In this week’s installment of Ask the Expert, Dr. Jessica Gordon, Rheumatologist, answers questions on Raynaud’s Phenomenon.
Q1. What is Raynaud’s Phenomenon?
Raynaud’s Phenomenon is an exaggerated response of the blood vessels to the cold or to emotional stress. It usually occurs in the fingers and/or toes and is characterized by white, blue, or red color change. Between 3 to 20% of the population has this condition.
Q2. What are the causes of Raynaud’s?
It is considered primary if there is no underlying cause or reason for it. It is considered secondary if there is another reason for it. Raynaud can be associated with different connective tissue diseases or rheumatologic disorders such as systemic sclerosis, systemic lupus erythematosus, Sjogren’s syndrome, and others. Some medications can make it worse, including amphetamines or Adderall, Beta-blockers, and chemotherapies. Smoking will make RP worse. Other medical illnesses can bring on RP too, including hypothyroidism, certain blood disorders, and vascular trauma, which can occur with vibration induced injury or with frostbite. Patients with RP and CTD, especially scleroderma, are at risk for digital ulceration due to RP. This can be very painful and can lead to disability of the hands.
Q3. What are the effects of cold weather for people that are diagnosed with Raynaud’s?
RP is triggered by cold and emotional stress. The cold weather months can be very difficult for those with Raynaud’s. Some preventative measures include:
- Staying warm- dress appropriately in cold weather with hats, gloves, and very warm coats. Also, dress in layers. One suggestion is to shop for cold weather wear at camping or ski stores. Hand warmers are also very helpful.
- Quitting smoking
- Minimizing caffeine and stress
- Minimizing time outside
- Warming up your car before putting your hands on the cold wheel
Q4. What are the surgical and non-surgical methods used to treat Raynaud’s?
There are many forms of methods that are used to treat Raynaud’s. Pharmacologic methods include:
- Calcium channel blockers- these are often the first choice medications to treat RP. Commonly prescribed CCbs are amlodipine (Norvasc), nifedipine, or felodipine. These are medications that will decrease the blood pressure, so sometimes they are not tolerated by persons with low blood pressure to start with.
- Aspirin- frequently added as well, but it is important to discuss with your doctor if you might be at risk for side effects from aspirin.
- Other medications less frequently used are angiotensin receptor blockers (losartan for example), phosphodiesterase inhibitors (sildenafil, tadalafil), and endothelin antagonists (bosentan). These are used more often in patients with digital ulcers as a complication of RP, and the use of any of these medications would be considered off-label.
- In very severe cases, IV prostaglandins may be considered.
In the event of surgery, some surgical methods include Botox, which may be considered in severe cases, and Sympathectomy, which may be performed in different ways by hand surgeons or by anesthesiologists.
Dr. Jessica Gordon is an Assistant Attending in the Department of Rheumatology at Hospital for Special Surgery. She specializes in the treatment of various rheumatologic conditions including scleroderma, vasculitis, systemic lupus erythematosus, and rheumatoid arthritis. She has been the recipient of numerous awards including a Scleroderma Foundation New Investigator Grant.