Raynaud's

The full extent of what causes Raynaud's still needs to be determined. Certain triggers cause small arteries in the skin to constrict (narrow), reducing the flow of blood to that area. Over time, repeated attacks lead to thickening of these arteries, reducing the blood flow even more. An attack is usually triggered by exposure to cold temperatures or stress, but can also be linked to certain medications.

Raynaud's is classified into two types: primary and secondary.

Primary Raynaud's

Primary Raynaud's (also known as Raynaud's disease) is not associated with any underlying medical condition and is the most common type of Raynaud’s, causing 90% of cases. It usually affects all the fingers on both hands and develops between the ages of 15 and 30. Symptoms vary from mild to significant and can be triggered even by getting something out of the freezer, or by a spell of relatively cool weather.

Secondary Raynaud's

Secondary Raynaud's is far less common and is related to an underlying medical condition. Because of this it can develop at any age and conditions linked with it include injuries to the hands or feet, carpal tunnel syndrome, scleroderma, multiple sclerosis, lupus and rheumatoid arthritis, as well as the impact of repetitive actions or vibrations such as using a pneumatic drill – sometimes also called ‘vibration white finger’. Medications that can cause blood vessels to narrow have also been implicated such as:

• beta-blockers (used in treating hypertension or anxiety
• some migraine medication
• chemotherapy treatment.

Most cases of primary Raynaud's can be managed at home without any treatment but it is important to seek further medical review if your symptoms are not improving with home treatment, or if they are getting worse and affecting your daily life.

Secondary Raynaud's is more likely to present later in life, so if your symptoms occur over 30 years old for the first time then it is important to seek further advice. Conversely, if it happens before the age of 12 or your symptoms are one-sided, or associated with other symptoms such as joint pain, skin rashes or muscle weakness (which might indicate a connective tissue disease) it is also advisable to speak to your doctor.

There are simple measures you can do at home which will make a big difference to symptoms. These include:

• keeping your body and hands warm with the right clothing

• taking extra care to protect your hands and feet (including wearing gloves when taking things out of a fridge or freezer)

• exercising regularly to help improve your body's circulation

• avoiding smoking (this is crucial)

• cutting out caffeine as this makes symptoms worse in some people with Raynaud’s

• warming your hands up as soon as they become cold (wearing heated gloves can be helpful with this)

If you have unsuccessfully tried to manage your symptoms or you have any associated symptoms, it is important to make an appointment with your doctor. They will review your symptoms, history, any medication you may be taking, and consider investigating you for any underlying causes such as lupus or rheumatoid arthritis. Your doctor may advise you to start medications that can dilate the blood vessels and improve your circulation, such as the calcium-channel blocker nifedipine, commonly used as a blood pressure medication. Relaxation techniques may also be helpful if you have primary Raynaud’s triggered by stress or emotion, and severe Raynaud’s (usually the secondary type) can sometimes be treated by specialists with nerve block treatment. The outlook for people with primary Raynaud’s is usually good, and in many people it lessens or goes away completely over time, although nifedipine works very well for many people, too.

With secondary Raynaud’s, treatment can work less well and the severity of symptoms is often linked to the severity of the underlying condition causing it. This means that in some people with secondary Raynaud’s, treating their condition as effectively as possible can lessen their Raynaud’s symptoms significantly.