What is Raynaud’s phenomenon?
In response to exposure to the cold, the body restricts blood flow to the skin to preserve its core temperature. People with Raynaud’s phenomenon (also called Raynaud’s syndrome) experience this restriction of blood flow more readily because of an enhanced sensitivity to cold. The areas of the body affected are typically the fingers and toes, although in rare cases Raynaud’s can affect the lips, nose, ear lobes, nipples, or tongue.[1] The restriction of blood flow in people with Raynaud’s is also commonly triggered by emotional stress. Raynaud’s can be categorized as primary (without another underlying cause) or secondary (resulting from complications of another condition).[2][3][4]
What are the main signs and symptoms of Raynaud’s phenomenon?
Raynaud’s phenomenon occurs when flares or “attacks” trigger blood vessels in certain parts of the body to constrict, reducing blood flow and causing pain, numbness, and tingling. The fingers and toes are the most common areas affected, but Raynaud’s can also affect the nose and ears.
During a Raynaud’s attack, loss of blood flow to the affected area causes the tissue to turn a pale white color. As blood in the area loses oxygen, the tissue becomes blue and feels cold and numb. When circulation is restored, the affected areas turn red and become swollen. People may also experience a tingling, burning, or throbbing sensation at this stage. Attacks can last from minutes to hours, but in rare cases Raynaud’s attacks can last for days, causing permanent damage to the affected areas.[1][2]
Severe attacks, which are more common with secondary Raynaud’s phenomenon, can cause ulcers or sores to form on the end of the affected fingers or toes.
How is Raynaud’s phenomenon diagnosed?
When Raynaud’s is suspected, a health care provider will consider risk factors such as the age of onset and location of the affected areas on the body and will evaluate the overall frequency and severity of symptoms. The person’s health history will also be reviewed for the presence of other symptoms that may indicate secondary Raynaud’s caused by another underlying condition.[2]
A technique called nailfold capillary microscopy (NCM) may also be used to differentiate between primary and secondary Raynaud’s. NCM allows the physician to see changes in the structure of the capillaries that may indicate the presence of underlying conditions implicated in secondary Raynaud’s, such as scleroderma or other connective tissue disorders.[5][6][7]
What are some of the main medical treatments for Raynaud’s phenomenon?
The main medical treatments for Raynaud’s are focused on reducing the severity and frequency of attacks and improving blood flow. Early treatments for Raynaud’s typically involve conservative therapies focused on lifestyle changes to avoid the circumstances that trigger attacks. This can include limiting cold exposure, avoiding stimulants such as caffeine[8] or ADHD medications such as Ritalin (methylphenidate)[9], and managing stress.
If conservative treatments fail, the following medications may be used to treat blood vessel constriction:
Have any supplements been studied for Raynaud’s phenomenon?
Several supplements have been studied for Raynaud’s phenomenon.
-
Pycnogenol: In a pilot trial comparing pycnogenol supplementation + standard therapy to standard therapy alone in women with primary Raynaud’s, pycnogenol supplementation significantly improved blood flow and reduced symptoms. Pycnogenol also improved tissue oxygen levels and reduced levels of biomarkers for oxidative stress.[15]
-
Fish oil: Fish oil was shown in one study to improve cold tolerance and delay blood vessel constriction in people with Raynaud’s.[16]
-
Essential fatty acids (omega-3 and omega-6): In a cohort of healthy participants, daily supplementation with an essential fatty acid (EFA) supplement for 6 months reduced red blood cell aggregation. Since red blood cell aggregation has been implicated in worsening blood flow to the affected extremities in people with secondary Raynaud’s, the authors speculated that EFA supplements and/or fish oil might be useful for treating Raynaud’s.[17]
-
Beetroot juice: Beetroot juice improved blood flow and blood vessel function and reduced inflammation in people with Raynaud’s.[18]
Additional supplements studied for treating Raynaud’s include L-arginine and N-acetylcystine (NAC). However, neither L-arginine[19][20] nor NAC[21] supplementation were found to improve blood flow in people with Raynaud’s.
How could diet affect Raynaud’s phenomenon?
There haven’t been many studies specifically testing the effect of diets on Raynaud’s. However, some investigators have speculated that foods with circulation-improving properties such as garlic[22] may help to improve blood flow. Additionally, foods that contain caffeine should be avoided, because it decreases blood flow to the extremities.[23]
Are there any other treatments for Raynaud’s phenomenon?
Some alternative, nonpharmaceutical interventions have been used to treat Raynaud’s, including exercise, therapeutic gloves, and laser therapy.[24][25]
Acupuncture has also shown some modest benefits, although it remains to be seen whether it can cause a meaningful reduction in symptoms.[26]
An older study found that immersing the hand in warm water then exposing it to cold increased finger temperatures in people with Raynaud’s,[27] possibly through training the body’s natural ability to constrict and dilate blood vessels in response to environmental conditions.
What causes Raynaud’s phenomenon?
The most common cause of Raynaud’s phenomenon is overactivation of the sympathetic nervous system. This causes an increased release of the neurotransmitter norepinephrine, which binds to and activates adrenergic receptors. When the alpha-2 adrenergic receptors on blood vessels are activated, the smooth muscle tissue that lines the blood vessel walls contracts, causing vasoconstriction (a narrowing of blood vessels).
Excessive blood vessel constriction reduces blood flow to the extremities, which causes the characteristic changes in skin color associated with Raynaud’s as well as pain, tingling, and numbness.
There are two main variants of Raynaud’s: primary and secondary. With primary Raynaud’s, the disorder occurs on its own, independent of any underlying condition. In contrast, secondary Raynaud’s is caused by the presence of another underlying condition, such as lupus, scleroderma, or other autoimmune disorders.[2]
Examine Database: Raynaud's Phenomenon
Frequently asked questions
In response to exposure to the cold, the body restricts blood flow to the skin to preserve its core temperature. People with Raynaud’s phenomenon (also called Raynaud’s syndrome) experience this restriction of blood flow more readily because of an enhanced sensitivity to cold. The areas of the body affected are typically the fingers and toes, although in rare cases Raynaud’s can affect the lips, nose, ear lobes, nipples, or tongue.[1] The restriction of blood flow in people with Raynaud’s is also commonly triggered by emotional stress. Raynaud’s can be categorized as primary (without another underlying cause) or secondary (resulting from complications of another condition).[2][3][4]
Raynaud’s phenomenon occurs when flares or “attacks” trigger blood vessels in certain parts of the body to constrict, reducing blood flow and causing pain, numbness, and tingling. The fingers and toes are the most common areas affected, but Raynaud’s can also affect the nose and ears.
During a Raynaud’s attack, loss of blood flow to the affected area causes the tissue to turn a pale white color. As blood in the area loses oxygen, the tissue becomes blue and feels cold and numb. When circulation is restored, the affected areas turn red and become swollen. People may also experience a tingling, burning, or throbbing sensation at this stage. Attacks can last from minutes to hours, but in rare cases Raynaud’s attacks can last for days, causing permanent damage to the affected areas.[1][2]
Severe attacks, which are more common with secondary Raynaud’s phenomenon, can cause ulcers or sores to form on the end of the affected fingers or toes.
A Raynaud’s attack typically starts at a single digit such as a finger and then spreads to additional fingers on both hands. The thumb isn’t typically affected, but if it is, this can be an indicator of secondary Raynaud’s phenomenon.[2]
Because of prolonged blood vessel constriction and reduced blood flow, ulcers can form on the tips of fingers or toes from the tissue damage. If left untreated, this can potentially lead to necrosis (a form of tissue death) and gangrene, potentially requiring amputation of the affected area.[2]
A primary care physician can treat primary Raynaud’s phenomenon. A rheumatologist should be consulted in cases of suspected secondary Raynaud’s phenomenon. In severe cases that are resistant to other forms of treatment, a vascular surgeon may perform a sympathectomy, which is a surgical procedure to destroy the nerves causing the affected blood vessels to narrow.[2][28]
When Raynaud’s is suspected, a health care provider will consider risk factors such as the age of onset and location of the affected areas on the body and will evaluate the overall frequency and severity of symptoms. The person’s health history will also be reviewed for the presence of other symptoms that may indicate secondary Raynaud’s caused by another underlying condition.[2]
A technique called nailfold capillary microscopy (NCM) may also be used to differentiate between primary and secondary Raynaud’s. NCM allows the physician to see changes in the structure of the capillaries that may indicate the presence of underlying conditions implicated in secondary Raynaud’s, such as scleroderma or other connective tissue disorders.[5][6][7]
The main medical treatments for Raynaud’s are focused on reducing the severity and frequency of attacks and improving blood flow. Early treatments for Raynaud’s typically involve conservative therapies focused on lifestyle changes to avoid the circumstances that trigger attacks. This can include limiting cold exposure, avoiding stimulants such as caffeine[8] or ADHD medications such as Ritalin (methylphenidate)[9], and managing stress.
If conservative treatments fail, the following medications may be used to treat blood vessel constriction:
There are currently no treatments available that can cure Raynaud’s. The treatments are focused on limiting the lifestyle factors that can trigger an attack and/or suppressing the constriction of blood vessels with prescription drugs. However, in people with primary Raynaud’s, the disorder may spontaneously resolve on its own.[2]
You should consult with your healthcare provider for Raynaud’s under the following conditions:
-
Reduced quality of life: You should seek medical treatment for Raynaud’s if you experience severe or frequent attacks that affect your quality of life and/or ability to carry out daily tasks. Because Raynaud’s mostly affects the hands, severe attacks can make it difficult to type or grasp objects.
-
Tissue damage: It is also important to get medical treatment if sores or ulcers form after a Raynaud’s attack to avoid permanent scarring and damage.
-
Secondary Raynaud’s diagnosis: Getting treatment for the underlying conditions that trigger secondary Raynaud’s, such as an autoimmune disorder, is critical for managing symptoms and avoiding complications. Secondary Raynaud’s attacks can be more severe than primary Raynaud’s, increasing the likelihood of permanent tissue damage and scarring. In severe cases of secondary Raynaud’s, extended attacks can cause tissue death and potentially gangrene, a condition that occurs when tissue dies from a prolonged lack of blood supply. Gangrene is a potentially life-threatening condition which may require amputation of the affected part of the body.[29][2]
Several supplements have been studied for Raynaud’s phenomenon.
-
Pycnogenol: In a pilot trial comparing pycnogenol supplementation + standard therapy to standard therapy alone in women with primary Raynaud’s, pycnogenol supplementation significantly improved blood flow and reduced symptoms. Pycnogenol also improved tissue oxygen levels and reduced levels of biomarkers for oxidative stress.[15]
-
Fish oil: Fish oil was shown in one study to improve cold tolerance and delay blood vessel constriction in people with Raynaud’s.[16]
-
Essential fatty acids (omega-3 and omega-6): In a cohort of healthy participants, daily supplementation with an essential fatty acid (EFA) supplement for 6 months reduced red blood cell aggregation. Since red blood cell aggregation has been implicated in worsening blood flow to the affected extremities in people with secondary Raynaud’s, the authors speculated that EFA supplements and/or fish oil might be useful for treating Raynaud’s.[17]
-
Beetroot juice: Beetroot juice improved blood flow and blood vessel function and reduced inflammation in people with Raynaud’s.[18]
Additional supplements studied for treating Raynaud’s include L-arginine and N-acetylcystine (NAC). However, neither L-arginine[19][20] nor NAC[21] supplementation were found to improve blood flow in people with Raynaud’s.
There haven’t been many studies specifically testing the effect of diets on Raynaud’s. However, some investigators have speculated that foods with circulation-improving properties such as garlic[22] may help to improve blood flow. Additionally, foods that contain caffeine should be avoided, because it decreases blood flow to the extremities.[23]
Some alternative, nonpharmaceutical interventions have been used to treat Raynaud’s, including exercise, therapeutic gloves, and laser therapy.[24][25]
Acupuncture has also shown some modest benefits, although it remains to be seen whether it can cause a meaningful reduction in symptoms.[26]
An older study found that immersing the hand in warm water then exposing it to cold increased finger temperatures in people with Raynaud’s,[27] possibly through training the body’s natural ability to constrict and dilate blood vessels in response to environmental conditions.
The most common cause of Raynaud’s phenomenon is overactivation of the sympathetic nervous system. This causes an increased release of the neurotransmitter norepinephrine, which binds to and activates adrenergic receptors. When the alpha-2 adrenergic receptors on blood vessels are activated, the smooth muscle tissue that lines the blood vessel walls contracts, causing vasoconstriction (a narrowing of blood vessels).
Excessive blood vessel constriction reduces blood flow to the extremities, which causes the characteristic changes in skin color associated with Raynaud’s as well as pain, tingling, and numbness.
There are two main variants of Raynaud’s: primary and secondary. With primary Raynaud’s, the disorder occurs on its own, independent of any underlying condition. In contrast, secondary Raynaud’s is caused by the presence of another underlying condition, such as lupus, scleroderma, or other autoimmune disorders.[2]
The following conditions have been implicated in the development of secondary Raynaud’s:
-
Autoimmune conditions: Autoimmune disorders such as systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, and Sjogren syndrome can trigger Raynaud’s attacks.[30][31][2]
-
Medications: Certain medications such as beta blockers, cyclosporine, and migraine medications have been linked to secondary Raynaud’s.[2]
-
Occupational exposure: Exposure to vibrations from machinery, chemicals from PVC, and chemicals associated with ammunition production can trigger Raynaud’s attacks.[2]
-
Obstructive vascular diseases: Diseases that block or reduce blood flow through blood vessels such as atherosclerosis and diabetic angiopathy (a condition that causes blood flow restriction from high glucose levels) can cause secondary Raynaud's.[2]
-
Infectious diseases: Infections such as hepatitis B, hepatitis C, and cytomegalovirus[2] can cause secondary Reynaud’s.
Secondary Raynaud’s has also been linked to other conditions such as fibromyalgia, cancer, and polycythemia (a blood condition associated with abnormally high red blood cell production).[2]
Younger women (teenaged through age 20–30) tend to be at the highest risk for developing Raynaud’s. Raynaud’s is more common among women than men, with a 9:1 female-to-male ratio.[32]
Although counterintuitive, much of the pain and potential tissue damage associated with the latter stages of a Raynaud’s attack occur after the constricted blood vessels have opened back up, which causes a rapid influx of oxygenated blood into the previously hypoxic (low oxygen) tissue. This triggers a type of ischemia-reperfusion injury, generating high levels of reactive oxygen species that are damaging to the tissue. In response to the damage, the immune system is mobilized, causing immune cells to move into the area and secrete high levels of pro-inflammatory cytokines. The characteristic deep-red and swollen appearance of the affected digits, as well as the pain and throbbing sensations, are caused by the inflammatory response. In extreme cases, the latter phase of Raynaud’s attacks can lead to the formation of blood clots, ulcers, or sores in the affected areas.[33]
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References
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- ^Musa R, Qurie ARaynaud Disease.StatPearls.(2024 Jan)
- ^Ventura I, Reid P, Jan RApproach to Patients with Suspected Rheumatic Disease.Prim Care.(2018 Jun)
- ^Pauling JD, Reilly E, Smith T, Frech TMEvolving Symptom Characteristics of Raynaud's Phenomenon in Systemic Sclerosis and Their Association With Physician and Patient-Reported Assessments of Disease Severity.Arthritis Care Res (Hoboken).(2019 Aug)
- ^Vidal C, Ruano C, Bernardino V, Lavado Carreira P, Lladó A, Santos MC, Gruner H, Panarra A, Riso N, Moraes-Fontes MFClinical Presentation and Long-Term Outcomes of Systemic Sclerosis Portuguese Patients from a Single Centre Cohort: A EUSTAR Registration Initiative.Acta Med Port.(2018 Jun 29)
- ^Ingegnoli F, Ughi N, Crotti C, Mosca M, Tani COutcomes, rates and predictors of transition of isolated Raynaud's phenomenon: a systematic review and meta-analysis.Swiss Med Wkly.(2017)
- ^Mirbod SM, Sugiura HA non-invasive technique for the evaluation of peripheral circulatory functions in female subjects with Raynaud's phenomenon.Ind Health.(2017 Jun 8)
- ^Bakst R, Merola JF, Franks AG Jr, Sanchez MRaynaud's phenomenon: pathogenesis and management.J Am Acad Dermatol.(2008 Oct)
- ^Meridor K, Levy YSystemic sclerosis induced by CNS stimulants for ADHD: A case series and review of the literature.Autoimmun Rev.(2020 Jan)
- ^Cleophas TJ, van Lier HJ, Faaber P, Fennis JF, van't Laar ATherapeutic efficacy of alpha-adrenoceptor blockade in primary and secondary Raynaud's syndrome.Angiology.(1984 Nov)
- ^Khouri C, Lepelley M, Bailly S, Blaise S, Herrick AL, Matucci-Cerinic M, Allanore Y, Trinquart L, Cracowski JL, Roustit MComparative efficacy and safety of treatments for secondary Raynaud's phenomenon: a systematic review and network meta-analysis of randomised trials.Lancet Rheumatol.(2019 Dec)
- ^Thompson AE, Pope JECalcium channel blockers for primary Raynaud's phenomenon: a meta-analysis.Rheumatology (Oxford).(2005 Feb)
- ^Arefiev K, Fiorentino DF, Chung LEndothelin Receptor Antagonists for the Treatment of Raynaud's Phenomenon and Digital Ulcers in Systemic Sclerosis.Int J Rheumatol.(2011)
- ^Buecking A, Rougemont E, Fabio Zullino DTreatment of Raynaud's phenomenon with escitalopram.Int J Neuropsychopharmacol.(2005 Jun)
- ^Hu S, Hosoi M, Belcaro G, Dugall M, Feragalli B, Cotellese R, Luzzi RManagement of mild, primary Raynaud Syndrome: supplementation with Pycnogenol®.Minerva Cardioangiol.(2019 Oct)
- ^DiGiacomo RA, Kremer JM, Shah DMFish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study.Am J Med.(1989 Feb)
- ^Ho M, Maple C, Bancroft A, McLaren M, Belch JJThe beneficial effects of omega-3 and omega-6 essential fatty acid supplementation on red blood cell rheology.Prostaglandins Leukot Essent Fatty Acids.(1999 Jul)
- ^Shepherd AI, Costello JT, Bailey SJ, Bishop N, Wadley AJ, Young-Min S, Gilchrist M, Mayes H, White D, Gorczynski P, Saynor ZL, Massey H, Eglin CM"Beet" the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud's phenomenon.J Appl Physiol (1985).(2019 Nov 1)
- ^Khan F, Litchfield SJ, McLaren M, Veale DJ, Littleford RC, Belch JJOral L-arginine supplementation and cutaneous vascular responses in patients with primary Raynaud's phenomenon.Arthritis Rheum.(1997 Feb)
- ^Khan F, Belch JJSkin blood flow in patients with systemic sclerosis and Raynaud's phenomenon: effects of oral L-arginine supplementation.J Rheumatol.(1999 Nov)
- ^Correa MJ, Mariz HA, Andrade LE, Kayser COral N-acetylcysteine in the treatment of Raynaud's phenomenon secondary to systemic sclerosis: a randomized, double-blind, placebo-controlled clinical trial.Rev Bras Reumatol.(2014 Nov-Dec)
- ^Wright, C.I. et alRaynaud's Phenomenon and the Possible Use of FoodsJournal of Food Science.(2006)
- ^Tesselaar E, Nezirevic Dernroth D, Farnebo SAcute effects of coffee on skin blood flow and microvascular function.Microvasc Res.(2017 Nov)
- ^Mahmood, F. et alRaynaud's Phenomenon and the Possible Use of Foods: Non-Pharmacological Interventions for the Treatment of Raynaud’s phenomenon—A Systematic ReviewUpdates in Family Medicine.(2024)
- ^Malenfant D, Catton M, Pope JEThe efficacy of complementary and alternative medicine in the treatment of Raynaud's phenomenon: a literature review and meta-analysis.Rheumatology (Oxford).(2009 Jul)
- ^Zhou F, Huang E, Zheng E, Deng JThe use of acupuncture in patients with Raynaud's syndrome: a systematic review and meta-analysis of randomized controlled trials.Acupunct Med.(2023 Apr)
- ^Jobe JB, Sampson JB, Roberts DE, Beetham WP JrInduced vasodilation as treatment for Raynaud's disease.Ann Intern Med.(1982 Nov)
- ^Thune TH, Ladegaard L, Licht PBThoracoscopic sympathectomy for Raynaud's phenomenon--a long term follow-up study.Eur J Vasc Endovasc Surg.(2006 Aug)
- ^Buttolph A, Sapra AGangrene.StatPearls.(2024 Jan)
- ^Ruaro B, Sulli A, Smith V, Pizzorni C, Paolino S, Alessandri E, Cutolo MMicrovascular damage evaluation in systemic sclerosis: the role of nailfold videocapillaroscopy and laser techniques.Reumatismo.(2017 Dec 21)
- ^Wollina U, Koch A, Langner D, Hansel G, Heinig B, Lotti T, Tchernev GAcrocyanosis - A Symptom with Many Facettes.Open Access Maced J Med Sci.(2018 Jan 25)
- ^Belch J, Carlizza A, Carpentier PH, Constans J, Khan F, Wautrecht JC, Visona A, Heiss C, Brodeman M, Pécsvárady Z, Roztocil K, Colgan MP, Vasic D, Gottsäter A, Amann-Vesti B, Chraim A, Poredoš P, Olinic DM, Madaric J, Nikol S, Herrick AL, Sprynger M, Klein-Weigel P, Hafner F, Staub D, Zeman ZESVM guidelines - the diagnosis and management of Raynaud's phenomenon.Vasa.(2017 Oct)
- ^Shah J, Billington AR, Elston JB, Payne WGRaynaud's Phenomenon.Eplasty.(2013)
Examine Database References
- Raynaud's Phenomenon Symptoms - Bredie SJ, Jong MCNo significant effect of ginkgo biloba special extract EGb 761 in the treatment of primary Raynaud phenomenon: a randomized controlled trialJ Cardiovasc Pharmacol.(2012 Mar)
- Raynaud's Phenomenon Symptoms - Choi WS, Choi CJ, Kim KS, Lee JH, Song CH, Chung JH, Ock SM, Lee JB, Kim CMTo compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study)Clin Rheumatol.(2009 May)
- Raynaud's Phenomenon Symptoms - DiGiacomo RA, Kremer JM, Shah DMFish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study.Am J Med.(1989 Feb)
- Raynaud's Phenomenon Symptoms - Zhou F, Huang E, Zheng E, Deng JThe use of acupuncture in patients with Raynaud's syndrome: a systematic review and meta-analysis of randomized controlled trials.Acupunct Med.(2023 Apr)
- Endothelial Function - Shepherd AI, Costello JT, Bailey SJ, Bishop N, Wadley AJ, Young-Min S, Gilchrist M, Mayes H, White D, Gorczynski P, Saynor ZL, Massey H, Eglin CM"Beet" the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud's phenomenon.J Appl Physiol (1985).(2019 Nov 1)