if the symptoms are so severe that there is a risk that the affected body part, such as the fingers or toes, could lose their blood supply and begin to die.

Can Raynaud’s be prevented?

For most people with Raynaud’s, avoiding getting cold prevents attacks and keeps symptoms under control. There are also a series of preventive measures that can be adopted to avoid the occurrence of Raynaud’s.

The main ones include:

• Wearing thermal fabrics.
• Eating a healthy, balanced diet.
• Using hand warmers or electric gloves.
• Caring for your feet and skin to prevent sores, ulcers and infection.
• Smoking cessation.
• Practising relaxation techniques to help you avoid attacks of Raynaud’s triggered by stress.
• Change of job, if required.
• Avoiding sympathetic stimulants, that is stimulants that cause vasoconstriction of most blood vessels, including those in the skin.

Final thoughts

For anyone who may be suffering from or who may know someone who is suffering from Raynaud’s, there is support, advice, information and connection with others who may be in a similar situation available from Scleroderma & Raynaud’s UK (SRUK), telephone: 020 3893 5998 or free helpline: 0800 311 2756.