Raynaud's disease

causes

General: Raynaud's attacks are caused by exposure to cold temperatures or emotional stress or anxiety.
Raynaud's disease (primary Raynaud's): The exact cause of Raynaud's disease, (also called primary Raynaud's) remains unknown. It has been suggested that genetics may play a role in the development of the disorder. Activities that put stress on the hands, such as playing the piano, typing, or frequently using vibrating tools (such as construction equipment), may increase an individual's risk of developing the disease.
Raynaud's phenomenon (secondary Raynaud's): Raynaud's phenomenon, also called secondary Raynaud's, is a symptom of an underlying medical condition. For instance, Raynaud's phenomenon occurs in most people who have scleroderma, a rare autoimmune disorder and connective tissue disease that causes the skin to become thick and hard. Scleroderma occurs when a patient's immune system does not function properly. Normally, the immune system helps fight against diseases and infections. In scleroderma patients, the immune system attacks the person's own cells. Because scleroderma often causes the blood vessels in the hands and feet to become thick and constrict easily, it commonly causes Raynaud's phenomenon.
In addition, Raynaud's phenomenon often occurs in patients with lupus, another autoimmune disease. Lupus affects many parts of the body, including the joints, skin, organs, and blood vessels. As a result, Raynaud's phenomenon often develops.
Raynaud's phenomenon may be caused by another type of autoimmune disorder called rheumatoid arthritis. Unlike other types of arthritis, rheumatoid arthritis involves an overactive immune system. Rheumatoid arthritis is also considered an inflammatory condition because it causes pain, swelling, and joint stiffness.
Other common medical conditions that may cause Raynaud's phenomenon include Sjogren's syndrome, diseases of the blood vessels (such as atherosclerosis or Buerger's disease, or primary pulmonary hypertension), carpal tunnel syndrome, underactive thyroid, prior injuries to the hands or feet (such as a broken wrist), and repetitive trauma that damages nerves serving blood vessels in the hands and feet.
Smoking may also cause Raynaud's phenomenon. Smoking constricts the blood vessels, making individuals more susceptible to the condition.
Some medications, including beta-blockers, birth control pills, chemotherapy drugs, medications that contain ergotamine, drugs that cause the blood vessels to narrow, and some over-the-counter cold medications, may contribute to the development of Raynaud's phenomenon. However, once the medication is stopped, symptoms will go away.
A chemical used to make plastic, called vinyl chloride, may be associated with Raynaud's phenomenon. Some workers in the plastics industry who are exposed to this chemical have developed scleroderma, which often causes Raynaud's phenomenon.

diagnosis

General: If Raynaud's disease is suspected, the doctor may perform a cold-stimulation test during a physical examination. During this test, the doctor may expose the patient to cold air or cool water to try to cause an episode of Raynaud's. Most doctors are able to make a diagnosis after observing the patient's symptoms in response to the test.
Nail fold capillaroscopy: To distinguish between primary or secondary Raynaud's, a doctor may perform a nail fold capillaroscopy. During the test, the healthcare provider uses a microscope to look at the skin at the base of the fingernail. If the small blood vessels, called capillaries, are enlarged or deformed, it usually indicates that another health problem is causing symptoms of Raynaud's. However, some secondary diseases cannot be detected with this test. If the healthcare provider suspects that another medical condition, such as a connective disuse or autoimmune disease, is causing Raynaud's, a fluorescent antinuclear antibody (FANA) test or erythrocyte sedimentation rate (ESR) test may be recommended.
Fluorescent antinuclear antibody (FANA) test: A blood test, called a fluorescent antinuclear antibody (FANA) test, may be performed if an autoimmune disorder is suspected. Raynaud's phenomenon is commonly associated with autoimmune disorders such as scleroderma or lupus. This test detects abnormal antibodies called autoantibodies. These autoantibodies bind to components of an individual's cells and cause the immune system to attack the body. If autoantibodies are present, this suggests that the patient has an autoimmune disorder. However, this test does not determine the specific type of autoimmune disorder that the patient has.
Erythrocyte sedimentation rate (ESR): An erythrocyte sedimentation rate (ESR) test may be conducted to measure and monitor inflammation associated with autoimmune disorders. This blood test measures the rate in which red blood cells settle in unclotted blood.
During an inflammatory response, the high proportion of fibrinogen in the blood causes red blood cells to stick together. The red blood cells form stacks called rouleaux, which settle faster than normal. Elevated levels usually occur in patients who have autoimmune disorders.
An ESR test does not suggest a specific diagnosis. However, an increased rate may indicate an underlying inflammatory or autoimmune disease.

signs and symptoms

General: Symptoms of Raynaud's disease occur in response to cold temperatures or emotional stress or anxiety. The fingers and toes are most likely to be affected. However, other parts of the body, including the nose, ears, tongue, and cheeks, may also be affected. Symptoms depend on the frequency, duration, and severity of the blood vessel constrictions that cause this condition. An episode may last anywhere from less than one minute to several hours. Over time, episodes may become more severe. Once the affected body parts are warmed or stress is reduced, the symptoms will start to go away.
Common symptoms: Cold temperatures or anxiety cause the skin to become white in color. The affected skin may then turn blue and feel cold and numb. The skin may become mildly swollen.
The affected body parts may then start to feel numb, prickly, or sting as they become warmed or as stress is reduced. As circulation improves, the affected skin may turn red, throb, or swell.

complications

General: Since it is rare for Raynaud's disease to become a severe condition, complications are uncommon. Patients who have severe Raynaud's disease should visit their doctors immediately if they develop ulcers or infections.
Deformities: Severe Raynaud's disease may permanently diminish the blood supply to the fingers or toes. As a result, the fingers or toes may become disfigured.
Hearing loss: Some cases of Raynaud's disease are associated with the frequent use of vibrating equipment, such as chain saws. In such cases, individuals may also have an increased risk of experiencing hearing loss as a result of the loud vibrating equipment. However, Raynaud's disease itself does not appear to affect hearing.
Tissue damage and/or infection: In rare cases, a blood vessel may become completely blocked during an episode of Raynaud's disease. This may lead to sores, ulcers, or dead tissue (called gangrene). Patients who develop gangrene may need to have their affected fingers or toes amputated.