March
2008
Raynaud’s Phenomenon
Raynaud Phenomenon (RP) is when arteries clamp down inappropriately, because of oversensitive response to cold or emotional stress. So the arteries go haywire and over constrict. Occurs mostly in fingers and toes. First the skin color changes to white due to lack of arterial blood flow. Then turns blue because the period of time without oxygen. Blood flow usually takes 15-20min to return and then the skin is red. RP is primary if there is no underlying cause. It is secondary if associated with disease, medications, etc and called Raynaud Syndrome. Everyone can get cold fingers, but RP means the severe color changes, and it hurts (or feels like pins and needles if not so painful)
Risk Factors: Probably 3-5% of people have RP. Family history, women, younger people. Usually starts between ages 15-30.
Fingers are most affected: usually index to ring finger. Starts normally with one finger and then spreads to the other fingers – on both hands. Toes can also be affected, as well as face, ears, nose, nipples, and even knees. Going from warm to cold suddenly is often the precipitating factor, like grabbing ice cream out of the freezer. Even if the whole body is cold, it can precipitate it. Nervousness/stress can do it to.
On the body, like the torso and legs, it is livido reticularis – a spiderweb like pattern of blue skin. It is also associated with antiphospholipid syndrome, vasculitis, and occlusive vascular disease.
Secondary causes: there are a lot. ANA and ESR elevation by blood test can indicate a rheumatologic disease: scleroderma, SLE (systemic lupus erythematosus), polymyositis, rheumatoid arthritis, cryoglobulins (like in Hepatitis B & C patients). Mechanical injuries can cause it such as in vibration syndrome (like a jack hammer), frostbite, not using crutches right and causing vascular damage in the armpit. Migraine patients can have it. Vascular disease in atherosclerosis or emboli. Hypothyroidism, pheochromocytoma. Some meds and cocaine.
If blood flow is poor enough from an extended attack or frequent attacks, tissue can die. That can lead to ulcers or even loss of part of the finger.
Diagnosis is made with a rheumatologist usually. A simple look in the fingernail with oil and an ophthalmascope can see if further workup is needed. Checking the blood pressure of the finger in cold water can confirm RP.
Treatment: keep warm! Wearing gloves and avoiding touching cold objects. Hand warmers. Avoid tobacco, caffeine & stimulants. Biofeedback might help some. If secondary RP, then treating the underlying disorder.
drjohnhong 
cardiovascular, rheumatology 
Comments (0) » |
(0 ratings) | 
Email it
