What is Raynaud's Disease

Raynaud’s disease is a condition that causes some areas of your body to feel numb and cool in response to cold temperatures or stress.  This is caused by narrowing of the small arteries that supply blood to your skin, limiting blood circulation.  When exposed to cold temperature the blood supply is markedly reduced and the skin turns pale or white and becomes cold and numb.  When the oxygen supply is depleted, the skin color turns blue, something that is known as cyanosis.  These events are episodic and when the episode subsides or the area is warmed, the skin turns back to a red, natural color and the blood flow returns to the skin.

These symptoms can also be a sign of other diseases.  For example, 90% of individuals with scleroderma and 85% of those with mixed connective-tissue disease have the same symptoms.  Some studies have found that 46-81% of affected patients have secondary Raynaud’s, where the disease is associated with another disease.

What treatments are available for Raynaud’s Disease?

In general, being prepared or making lifestyle changes can help mitigate the effects of Raynaud’s disease.  General measures like avoiding triggers and making sure to keep warm and use gloves of needed can help with Raynaud’s.  Quitting smoking, if you do smoke, is also helpful as nicotine worsens episodes of the disease. Unfortunately, patients with autoimmune disorders do not usually respond well to therapy.

Below are some common treatments available:

·       Pharmacologic therapy

o    Calcium channel blockers (nifedipine) which cause vasodilation

o   ARBs (angiotensin receptor blockers)

o   serotonin uptake inhibitors (fluoxetine)

·       Medications to avoid

    • Certain over-the-counter cold drugs. Examples include drugs that contain pseudoephedrine (Chlor-Trimeton, Sudafed).
    • Beta blockers. This class of drugs, used to treat high blood pressure and heart disease, includes metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and propranolol (Inderal, Innopran XL).
    • Birth control pills. If you use birth control pills, you may wish to switch to another method of contraception because these drugs affect your circulation and may make you more prone to attacks.

Currently, trials are being conducted that test rho kinase inhibitors as a method of vasodilation, and some, like nitroglycerin show potential in reducing the severity of Raynaud’s phenomenon.  Preliminary reports also suggest that botulinum toxin A improves symptoms, reduces the frequency of attacks, and improves the healing of digital ulcers. In those people with severe and disabling Raynaud’s phenomenon, oral phosphodiesterase type 5 inhibitors may be effective although further studies are needed.