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Raynaud’s syndrome: symptoms, triggers, therapy

by Josephine Andrews
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In Raynaud’s syndrome (Raynaud’s disease), attacks of circulatory disorders occur, which primarily affect the fingers. These then become pale and cold, feel numb or even hurt. The symptoms are usually harmless, but sometimes there is a serious illness behind the symptoms. Find out more about the signs, diagnosis and treatment of Raynaud’s syndrome here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

I73 M34

quick overview

  • Symptoms: Attack-like circulatory disorders in the fingers and sometimes the toes with discoloration of the affected areas from pale to blue to red, sometimes with discomfort, numbness and pain.
  • Causes and risk factors: Possible causes are disorders of the blood vessels, nerve activity or the hormone balance as well as other underlying diseases, important triggers are stress and cold.
  • Treatment: Stress reduction, heat, calcium blockers, circulation-enhancing drugs and ointments, in particularly severe cases surgical interventions
  • Prognosis: Depending on the cause, provided there is no underlying disease, usually good
  • Diagnosis: The diagnosis is based on the characteristic symptoms and various tests. Further investigations may be necessary to differentiate it from other diseases.
  • Prevention: The disease cannot be prevented, but it is advisable for those affected to avoid the previously known risk factors as much as possible.

How do you recognize Raynaud’s syndrome?

Raynaud’s syndrome (Raynaud’s disease) is a circulatory disorder caused by vascular spasms (vasospasms). The spasms usually occur in the fingers, more rarely in the toes and other parts of the body. They cause blood vessels to constrict and restrict blood flow to the affected area.

A typical symptom of Raynaud’s syndrome is therefore that the fingers (usually with the exception of the thumb) or the toes turn pale and later turn blue during an attack. Due to the pallor that occurs, the disease is also known as white finger disease or corpse finger disease. Many of those affected suffer from paraesthesia and numbness, and pain is also common.

The attacks usually last no longer than half an hour. Then the skinis often red afterwards. The typical three-phase color progression from pale to blue and later to red is also referred to by physicians as the tricolor phenomenon. In primary Raynaud’s syndrome, where the cause is unknown, symptoms appear in both hands or feet. In the case of secondary Raynaud’s syndrome, which is due to another underlying disease, usually only one side is affected.

If, in rare cases, the cramps (spasms) persist for a longer period of time, the vessels will suffer permanent damage. In some cases, the tissue sometimes dies – necrosis forms. However, such damage usually only occurs as a complication of secondary Raynaud’s syndrome.

If Raynaud’s syndrome is the result of scleroderma , a hereditary disease of the connective tissue, the skin on the hands, arms or face is also thickened and tight.

Causes and risk factors

Raynaud’s syndrome is caused by very strong and sudden constriction of the vessels, especially in the fingers and hands, which loosens again after a while. The seizures occur particularly in cold temperatures and under stress. The cause of this phenomenon is an imbalance between vasodilating and vasoconstricting factors.

Possible causes of Raynaud’s syndrome are disorders of the blood vessels in the toes and fingers or an increased state of excitement of the nervous system. Hormonal imbalances are also believed to play a role. However, it is still unclear how these various factors are related.

In most people, the causes of Raynaud’s syndrome remain unclear. In this case, doctors speak of primary or idiopathic Raynaud’s syndrome. Young women in particular are affected, and there is often a family predisposition. In the course of life, the attacks usually become rarer and weaker. Primary Raynaud’s syndrome often runs in families. Smoking in particular promotes circulatory disorders.

In contrast to primary Raynaud’s syndrome with an unclear cause, secondary Raynaud’s syndrome is the result of a variety of different diseases. These include, for example

  • rheumatological diseases
  • Autoimmune diseases, especially connective tissue diseases such as scleroderma or lupus erythematosus
  • Diseases of the nerves (e.g. multiple sclerosis)
  • Vascular diseases such as arteriosclerosis
  • Disease of the hematopoietic system
  • cancers
  • Carpal tunnel syndrome (pinched nerves in the wrist)

In the context of autoimmune diseases, so-called cold agglutinins can sometimes be detected in the blood. Cold agglutinins are antibodies that bind to the surface of red blood cells when it is cold, causing them to clump together. The body reacts to this with inflammatory reactions, which in turn promote vasoconstriction and thus promote Raynaud’s syndrome.

Some medications (contraceptives, cytostatics, interferon, beta-blockers, ergotamine preparations and dopaminergic substances) or drugs (cocaine, designer drugs) also cause Raynaud’s syndrome in some cases. People who come into contact with certain chemicals in their job (e.g. polyvinyl chloride) or who work with vibrating machines such as jackhammers or chainsaws for a long time also belong to the risk group.

treatment

Raynaud’s syndrome therapy is initially based on general measures. It is crucial to avoid the triggers of the attacks, ie above all stress and cold. Avoiding cold drinks and foods may help reduce the frequency of attacks. It is advisable to wear gloves when handling cold or frozen food.

In the cold season, those affected benefit from heated gloves, pocket warmers or thick socks and shoe soles. People with Raynaud’s syndrome should also refrain from smoking. A diet rich in omega-3 fatty acids may also help, but this has not been scientifically proven. On the other hand, in the case of secondary Raynaud’s syndrome, it is above all important to treat the underlying disease.

stress relief

A significant contribution to an improvement in symptoms is stress reduction. It is helpful to learn a relaxation technique such as autogenic training or progressive muscle relaxation. Sport also helps to reduce stress.

wound care

People with Raynaud’s syndrome should have wounds in the affected areas treated intensively and professionally, as they may heal poorly and therefore persist for a long time.

What to do in the event of a Raynaud attack?

If a seizure is imminent, those affected should wash their hands with warm water. It is also advisable to move and massage your hands so that the vessels dilate again quickly. Sometimes it also helps to warm up your handsunder your armpits to

A Raynaud attack usually subsides on its own after a maximum of half an hour – before permanent damage occurs. However, if the vasoconstriction does not resolve, bed rest and warmth often help. If that is not enough either, the doctor has the option of prescribing anticoagulant therapy, for example with heparin.

medication

If general measures are not enough, there is an option to take medication for Raynaud’s syndrome. Administering medication is particularly useful if the tissue is already damaged and it is therefore particularly important to ensure good blood circulation over the long term.

The most important group of drugs against Raynaud’s syndrome are calcium blockers (calcium antagonists). Nitroglycerin, a vasodilating substance, is also used as an ointment. However, both active ingredients lead to undesirable side effects in some people. In some cases, calcium antagonists cause the fingers to swell, while nitro ointment occasionally causes headaches.

In the case of very severe Raynaud’s syndrome, a number of other drug groups are available, but not all of them are specifically approved for Raynaud’s syndrome therapy. The use of these drugs is controversial. This is especially true for antidepressants.

operations

In particularly severe cases, an operation may make sense. This includes, for example, the blockage of vasoconstricting nerves (sympathectomy). Such a blockage can also be achieved with medication. Although this treatment only works for a limited time, it is usually sufficient for wounds and tissue damage to heal.

If Raynaud’s syndrome occurs in connection with work, a job or even career change may be necessary.

Course of the disease and prognosis

Primary Raynaud’s syndrome mainly affects women between the ages of 20 and 40. Overall, women are affected about five times more often than men. It is estimated that three percent of the population have the typical symptoms of primary Raynaud’s syndrome. Although primary Raynaud’s syndrome is disturbing and uncomfortable, it is harmless and usually only slightly affects the quality of life. The symptoms usually improve over time.

In the case of secondary Raynaud’s syndrome, the level of suffering is sometimes significantly higher and may even worsen over time. The course of the disease varies greatly from case to case due to the many different causes. Some patients develop complications such as poorly healing wounds or other tissue damage, which are often difficult and time-consuming to treat.

In particularly severe cases, tissue areas also die off. However, since new vessels form relatively quickly in the event of vascular damage, amputation, for example of the affected finger, is only very rarely necessary in the case of Raynaud’s syndrome.

What is Raynaud’s Syndrome?

Raynaud’s syndrome is a vascular disease caused by vascular spasms (vasospasms). The cramps usually appear in paroxysms on the fingers, more rarely on the toes and other parts of the body. This reduces the blood supply to the affected body region – they become pale and cold, which is why it is also referred to as corpse finger or white finger disease. The cramps are usually triggered by cold and psychological stress.

Primary Raynaud’s syndrome mainly affects women between the ages of 20 and 40. Overall, women are affected about five times more often than men. It is estimated that three percent of the population have the typical symptoms of primary Raynaud’s syndrome.

investigations and diagnosis

The first point of contact in the case of Raynaud’s syndrome is the family doctor who may refer you to a rheumatologist. As a rule, a detailed description of the symptoms is sufficient to make the diagnosis “Raynaud’s syndrome”.

The medical consultation provides important information about the type and cause of Raynaud’s syndrome. During the interview, the doctor will ask the following questions, among others:

  • Is there sudden discoloration of the hands, possibly associated with pain?
  • Do the symptoms appear symmetrically on both hands?
  • Do the symptoms often occur under stress or when it is cold?
  • Are there any changes to the skin or nails?
  • Are previous illnesses known?
  • Are there similar cases in the family?

A number of tests support the diagnosis of Raynaud’s syndrome. For example, the blood flow into the fingers can be tested by comparing the sides of the fist with the help of the fist clenching test. To do this, the doctor firmly encloses the patient’s wrist and lets him clench and open his fist about 20 times. If Raynaud’s syndrome is present, the fingers usually turn pale during this experiment.

The Allen test is used to examine the arteries that carry blood to the hand. The doctor squeezes one of the two arteries one after the other and checks whether the artery that is open in each case is supplying the hand with sufficient blood. If the hand goes pale during compression, the artery that was not squeezed is probably occluded.

The doctor uses a cold provocation test to determine whether cold is a possible trigger of an attack. To do this, the person concerned dips their hands in ice water for around three minutes. However, this investigation is controversial because the attacks cannot be reliably triggered in this way.

It is also important to inspect the hands if Raynaud’s syndrome is suspected. The doctor pays attention to wounds and tissue damage such as dead areas on the fingertips, so-called rat bite or fingertip necrosis. The doctor also looks for changes in the nail.

Diagnosis of primary Raynaud’s syndrome

The criteria for diagnosing primary Raynaud’s syndrome are:

  • Both hands are affected.
  • The attacks occur mainly when it is cold or stressed.
  • There is tissue damage.
  • Symptoms have been present for over two years without an underlying disease being identified.
  • Further investigations are unremarkable.

A primary form of Raynaud’s syndrome also speaks if those affected are young (under 30) and female or also suffer from migraines or a special form of heart narrowing (Prinzmetal’s angina). Both diseases are based on spasms of certain blood vessels.

Diagnosis of secondary Raynaud’s syndrome

The criteria that speak for the presence of secondary Raynaud’s syndrome are:

  • Only one hand is affected.
  • The tissue in the affected regions is damaged.

If the symptoms occur in men who are over 30 years old, this also speaks more for secondary Raynaud’s syndrome. Certain diseases, such as kidney inflammation or bone pain, as well as taking certain medications or consuming drugs, also increase the suspicion.

A number of further examinations are possible in order to reliably differentiate Raynaud’s syndrome from other diseases with partly similar symptoms.

capillary microscopy

As part of a capillary microscopy, the doctor examines the smallest vessels (capillaries) in the hands. This can be used, for example, to identify scleroderma as the cause of secondary Raynaud’s syndrome. This disease is associated with giant capillaries, avascular regions, and minor hemorrhages.

blood tests

Blood tests reveal other diseases that sometimes result in secondary Raynaud’s syndrome. For example, a blood count, the inflammation levels and the detection of certain antibodies are important. These include so-called ANA and anti-DNA antibodies, which are typical of the rare immune disease lupus erythematosus.

imaging procedures

Magnetic resonance angiography and duplex sonography enable the detection of vascular cramps (spasms), constrictions (stenoses) and other vascular changes. It is usually advisable to also examine the heart and neck vessels. During the examination, the doctor has the option of administering a so-called α-blocker. This drug causes the narrowing to open. If this is not the case, a vascular disease can be assumed.

It is important to rule out other diseases that are associated with symptoms similar to those of Raynaud’s syndrome. These include blood clots (embolisms) and peripheral arterial disease (PAD), in which blood vessels become blocked. In addition, the so-called isolated acrocyanosis is accompanied by a painless blue discoloration of the hands. Spontaneous bruising of the finger (the so-called spontaneous finger hematoma) is a disturbing but harmless disease at first glance.

Prevent

In principle, it is not possible to prevent Raynaud’s syndrome. However, it is advisable for those affected to avoid triggers for the attacks, ie above all stress and cold. People with Raynaud’s syndrome should also refrain from smoking. A diet rich in omega-3 fatty acids may also help, but this has not been scientifically proven. For those affected with secondary Raynaud’s syndrome, it is important to have the underlying disease treated by a doctor.

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