Raynaud

Raynaud phenomenon is a vascular condition characterized by episodic vasospasm of the small arteries and arterioles in the fingers and toes in response to cold or emotional stress. During an attack, affected digits turn white due to reduced blood flow, then blue as deoxygenated blood accumulates, and finally red as blood flow returns, often with numbness, tingling, or pain.

There are two main forms. Primary Raynaud, also called Raynaud disease, occurs without an associated medical condition and is typically milder. Secondary Raynaud, or Raynaud phenomenon, accompanies other diseases—most notably connective tissue disorders such as systemic sclerosis, lupus, and rheumatoid arthritis—or results from injuries or certain medications. Secondary cases may be more severe and can lead to ulcers or tissue damage.

Triggers include exposure to cold environments, sudden temperature changes, emotional stress, caffeine intake, and vasoconstrictive drugs. Smoking increases risk, and the condition is more common in women. Family history may be present.

Diagnosis is clinical, based on pattern and history. Tests may be used to exclude secondary causes: nailfold capillaroscopy can reveal characteristic microvascular changes, and blood tests for autoantibodies (e.g., ANA, anti-centromere, RF) may be pursued when a secondary form is suspected, along with evaluation for other conditions that mimic Raynaud’s.

Management emphasizes protection and lifestyle modification: keeping hands and feet warm, wearing insulated gloves, and avoiding rapid temperature changes. Pharmacologic treatment, when needed, commonly includes calcium channel blockers (such as nifedipine), with alternatives like topical nitrates or PDE-5 inhibitors. In severe secondary cases, treatment targets the underlying disease; rare interventions include botulinum toxin injections or sympathectomy. Prognosis is favorable for primary Raynaud but can be more serious when secondary disease is present.