Diagnosing and treating Raynaud’s disease

I first noticed that my body wasn’t responding well to the cold when I was living in Vermont, where the average winter temperature is 22 degrees Fahrenheit. My fingers and toes turned red and purple; they became stiff and difficult to move. It took me three years, a visit to a specialist, and a trip to the lab before receiving a diagnosis of primary Raynaud’s disease. 

Raynaud’s occurs when the small blood vessels in your extremities (including fingers and toes, but also nose and ears) contract in cold weather and cut off blood supply to your skin in the localized area. Despite this common and largely manageable symptom, Raynaud’s can affect people differently. There are considerations for diagnosis and treatment of Raynaud’s that can improve quality of life and even lengthen lifespan.

Raynaud’s disease vs. Raynaud’s phenomenon

There’s not just one type of Raynaud’s. There are two categories you should know about (which are collectively known as Raynaud’s syndrome):

• Primary Raynaud’s (also called Raynaud’s disease) occurs when there is no known underlying condition that contributes to the symptoms of Raynaud’s. This version is more common and typically more mild.
• Secondary Raynaud’s (also called Raynaud’s phenomenon) occurs when there is an underlying condition that contributes to the symptoms of Raynaud’s. Some examples of underlying medical conditions include scleroderma, lupus, rheumatoid arthritis, and carpal tunnel syndrome. While less common, secondary Raynaud’s tends to be more severe.

In both primary and secondary Raynaud’s, the key component is vasoconstriction (or the narrowing of blood vessels). The presentation is the same, with discoloration of the extremities of white, purple, and red as the blood flow cuts off and subsequently returns. However, only secondary Raynaud’s phenomenon has a traceable root cause.

Diagnosing primary and secondary Raynaud’s

When looking for Raynaud’s symptoms, a healthcare provider may simply be able to see the white, purple, and red color changes on your digits through a physical exam. Otherwise, a physician may use a cold water test, where you place your hands and feet into ice water to see how skin reacts.

Because primary Raynaud’s has no known cause, the diagnosis process involves ruling out underlying conditions. “You can only be diagnosed with primary Raynaud’s after completely evaluating for other causes,” says Aaron Emmel, Pharm.D., the program director at Pharmacy Tech Scholar. “So you really have to rule out secondary Raynaud’s phenomenon before you can have a diagnosis of primary.” If you show signs of Raynaud’s, a doctor may do this by ordering blood tests. 

When diagnosing secondary Raynaud’s, healthcare providers are often dealing with autoimmune diseases. “The skin is a window to the inside in these autoimmune conditions,” explains Noreen Galaria, MD, board-certified dermatologist and owner of Galaria Plastic Surgery & Dermatology. Those who have these types of autoimmune disorders may be more inclined to experience sunburn, rashes, hair loss and—of course—Raynaud’s phenomenon.  

How common is Raynaud’s?

Upwards of 20% of the world’s population have either the primary form or secondary Raynaud’s, according to National Health Scotland. However, the estimates vary widely and the number may be much greater because only a portion seek treatment. Many may never notice symptoms because they are so mild or the person may live in a warm climate. (My own symptoms subsided for a full year when I lived in a tropical country.)

Anyone can get Raynaud’s syndrome, but women are slightly more likely than men to develop symptoms of the health condition. Primary Raynaud’s tends to be diagnosed younger (between ages 15 and 30). Secondary Raynaud’s diagnoses tend to come later in life, typically between the ages of 35 and 40. 

Sometimes, people who are diagnosed with primary Raynaud’s eventually receive a diagnosis of an underlying disease later in life. “​In my experience, about 10% of those with primary Raynaud’s go on to develop a secondary cause in the future,” Dr. Galaria says.

What triggers Raynaud’s?

There are many different factors that can cause a new onset of Raynaud’s symptoms.

Medications

Medicines that cause symptoms consistent with Raynaud’s are widespread. Drugs that cause vasoconstriction—such as birth control or beta blockers—often result in Raynaud’s presentation. Or, the blood thinner Warfarin “can cause this distal ischemia that almost mimics Raynaud’s,” Dr. Emmel says.

This reaction may happen for people with underlying Raynaud’s. Or, it may simply mimic the symptoms. In those cases, once a patient ceases a drug that’s causing the condition, the symptoms are reversible. “Any time somebody’s got a new symptom of anything, the first thing that comes to my mind is, ‘Okay, review the medication list,'” says Dr. Emmel. 

Smoking

Smoking makes your blood vessels stiffen and contract, which can trigger symptoms. The CDC reports that 14% of U.S. adults currently smoke tobacco, and so this raises the possibility that many people may experience Raynaud symptoms. 

Moisture

For people who have Raynaud’s, moisture from sweat can cool the skin and activate symptoms. For example, if you wear warm socks, but the material doesn’t wick moisture, your sweat can then trigger a Raynaud’s attack.

Caffeine

For some, too much caffeine also triggers attacks of Raynaud’s.

How serious is Raynaud’s?

Primary Raynaud’s disease likely won’t get worse with age, though it can last for a lifetime. For those with a secondary condition, you could be dealing with other symptoms of a rheumatic disease or injury down the line. That underlying illness could come with additional risks or reduction in life expectancy. For example, there is no cure for scleroderma (which is associated with Raynaud), though the mean life expectancy has improved to 74.5 years old. 

Even primary Raynaud’s (which isn’t associated with an underlying condition) has risks. “If Raynaud’s goes unmanaged, the lack of blood flow to digits can lead to ulcers, necrosis, and—in severe cases—death of the digit, requiring amputation,” says Dr. Galaria.

Despite the fact that Raynaud’s most commonly affects the extremities, it can also affect your heart. In 2017, a study showed patients with Raynaud’s have low blood penetration in heart tissue, which can result in heart conditions down the line. However, not all have heart involvement, and many people manage their condition well through preventive techniques.

How to treat Raynaud’s

Despite the fact that Dr. Emmel is a pharmacist, he says, “It’s always best to start with any non-pharmacological therapies.” Most people choose to utilize lifestyle changes and holistic remedies rather than depending on full-time or seasonal medication.

Lifestyle changes

For primary and secondary Raynaud’s, preventive care is key. The following techniques can help keep symptoms at bay:

• Avoid cold weather. This can mean living in a warm climate, or staying indoors when the temperature drops.
• Keep yourself warm when you are outdoors—and not just your digits. “I always tell my patients it’s important for them to keep their core warm,” Dr. Galaria says. “If the body feels that it is warm centrally, it will more readily send blood to the extremities instead of constricting the small arteries in the fingers and toes.”
• Stay toasty indoors, too. Use a heating pad, blanket, portable heater, or fingerless gloves in the house
• Wear gloves, socks, and hats made from moisture-wicking material, such as merino wool. Consider using hand warmers inside of gloves or mittens.
• Hold or drink a warm beverage such as decaffeinated tea or cocoa.
• Limit caffeine, which can constrict your blood vessels.
• Work on smoking cessation. This habit can constrict blood vessels.
• Place fingers and toes in a warm water bath. Unlike frostbite, warm water improves Raynaud’s symptoms.
• Complete a medication review with your pharmacist to ensure you’re not taking anything that could constrict blood vessels. If necessary, look for alternatives to those medications.
• Avoid emotional stress. Stress can cause blood vessel constriction. Addressing environmental stressors is important from a holistic standpoint.
• Consult with your healthcare provider about supplements that promote blood circulation, such as ganoderma lucidum, or reishi mushroom

If these techniques don’t help to alleviate symptoms, there are other Raynaud’s treatment options available.

Medications

If Raynaud’s is still impacting your quality of life after making lifestyle changes, you may want to seek pharmacological treatment. There are four main prescription options.

1. Calcium channel blockers

“Calcium channel blockers are generally the first line of therapy,” Dr. Emmel says, specifically dihydropyridine calcium channel blockers like amlodipine or nifedipine. These drugs are vasodilators, which means they dilate the blood vessels. “That dilation of the blood vessel may help blood flow into the fingers and toes and help relieve the symptoms,” explains Dr. Emmel

2. Topical nitrates

Your healthcare provider may also prescribe a topical nitrate, such as nitroglycerin. This treatment has minimal evidence supporting its efficacy, it can be messy, and it often causes headaches as a side effect. Despite its topical nature, nitroglycerin is rather strong and can lower your blood pressure a marked amount. However, some people can’t take calcium channel blockers and may be inclined to try it.

3. Phosphodiesterase inhibitors

There’s also a class of potent vasodilators called phosphodiesterase inhibitors, and one of these medications is more widely known under the brand name Viagra. “There’s minimal evidence—but some evidence—of benefit,” Dr. Emmel says.

4. Botox

Dr. Galaria adds that there is another surprising treatment out there for Raynaud’s: “Botox helps with vasodilation and may also inhibit some neurotransmitters, helping with mobility and decreasing the number of attacks.”

In general, Emmel says, “All these drugs that you could use to treat it have caveats.” Patients should discuss drug interactions and drug-disease interactions with their healthcare provider before taking a specific medication.