From the Guidelines
To manage Raynaud's phenomenon, it is essential to avoid triggers such as cold, trauma, stress, smoking, and certain medications, and to use calcium channel blockers like nifedipine as first-line treatment. Raynaud's phenomenon is a condition where blood vessels in the extremities, typically fingers and toes, overreact to cold temperatures or stress, causing them to narrow and temporarily limit blood flow. To reduce the frequency and severity of attacks, wearing proper warm clothing in cold conditions, such as a coat, mittens, hat, dry insulated footwear, and hand and/or foot warmers, is suggested, based on expert opinion 1.
Lifestyle Modifications
Some lifestyle modifications can help alleviate symptoms, including:
- Avoiding sudden temperature changes
- Minimizing stress
- Stopping smoking, as nicotine constricts blood vessels
- Wearing layered clothing to keep the whole body warm
- Using insulated gloves, socks, and hand warmers to keep hands and feet warm
Medication Options
For medication options, calcium channel blockers like nifedipine (10-30 mg daily) are first-line treatments that help relax blood vessels 1. Other medications include topical nitroglycerin (apply to affected areas), sildenafil (20-50 mg as needed), or losartan (25-100 mg daily) for those who don't respond to calcium channel blockers.
Managing Attacks
During an attack, warming the hands or feet by placing them in warm (not hot) water, moving to a warmer environment, and performing gentle arm windmills or wiggling fingers and toes to increase circulation can help. Severe cases may require medical evaluation, as Raynaud's can sometimes indicate underlying autoimmune conditions. The condition occurs because certain people have an exaggerated nervous system response that causes excessive constriction of small blood vessels in the extremities when exposed to cold or stress. Physical therapy, biofeedback, and laser treatment are also being studied as potential treatments 1.
From the Research
Definition and Prevalence of Raynaud's Phenomenon
- Raynaud's phenomenon (RP) is a vasospastic disorder characterized by episodic color changes of blanching, cyanosis, and hyperemia in response to cold and/or emotional stress 2.
- The prevalence of RP in adults is more common in women than men, with estimates ranging from 4% to 30% 2.
- Geographic variations in the prevalence reflect differences in climate 2.
Primary and Secondary Raynaud's Phenomenon
- Primary RP is characterized by symmetric attacks, the absence of tissue necrosis, ulceration or gangrene, the absence of a secondary cause, negative antinuclear antibodies, normal nailfold capillaroscopy and a normal erythrocyte sedimentation rate 2.
- Secondary RP is characterized by an age of onset of more than 30 years, painful and asymmetric attacks, ischemic skin lesions, positive autoantibodies, capillaroscopic abnormalities and/or clinical features suggestive of connective tissue diseases (CTDs) 2.
- Systemic sclerosis has the highest frequency of RP among CTDs 2.
Diagnosis and Treatment
- Diagnosis of RP requires a knowledge of the patient's occupational, smoking, drug history, physical examination, nailfold capillaroscopy, routine laboratory tests and autoantibodies 2.
- Treatment of RP includes abstinence from smoking, discontinuation of offending drugs, and avoidance of abrupt changes in temperature 2.
- Calcium-channel blockers, such as nifedipine, are the most widely used treatment for RP 2, 3, 4, 5.
- Other treatments that may be useful include sympatholytic agents, angiotensin II-receptor type I antagonists, selective serotonin-reuptake inhibitors, and prostaglandins 2, 3, 6.
Management Strategies
- Non-pharmacological interventions, such as avoiding cold and smoking cessation, are first-line in the management of RP 3, 6.
- Pharmacological treatment strategies vary significantly internationally, and there is continued interest in developing surgical approaches 5.
- Calcium channel blockers are first-line treatment and can be initiated by primary care physicians 5.
- Second-line drug therapies used for refractory RP include alpha-1 adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors, nitric oxide, prostaglandin analogs, and phosphodiesterase inhibitors 6.