Raynaud's Phenomenon (cont.)

How is Raynaud's phenomenon treated?

Management of Raynaud's phenomenon involves protecting the fingers and the toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasm should be avoided by patients with RP. In patients with persistent symptoms, medications that dilate the blood vessels can be administered.

Patients with Raynaud's phenomenon who have no symptoms other than the color changes of extremities may require only measures to prevent complications. Prevention measures are important in primary and secondary RP regardless of the severity. Simple initial care involves keeping the body warm, especially the extremities. Warm clothing in colder environments is essential. Cotton gloves can be helpful while searching the freezer. Room temperatures should not be too cool. Rubber gloves protect the hands and prevent cooling while washing dishes. Barefoot walking should be minimized. Compression of the blood vessels by tight-fitting wrist bands, rings, or footwear should be avoided.

Those with RP should guard their hands and feet from direct trauma and wounds. Any wounds or infections should be treated early to prevent more serious infections. Avoiding emotional stresses and tools that vibrate the hand may reduce the frequency of attacks. Biofeedback can also help to decrease the severity and frequency of RP in some patients.

Direct and indirect (passive) smoking should be avoided by patients with RP. The chemicals in tobacco smoke can cause blood-vessel constriction and lead to atherosclerosis (hardening of the arteries), which can further impair oxygen supply to the extremities.

Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the tips of the digits should be monitored closely by the doctor. These can become infected. Gently applied finger splints are used to protect ulcerated areas. Ointments that open the blood vessels (nitroglycerin ointment) are sometimes used on the sides of severely affected digits to allow increased blood supply and healing.

Medications that can aggravate symptoms of RP by leading to increased blood-vessel spasm include over-the-counter cold and weight-control preparations, such as pseudoephedrine (Actifed, Chlor-Trimeton, Cotylenol, and Sudafed). Beta blockers, medicines used for high blood pressure and heart disease, can also worsen RP. These include atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), and propranolol.

Patients with persistent or bothersome symptoms may be helped by taking oral medications that open (dilate) blood vessels. These include calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine (Cardene), nifedipine (Procardia), and other medicines used in blood pressure treatment, such as methyldopa (Aldomet) and prazocin (Minipress). Recent research has shown that the blood-pressure drug losartan (Cozaar, Hyzaar) can reduce the severity of episodes of RP possibly more than nifedipine.

Medications that "thin" the blood, such as low doses of aspirin or dipyridamole (Persantine), are sometimes helpful.

Some patients with persistent symptoms can benefit by adding a medication called pentoxifylline (Trental) which makes the red blood cells more pliable, thereby improving circulation.

Severe RP can lead to gangrene and the loss of digits. In rare cases of severe disease, nerve surgery called "sympathectomy" is sometimes considered. In this procedure, to prevent blood-vessel spasm, the nerves that stimulate the constriction of the vessels (sympathetic nerves) are surgically interrupted. Usually, this is performed during an operation that is localized to the sides of the base of the fingers at the hand. Through small incisions the tiny nerves around the blood vessels are stripped away. This procedure is referred to as a digital sympathectomy.

Research

Researchers have reported finding a substantial genetic (inherited) contribution both to the symptoms of RP and to the associated blood-vessel changes of patients with Raynaud's phenomenon.

Other researchers are studying nitric oxide and its potential relationship to Raynaud's phenomenon. A gel is being studied which might promote local production of nitric oxide in involved digits. The local nitric oxide, it seems, may open the blood vessels and improve the impaired circulation.

Raynaud's Phenomenon At A Glance

• Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold.
• Raynaud's phenomenon occurs because of spasm of blood vessels.
• The cause of Raynaud's phenomenon is unknown, although abnormal nerve control of blood-vessel diameter and nerve sensitivity to cold are suspected of being involved.
• Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood-vessel spasm.
• There is no blood test for diagnosing Raynaud's phenomenon.
• Treatment of Raynaud's phenomenon involves protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.

For further information about Raynaud's phenomenon, please visit the following site:

The Arthritis Foundation (http://www.arthritis.org)

Or you can write to:

The Arthritis Foundation
P.O. Box 19000
Atlanta, Georgia 30326

References: Clinical Primer of Rheumatology, Lippincott Williams & Wilkens, edited by William Koopman, et al., 2003.

Kelley's Textbook of Rheumatology, W B Saunders Co., edited by Shaun Ruddy, et al., 2000.

Last Editorial Review: 9/26/2008

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