Raynaud's Phenomenon

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Category: Systemic Lupus Erythematous Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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RAYNAUD’S PHENOMEWHAT?

Are your fingers, toes, nose or ears sensitive to cold? Do they burn, tingle and go numb? Do they turn white or blue, then red? If so, you may have Raynaud’s phenomenon.

Julie, a professional surfer, Dawn, who works at a local ice cream shop, and Jennifer, a transcriptionist all experience numbness, tingling and burning in their fingers. They noticed that their fingers would periodically turn white and blue, but Julie also had a skin rash on her cheeks and nose and was sensitive to sunlight, and Jennifer had pain and swelling in her wrists: three classic cases of Raynaud’s phenomenon.

WHAT IS RAYNAUD’S?

Raynaud’s phenomenon is a condition in which attacks that cause the blood vessels in the fingers, toes, nose or ears to constrict, can occur, decreasing their blood supply, thus making them turn white (pallor) or blue (cyanosis) and feel numb, tingly and cold. Afterwards, when blood flow returns to normal, the affected areas may turn red (rubor) along with a throbbing and tingling sensation.

PRIMARY OR SECONDARY?

In the cases of Julie, Dawn, and Jennifer, Dawn’s is primary (of unknown origin) and Julie’s and Jennifer’s are secondary (due to another condition). Usually, primary Raynaud’s is considered a minor condition, and more simply a nuisance. However, secondary Raynaud’s is taken more seriously because it is most often due to an underlying connective tissue disease such as lupus, scleroderma, Sjogren’s syndrome, dermatomyositis and polymyositis or other conditions such as carpal tunnel syndrome and obstructive arterial disease.

TRIGGERING FACTORS:

Exposure to cold, as in air conditioning, weather or handling frozen foods, as in Dawn’s case, excessive use of the wrists causing carpal tunnel syndrome, as in Jennifer’s case, and lupus (butterfly rash on her face and photosensitivity), as in Julie’s case can be triggering factors with Raynaud’s phenomenon. However, this condition can also occur for no known reason or because of emotional stress, smoking, which drops body temperature and lack of exercise.

MAKING A DIAGNOSIS:

Diagnosing Raynaud’s phenomenon is a fairly easy process. However, knowing your medical history and your triggering factors are important facts your doctor will need to know in addition to performing a physical examination of your hands, feet, nose, ears, nail beds, skin ulcers and scars as well as blood tests such as an ANA (anti-nuclear antibody) and ESR (erythrocyte sedimentation rate) to rule out underlying conditions.

TREATING IT:

For mild primary cases of Raynaud’s phenomenon, actions such as keeping warm, not smoking, and controlling stress may suffice in controlling your symptoms. For severe cases, medications such as anti-hypertension drugs can be used to dilate the blood vessels and increase. However, the main goal in treating secondary Raynaud’s is to first control the primary condition.

Knowing the facts and getting the proper treatment is like catching a good wave, having a triple scoop cone or typing 1000 words a minute.

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