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RAYNAUD'S DISEASE At this time of the year, we frequently see people who complain of problems tolerating cold weather. Many of these complaints are related to a dislike of the cold, but others may be associated to a medical problem. When briefly exposed to the cold, do your fingers turn white and get numb? Do they hurt? Does the white color turn to a bluish hue? Once warmed, do they turn bright red? This may sound like a normal response to the cold, but there may be an underlying medical problem called Raynaud’s Disease or Phenomenon. Let’s take a look at this somewhat rare condition. What is Raynaud’s Disease? This is a condition that affects the blood vessels in the hands, fingers, feet, toes, tip of the nose, and the ears. The fingers are the most commonly affected area, and over 40 percent of patients with Raynaud’s will have complaints of finger discomfort. When exposed to the cold, the blood vessels will spasm, leading to a lack of blood supply to the affected body part. Raynaud’s disease is an entity of itself, while Raynaud’s phenomenon is associated with another medical condition. What are the symptoms? Raynaud’s is not just simply having cold hands or feet. There is a specific sequence of events that must occur to make the diagnosis when exposed to the cold. When exposed, the affected area will first turn white. Then the skin will turn blue and the area will feel cold and numb. This is all due to the blood vessels going into spasm. Once they relax, blood will start flowing again and the area will get red, warm, and there will be tingling. The order of color change is usually the same for most people, but not always. What are the causes? It is unclear with Raynaud’s disease why a person will overreact to the cold, sending blood vessels into spasm. Researchers have found that there may be a genetic relationship to the problem. With Raynaud’s phenomenon, there are several underlying medical conditions that are associated with the condition, most of which are associated to a rheumatologic disease such as Rheumatoid Arthritis, Scleroderma, Lupus disease, and Sjogren’s syndrome. All of these conditions are related to the joints and considered an autoimmune problem, whereby the body develops an allergic reaction to itself. Other risks associated with Raynaud’s include smoking, trauma, and certain medications. It should be noted that more women than men are affected and the usual age of onset is between 15-25 years. How is this treated? The diagnosis is usually made clinically based upon the history and the appearance of the affected area. Your health care provider may perform a cold provocation test in order to simulate the condition. Since this can be associated with underlying medical problems, a rheumatologic work-up will occur involving some blood tests. If there is an underlying medical condition, it will need to be appropriately treated. Prevention of the attacks is important through avoidance of the offending factors. Some medications have been prescribed in order to control the episodes of vasospasm. Certain blood pressure medications, like calcium channel blockers have been shown to decrease the incidence and frequency of attacks. Other medications include alpha blockers, which are also used for prostate problems. Usually, surgical intervention is not necessary to treat the problem. Living with Raynaud’s may require some lifestyle changes, such as quitting smoking. Avoidance of the cold is important, so dressing appropriately to limit exposure will help. As with most medical conditions, seeking treatment in a timely manner will improve outcome and quality of life. |
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