Raynaud’s phenomenon – the cold hard facts

Raynaud’s phenomenon is a highly inconvenient, annoying and somewhat incapacitating condition for the estimated ten million UK people who suffer with it. Reducing the blood supply to any of the extremities, it can cause numbness, pain and difficulty in utilising the part of the body it affects. (1)

What is Raynaud’s phenomenon and what causes it?

Raynaud’s phenomenon, often shortened to Raynaud’s, is a condition characterised by restricted blood supply to any of the extremities of the body – usually this is the fingers or toes, but it can also affect the ears, nose, lips and nipples. Depending on skin tone, the lack of blood flow to the affected extremity can cause it to turn white or paler than usual, then blue, then red as the blood supply is re-established. The area may become numb or painful, and you may experience a ‘pins and needles’ sensation (paraesthesia). These symptoms may be short-lived or persist for hours at a time. They can make simple activities which are usually taken for granted much more challenging, such as typing, buttoning up clothes and even speaking if the lips are affected. Symptoms generally start in people in their twenties to forties, but people of all ages can develop the condition. (1, 2)

The cause is the blood vessels in these areas of the body being hypersensitive to temperature changes, or changes in blood flow as a result of stress or anxiety. This in turn leads to spasm in the vessels, restricting blood supply. (1, 2)

Raynaud’s is split into two forms:

• Primary Raynaud’s develops of its own accord and affected people can usually manage the condition without input from their GP.

• Secondary Raynaud’s occurs as a result of another pre-existing condition – usually an autoimmune condition such as rheumatoid arthritis. This type of Raynaud’s is more severe than the primary type and will require medical input in the form of monitoring for sores and, in the worst case scenario, gangrene. (1, 2)

Treatment and management of Raynaud’s

The first-line approach to managing Raynaud’s is not medical treatment, but self-care:

• Make sure you wrap up warm in cold weather, paying particular attention to the hands and feet (warm gloves and socks)

• Encourage blood flow to the extremities through exercise – 30 minutes at moderate intensity five times a week is recommended

• Stopping smoking will also help to improve circulation

• Reduce stress where possible by eating well, setting time aside to do something you enjoy and relaxation techniques

• Don’t try to warm your hands and feet very quickly by putting them next to or on a radiator or other hot object, as this may cause chilblains (sore, itchy red lumps) to appear – this will only add to your discomfort! (1, 3, 4)

If self-care is not sufficient to control the symptoms, you may be prescribed a medicine called nifedipine, the only licensed treatment in this country for Raynaud’s. This medicine works by dilating the blood vessels, thereby improving circulation to the body’s extremities. It is usually taken once daily, but you may be able to take it only when you will most need it, for example in the winter months. If nifedipine turns out to be unsuitable or does not work, there are a number of unlicensed medicines available at the discretion of your doctor. (3)

In extreme cases, surgery known as sympathectomy may be considered. The nerves responsible for the blood vessel spasms associated with Raynaud’s are cut, stopping them from functioning. (3)

When to see your GP

If you have a long term condition such as an autoimmune disease or diabetes and you begin to experience the symptoms described above, see your GP as you may have secondary Raynaud’s which will need to be monitored. Equally, make an appointment if your symptoms are interfering with your everyday life and you cannot manage them on your own, or treatment has failed to improve your symptoms.

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References

1. NHS Choices. Overview [cited 6 December 2017]. Available from: https://www.nhs.uk/conditions/raynauds/

2. Scleroderma & Raynaud’s UK. What is Raynaud’s? [cited 6 December 2017]. Available from: https://www.sruk.co.uk/raynauds/what-raynauds/

3. NHS Choices. Treatment [cited 6 December 2017]. Available from: https://www.nhs.uk/conditions/raynauds/treatment/

4. Scleroderma & Raynaud’s UK. Chilblains [cited 7 December 2017]. Available from: https://www.sruk.co.uk/raynauds/chilblains/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 15/12/17