Wrestling With Raynaud’s Syndrome

Your hands are frozen. Winter can be brutal to your extremities. Your fingers and toes are numb. You might have a condition known as Raynaud’s syndrome.

Raynaud’s syndrome is a circulatory condition in which it is difficult to keep your fingers and toes warm. Though the condition isn’t dangerous, it can cause discomfort and inconvenience.

For those severely affected by Raynaud’s, outdoor activities in cold weather may be out of the question. Prolonged shutdown of circulation may lead to skin ulcers and gangrene.

Even when the condition is mild and causes only temporary numbness, the amount of protection needed for winter comfort—layer upon layer of clothing, gloves inside mittens, earmuffs over a hat, heavy socks under fur-lined boots—can discourage all but the most determined outdoor enthusiast.

While clothing is the first line of defense against the discomforts of Raynaud’s, physicians have explored a number of other options, some of which will provide protection against the winter for most patients.

Evolution has taught the body mechanisms for countering survival under stress. Sometimes they work too well and they cause distress instead.

Such is the body’s natural defenses against the cold. To preserve body heat and maintain normal function of vital internal organs, outlying blood vessels constrict, and blood is automatically diverted away from the extremities to prevent heat from escaping through the surface of the hands and feet. Blood is shunted automatically to the core of the body when you are exposed to the cold without adequate protection.

For those with Raynaud’s syndrome, this can be an all-out effort year-round to bring warmth to the extremities when doing everyday activities like removing a jar of juice from the refrigerator, rinsing vegetables in cold water or bringing in the mail on a cold wintry day.

When exposed to the cold, the arteries of someone with Raynaud’s narrows and shuts down temporarily. The affected areas which include the ears and nose, turn white then blue then numb. When the affected areas are no longer exposed to the cold, they turn red and may throb, tingle, swell and feel warm.

The disorder was first described in 1862 by Maurice Raynaud who thought the condition stemmed from an overly sensitive nervous system. Some recent studies suggest that in most patients, the problem is one of localized sensitivity to hormones that cause the blood vessels to constrict.

Symptoms of Raynaud’s can occur without an underlying cause, in which it is referred to as primary Raynaud’s or Raynaud’s disease. Or the symptoms may be due to a secondary problem to which the disorder is referred to as secondary Raynaud’s or Raynaud’s phenomenon. Connective tissue diseases, emotional stress, certain medications and physical injury are among the common causes of Raynaud’s phenomenon.

An estimated 5 to 10 percent of the population has Raynaud’s. Most patients who have it are only mildly affected. Women are nine times more likely to be affected than men. This is due to the fact that some of the underlying causes, like autoimmune diseases, afflict more women.

Symptoms typically start in women between the ages of 13 and 40. When men are affected, they tend to be older and have fat-clogged arteries as an underlying cause. In 75 percent of patients, the symptoms are precipitated by exposure to cold. In the remaining 25 percent, emotional distress can set off the arterial spasms that rob fingers and toes of blood. Stress signals a release of hormones that cause arteries in the extremities to constrict.

Raynaud’s is common among occupations where people subject their hands to wear and tear like typists, pianists, meat cutters and those that use vibrating tools such as jackhammers and chain saws. The problem can result from using the palm of your hand as a hammer even in a single instance.

Such things as chronic exposure to cold, repeated exposure to alternating hot and cold temperatures or an episode of frostbite can increase your susceptibility to Raynaud’s. Exposure to certain chemicals can also be a cause like vinyl chloride, which is used in the rubber industry.

Certain connective tissue disorders can cause Raynaud’s like scleroderma, which causes hardening of skin and lining tissues; Sjogren’s syndrome which affects the secretory glands and rheumatoid arthritis. The disorder can also be caused by diseases involving arterial blockage like atherosclerosis and Buerger’s disease, an inflammation of the arteries.

In addition, certain drugs like nicotine can cause spasms of the arteries and symptoms of Raynaud’s. Some medications can bring on Raynaud’s such as oral contraceptives, ergot-containing drugs that are used to treat migraine headaches and beta-blockers, which are used to treat high blood pressure and abnormal heart rhythms. Some drugs used in cancer treatment may also cause problems with Raynaud’s like cisplatin and vinblastine.

While no treatment is permanent or perfect, progress has been made in preventing attacks. In circulatory conditioning, the arteries are taught to remain open while the person is out in the cold. The therapy involves sitting outdoors in cold weather and keeping one’s hands in a pail of warm water. The conditioning done every other day over a period of three to four weeks is repeated several times a day for 10 minutes at a time. The benefits last through the winter.

Promising results have also been achieved through biofeedback training. The sessions usually last 30 to 60 minutes and are repeated once or twice a week for about 10 sessions. At each session, the temperature of the fingertips is recorded and the results displayed visually so that the patient can detect tiny increases in finger temperature. In this way patients are training their minds to prevent or abort attacks of Raynaud’s.

Therapists can also use medication to dilate blood vessels. But drugs like calcium-channel blockers like nifedipine may lose their effectiveness over time. Other medications like ones normally used to treat high blood pressure have unpleasant side effects.

Synthetic versions of hormone-like substances called prostaglandins have also been used to treat Raynaud’s. Though usually administered intravenously—an analogue of prostaglandins E2 can be absorbed through the skin, increasing blood flow for up to three and a half days after application.