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What is Raynaud's?
Overview
Raynaud's is a vascular disorder commonly found in sclerodema. It is an extreme spasm of blood vessels in response to cold or stress.
The fingers and/or toes become white and/or blue, and may become red on re-warming. (Also see What is Scleroderma?, Types of Scleroderma and Systemic Symptoms)
How do you pronounce "Raynaud's"? Raynard, Raynod, Raynoze, RAYnadds, Raynaws, Raynowds, RAYnoz, Rayners, RP, or Raywhatsit? ISN's Sclero Forums discussion.
Raynaud Phenomenon. Raynaud phenomenon manifests as recurrent vasospasm of the fingers and toes and usually occurs in response to stress or cold exposure. Medscape.
Images of Raynaud's Attacks
All of these pictures of Raynaud's are from our ISN Photo Repository of Scleroderma Symptoms.
Most Raynaud's attacks are not as colorful as the photo at left. Usually attacks cause the skin to go dead white.
Blue phases indicate that at least some blood is getting through, which means blue is better than white when it comes to Raynaud's. However, blue episodes or phases are much more dramatic, attention-getting, and photogenic.
SICK OR CYBERCHONDRIA?
Also, an isolated or very occasional color change due to prolonged or significant cold exposure or consumption of vasco-constrictors (caffeine or nicotine, for example) is possible for even an entirely healthy person. In those cases, it would be wise to wear gloves, keep warm, avoid triggers, and see your doctor if it continues or worsens, or if you develop other symptoms as well.
In between attacks of Raynaud's, the affected areas appear normal.
Sometimes when the circulation returns (which is called "reperfusion") the skin will turn bright pink or red (which is a good thing.)
Because perfusion (and reperfusion) is a good thing, it is only the phase of turning white or blue (or both) that meets the diagnostic criteria for Raynaud's.
ISN Photo Repository: Raynaud's (Alexandra M.) ISN.
ISN Photo Repository: Raynauds (Joyce) ISN.
ISN Photo Repository: Raynauds (Judith). ISN.
ISN Photo Repository: Raynaud's (Judith T.) ISN.
ISN Photo Repository: Raynaud's (Shelly S). ISN.
Gangrene and Amputations. ISN.
ISN Photo Repository: Finger Ulcers. ISN.
ISN Photo Repository (Main Page). ISN.
Raynaud's Disease vs. Raynaud's Phenomenon (or, Secondary Raynaud's)
Raynaud's occurs in 3 to 5% of the general population; however, more than 80% of patients with Raynaud's do not have a connective tissue disease or other serious illness. Scleroderma: Symptoms and Complications. University of Maryland Medical Center.
When Raynaud's appears by itself, without any other medical condition, it is called Raynaud's Disease. When it appears along with autoimmune diseases such as Scleroderma, Systemic Lupus Erythematosus, and Rheumatoid Arthritis, it is called Raynaud's Phenomenon (or, Secondary Raynaud's.)
In primary Raynaud's, the blood vessels return to normal afterwards. However, in Raynaud's with scleroderma there may be blood vessel scarring which can sometimes make medication ineffective. Digital (Finger) Ulcers are caused by the lack of oxygen to skin cells.
Raynaud's and Scleroderma
Just 5 to 20 percent of people with Raynaud's phenomenon subsequently develop scleroderma, but about 90 percent of scleroderma patients experience this extreme cold sensitivity with red/blue flashes in their hands and feet as a primary manifestation of their disease. What Causes Raynaud's? National Heart Lung and Blood Institute. NIH.
Factors influencing Raynaud's condition score diary outcomes in systemic sclerosis. Patient–reported assessment of SSc–RP severity is associated with a number of factors including pain, catastrophisation and coping strategies. PubMed, J Rheumatol, 03/01/2019.
Joint Contractures, Ulcerations, Severe Raynaud’s Linked to Impaired Hand Function in Scleroderma. The presence of moderate or severe small joint contractures, finger ulcerations, and the severity of Raynaud’s phenomenon show the strongest association with impaired hand function in scleroderma patients, a study reports. Scleroderma News, 11/06/2018. (Also see Hand and Joint Involvement)
Evolving symptoms of Raynaud's phenomenon (RP) in systemic sclerosis (SSc) are associated with physician and patient–reported assessments of disease severity. Patients identify with distinct patterns of SSc–RP that may relate to progression of the obliterative microangiopathy of SSc. PubMed, Arthritis Care Res (Hoboken), 08/21/2018.
Vascular Disease and Systemic Scleroderma. Any condition that affects the vascular system, all of in part, is considered a vascular disease. ISN.
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Raynaud's and Other Diseases
Prevalence and Clinical Associations of Antiphospholipid Antibodies in Systemic Sclerosis: New Data From a French Cross-Sectional Study, Systematic Review, and Meta-Analysis. These data provide additional insights into the role of aPL in the vasculopathy observed in SSc. PubMed, Front Immunol, 2018 Nov 2;9:2457. (Also see Antiphospholipid Syndrome, Causes of Pulmonary Hypertension , and Digital Ulcers)
Raynaud's Phenomenon of the Nipples
Raynaud's can affect the nipples of breastfeeding mothers, causing severe pain.
Raynaud's Phenomenon of the Nipple Associated with Labetalol Use. Precipitants for Raynaud's phenomenon of the nipple are known to be cold temperatures, caffeine, and emotional stress. J Hum Lact, February.
Raynaud's in the Lungs
Raynaud's may also affect the tip of the nose, earlobes, cheeks, chin, or lungs. Some people with scleroderma and Raynaud's experience coughing attacks when breathing cold air or drinking/eating cold liquids and foods. The coughing may or may not be caused by pulmonary vasospasms caused by exposure to cold.
Doubles Risk of Coronary Artery Disease and Stroke
A 1998 study indicated that people who have Raynaud's may have double the risk of coronary artery disease and stroke. "Hopkins: Is Raynaud's a Predictor of Heart Disease?" by Fredrick M. Wigley, M.D., Professor of Medicine and Director of Molecular and Clinical Rheumatology, Johns Hopkins School of Medicine, August 19, 1998, Aetna InteliHealth.
Coronary Artery Disease HeartPoint Gallery
Importance of Controlling Raynaud's
Scleroderma and Raynaud's can in some instances become so severe as to require amputation of fingers and/or toes, so keeping "aggressively warm" plus promptly treating all Raynaud's attacks is essential for all Scleroderma patients. As Raynaud's progresses, slight drops in temperature may trigger it with longer duration of the attacks.
Additionally, recent research indicates that Raynaud's might be part of how the disease process advances in Scleroderma, due to the oxygen deprivation caused by Raynaud's spurring an abnormal chemical reaction which produces oxygen radicals. Therefore, taking great precautions to prevent Raynaud's attacks could be of paramount importance for Scleroderma patients.
Other Ways Scleroderma Can Affect Hands
Raynaud's isn't the only way in which Scleroderma can affect the hands. Hand involvement may include skin tightening and hardening, finger contractures, Telangiectasia, Calcinosis, and arthritis. (Also see Scleroderma Skin Involvement, Skeletal Involvement, Telangiectasia, and Calcinosis)
Raynaud's in Children
Pediatric Raynaud Phenomenon. The overall prevalence of Raynaud's in 12-15 year olds was 14.9%. Medscape.
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