Raynaud's syndrome

Raynaud's syndrome is a condition that affects the circulation in the small blood vessels, usually in the fingers and toes. In response to cold temperatures or emotional stress, these blood vessels temporarily narrow, reducing blood flow to the affected areas. Less commonly, Raynaud's can also affect the ears, nose, lips, and other areas of the body.

What are the symptoms of Raynaud's syndrome?

Symptoms come in episodes, often called attacks, rather than being there all the time. A typical attack can be around 20 minutes, though yours may be shorter or longer.

During an attack you may notice:

• your skin changing colour, often going white first, then blue, then red as the blood comes back
• cold skin in the affected fingers or toes
• numbness or a ‘pins and needles’ feeling
• pain or throbbing, particularly as the blood flow returns.

Attacks usually settle on their own once you warm up. Symptoms tend to be milder if you have the primary form of the condition and more troublesome if there's an underlying illness behind it.

What causes Raynaud's syndrome and who is at risk?

Your body narrows the blood vessels near the skin when it's cold, so that warm blood stays around your vital organs. In Raynaud's, that normal response is exaggerated, and blood flow drops even when the cold is only mild. Common triggers are:

• cold weather, or handling cold objects
• a change in temperature, even a small one
• emotional stress and anxiety
• nicotine from smoking or vaping, which tightens blood vessels.

In many people, no underlying cause for Raynaud's is found. However, in some cases it is linked to another medical condition known as secondary Raynaud's. The conditions most commonly associated with secondary Raynaud's are autoimmune diseases, such as lupus, scleroderma, Sjögren's syndrome, rheumatoid arthritis, and inflammatory muscle diseases.

Less commonly, Raynaud's may be associated with thyroid disorders, certain blood or clotting disorders, carpal tunnel syndrome, or exposure to vibrating tools, certain chemicals and some medications.

Are there different types of Raynaud's syndrome?

Yes. Healthcare professionals generally divide Raynaud's into two main types:

• Primary Raynaud's: This is sometimes called Raynaud's disease – it happens on its own with no other condition behind it and symptoms are usually mild.
• Secondary Raynaud's: This is sometimes called Raynaud's phenomenon – it happens because of another illness, a medicine or something you're exposed to, and symptoms tend to be more severe.

Raynaud's syndrome is used as an umbrella term covering both. In everyday use, most people use all of these names for either type.

Timing gives a clue as to which you have. Most cases of primary Raynaud's start between the ages of 20 and 30, so symptoms beginning after 30 make an underlying cause more likely.

How is Raynaud's syndrome diagnosed?

There's no single test for Raynaud's. Your GP will usually diagnose it by asking about your symptoms and your medical history, then examining you.

Your GP may also:

• put your hands in cold water or cool air to see whether symptoms appear
• look closely at the tiny blood vessels, called capillaries, where your nail meets your finger. These are often enlarged in secondary Raynaud's and can look like red pen marks.

Blood tests are often arranged to look for a condition underneath the symptoms. These may include a full blood count, an antinuclear antibodies (ANA) test to check for an overactive immune system, and an erythrocyte sedimentation rate test, which also looks for signs of an autoimmune disorder.

Further testing is usually recommended to work out whether you have the primary or the secondary form, because that changes what treatment you need.

How is Raynaud's syndrome treated?

Self-care

Most people can manage Raynaud's themselves. The aim is to prevent attacks rather than treat them once they start.

The advice below applies to both primary and secondary Raynaud's:

• keep your whole body warm, not just your hands and feet, and wear gloves and warm footwear in cold weather
• stop smoking, which improves your circulation and should ease your symptoms
• exercise regularly to help your circulation and lower your stress levels. For most people, 150 minutes of vigorous exercise a week is recommended
• bring your stress levels down through regular exercise, a healthy diet and relaxation such as deep breathing or yoga
• consider cutting back on stimulants such as coffee, tea and caffeinated drinks.

If you find stress hard to control on your own, counselling may help.

Medicines

If self-care measures aren’t enough to control your symptoms, your GP may prescribe nifedipine, which is the main medicine used to treat Raynaud's phenomenon in the UK.

Nifedipine belongs to a group of medicines called calcium channel blockers. It works by relaxing and widening the small blood vessels, helping to improve blood flow to the fingers and toes. Although it doesn’t cure Raynaud's, it can reduce the frequency and severity of attacks.

Some people take nifedipine every day, particularly during colder months, while others use it only when symptoms are more troublesome.

If nifedipine is not suitable or doesn’t work well enough, a specialist may occasionally recommend other medicines. Your doctor can advise on the most appropriate treatment for your individual circumstances.

Surgery

Surgery is uncommon. An operation called a sympathectomy, which interrupts the nerves that make the arteries tighten, is occasionally considered. The results are often only temporary, and further treatment or more surgery may be needed after a few years.

Treating the cause

If you're diagnosed with secondary Raynaud's, you may be referred to a specialist who treats the underlying condition. Secondary Raynaud's often needs more treatment than the primary form.

When should I see a doctor?

See your GP if you think you have Raynaud's, so you can get a proper diagnosis and rule out anything more serious underneath.

It's particularly worth getting checked if:

• your symptoms started after the age of 30
• you get severe pain during an attack
• your symptoms are getting worse, or self-care isn't controlling them
• you have other symptoms that might point to a condition such as lupus or rheumatoid arthritis.

If you use vibrating tools at work and you develop tingling or numbness in your fingers, tell your employer as soon as you're diagnosed. Stopping early can mean a full recovery.