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RAYNAUD'S SYNDROME

What is Raynaud's Syndrome ?

Raynaud's syndrome is the name given to spasm which periodically narrows the small blood vessels of the fingers and/or toes. This spasm is brought on by cold temperatures. It may be mild, resulting only in the fingers going white. If it is severe, the fingers may become numb or extremely painful. Raynaud's syndrome may be caused by two broadly different processes: an inbuilt increased sensitivity to the cold or to a widespread disorder of the small blood vessels. These disorders, known as the collagen or connective tissue disorders, may first come to the doctor's attention because you developed Raynaud's syndrome. In these conditions, the walls of the smaller arteries become stiff and restrict blood flow in the fingers and toes. It is important for your doctor to determine which process is present, as the treatment will be different.

How does Raynaud's Syndrome occur ?

The whiteness of the fingers is due to spasm in the arteries preventing blood getting in to the fingers. A little later the fingers become dusky and as the blood returns to the fingers there may be severe pain. The return of blood to the fingers is due to the spasm ending. However, in severe cases the spasm may be prolonged and may lead to skin damage at the tips of the fingers because insufficient blood is getting through.

Why does Raynaud's Syndrome occur ?

It is not known why some people's blood vessels should be more sensitive to the cold but the doctor may want to rule out more unusual causes by doing some blood tests. In a very few cases, x-rays of the circulation may be required to ensure that the larger arteries are normal. An x-ray of the blood circulation is known as angiography. This requires injection of a dye into the circulation and then x-rays taken to show the outlines of the blood vessels.

Treatment Involved for Raynaud's Syndrome

Your doctor is likely to do some tests to be sure that there is no inflammatory condition present in the arteries. If there is such evidence, you will be referred to a rheumatologist or immunologist for more tests, a definite diagnosis and appropriate treatment. If it is decided that the condition is due simply to sensitivity to the cold, the most useful treatment is simply to keep your hands warm. This means wearing gloves out of doors and avoiding cold water. If the symptoms are severe then a course of tablet treatment may be recommended. These tablets will reduce the spasm in the blood vessels but they usually have only a temporary effect. If the tablet treatment is not sufficient and if there is the possibility of skin damage, then surgery may be considered. However, this is very rare. Surgery consists of cutting the nerves which normally cause the blood vessels to contract, thus reducing the spasm. This surgery is done usually through an incision at the base of the neck, under a general anaesthetic. It is then possible to reach the nerves which supply the arteries of the arms. It is important to emphasize that the nerves which are cut only affect the blood vessels and will not affect the movements of the arm or hand. While surgery may be very helpful at the beginning the spasm can recur after several months. Another method of treating Raynaud's syndrome is by using a type of injection into these nerves to block their function. This can be done without an anaesthetic, usually by an anaesthetist working in a pain clinic. When the problem is due to one of the collagen vascular diseases treatment is aimed directly at this disease. Treatment is usually in the form of tablet therapy and may be a steroid drug, which acts by dampening down the inflammation which occurs in the artery. No matter what the cause of the vessel spasm it is essential to stop smoking, since this can easily aggravate spasm in blood vessels.

During Treatment for Raynaud's Syndrome

Many of the drugs used to treat Raynaud's disease have the effect of lowering the blood pressure and so can cause dizziness. Other possible side-effects include skin-flushing and a feeling of intense warmth. While these side-effects are not usually dangerous they can be quite uncomfortable and indeed sometimes the treatment may be worse than the original complaints!

After Treatment for Raynaud's Syndrome

With every form of this condition there is a tendency for it to come back especially when the weather gets colder. Most forms of treatment give temporary rather than complete relief and so the most important part of the treatment is to adopt a reasonable attitude towards the problem and avoid cold temperatures.

If Raynaud's Syndrome is Left Untreated

Most people with Raynaud's disease have mild symptoms and will not require much treatment from their doctor. However, in severe cases the vessel spasm can result in severe pain and skin damage which may be extremely disabling.