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Monday Medial: Understanding Raynaud’s Phenomenon

Lindsey Reznicek
UCHealth Yampa Valley Medical Center

It’s normal for fingers and toes to turn a blueish color when they are cold. By decreasing blood flow to your hands and feet, your body is able to keep the core warmer.

But, if you notice a “tri-color” change, it’s a signal you may have Raynaud’s Phenomenon.

“Raynaud’s Phenomenon is a reversible constriction of the peripheral arteries that, upon cold exposure, leads to color changes in the fingers and toes,” said Dr. Nicole Cotter, a rheumatologist at UCHealth Rheumatology Clinic in Steamboat Springs. “It is very different than simply having cold hands or feet.”



Identifying Raynaud’s Phenomenon

Raynaud’s Phenomenon presents as a tri-color change in the skin.

“The fingers, or digits, turn white as the blood vessels constrict, then blue due to lack of oxygen in the blood. They then turn red when the blood flow returns to the digits,” said Cotter. “It is very visually dramatic. The difference from normal tissue color to the stark whiteness of a Raynaud’s Phenomenon digit is unmistakable.”



Pain and numbness often accompany the color changes in the fingers. Raynaud’s Phenomenon can also occur in the toes. Less commonly, it can occur in the ears, nose, skin over the knees and even the nipples of breastfeeding mothers.

The condition is usually chronic, but episodic, with most attacks lasting only a few minutes. Raynaud’s Phenomenon is more common in those who have first-degree relatives like a parent, sibling or child with the condition.

Primary vs. secondary

Raynaud’s Phenomenon can be diagnosed as a primary or secondary condition. Primary Raynaud’s Phenomenon occurs in the absence of an underlying medical problem, while Secondary Raynaud’s Phenomenon is associated with a larger medical problem, like lupus or scleroderma.

“While it can be painful and disruptive, primary Raynaud’s Phenomenon is not serious and will not cause damage to the body,” said Cotter. “Secondary Raynaud’s Phenomenon has the potential to be serious because it can lead to tissue damage, such as ulcers on the fingertips.”

Primary is more common in women and usually starts in the teens or 20s. Secondary may be suspected if a person is older than 40 years of age when they develop Raynaud’s Phenomenon or if the person is male.

Treatment

Raynaud’s Phenomenon can typically be managed with a conservative approach.

“The best treatment is avoidance of triggers, such as cold exposure,” said Cotter. “Wear gloves and use hand warmers. Let someone else get things out of the freezer. Use insulated drinking glasses.”

Medications may be prescribed to cause vasodilation, or a widening of blood vessels to allow for increased blood flow, or to better dilate blood vessels. In severe cases, a surgery to cut the nerves responsible for the constriction of the peripheral blood vessels may be discussed.

Seeking care

If you think you may have Raynaud’s Phenomenon, talk to your doctor about your symptoms. Cotter recommends taking pictures during the next attack.

“This can be really helpful as you may not have an attack during your appointment,” she said. “Seeing the tri-color presentation can aid in a possible diagnosis.”

If there is a suspicion of secondary Raynaud’s Phenomenon, you may be referred to a rheumatologist for further evaluation.

“Raynaud’s Phenomenon is common in patients who have rheumatic diseases,” said Cotter. “Don’t panic. Most of the time it’s primary and there’s nothing to worry about. If it’s secondary, we can work together to determine what lifestyle modifications or next steps to take.”

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