Raynaud’s phenomenon (RP) is an exaggerated constriction of blood vessels to the extremities, triggered by cold temperatures or emotional stress. As a result of this spasm, the hands (and often the feet and sometimes the ears and nose) change color. They will often first become white and then blue. Often, along with the color change will be discomfort or even severe pain.
Raynaud's phenomenon is generally broken down into primary (PRP) and secondary (SRP) types, both of which are more common in women. The primary type occurs in individuals who are otherwise healthy, while the latter arises in association with another condition. RP is common, and occurs in more than 3% of the population. Causes associated with secondary Raynaud's phenomenon include certain medications and local trauma. More common, however, is for the SRP to be associated with one of a group of disorders called connective tissue diseases, such as scleroderma, lupus, and myositis. Also, secondary RP is more likely to be associated with complications such as ulcers on the fingers or fingertip infections than is the primary type.
Color changes of the extremities can have other causes, especially if these changes are present only on one side of the body (RP usually involves both sides). Especially when the problem is not symmetrical, it’s important to make sure another cause, such as a clot in an artery or hardening of the arteries, is not present. Also, RP is different from simply having cold hands. RP includes both coolness and the characteristic white and blue color changes. Some people have only one color change in the cold, such as only white or only blue, and those people are considered to have “possible” Raynaud's phenomenon.
Raynaud's phenomenon is generally a chronic problem once it occurs. However, in most adults and children the problem is mild and no specific treatment is needed other than protecting the hands from the cold and warming the hands quickly if they are chilled. For other people, medications that dilate the small extremity vessels can help to prevent recurrences or to make them milder. In more severe cases, a nerve block that quiets the sympathetic nerves at the wrist can help the blood vessels dilate and end a painful episode. In the most severe cases which fail other efforts at treatment, a surgical procedure to allow the finger blood vessels to dilate is an option. It’s especially important to seek treatment if the RP is severe enough to cause major continuing pain or to be associated with ulcers or infections of the fingers.
Hospital for Special Surgery’s specialists in rheumatology and pediatric rheumatology manage cases of both primary and secondary Raynaud's phenomenon. When needed, our anesthesiology specialists provide nerve blocks, and our Hand and Upper Extremity Service can assist in the most difficult cases. A rheumatologist can also help to separate primary from secondary RP by searching for any clues to an associated inflammatory condition.