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RAYNAUD'S: MAIN MENU
What is Raynaud's?
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What is Raynaud's?
This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. Just because something is listed here does not mean an individual patient will ever experience it. See Disclaimer.
What is Raynaud's?
Photos of Raynaud's Attacks
Raynaud's Disease vs. Phenomenon
Raynaud's and Scleroderma
Raynaud's of the Nipple
Raynaud's in the Lungs
Doubles Risk of Heart Problems

Importance of Controlling Raynaud's
Other Ways SD Can Affect Hands
Raynaud's in Children
What is Raynaud's?

Attack of Raynaud's, ISN Photo RepositoryRaynaud's is an extreme spasm of blood vessels in response to cold or stress. The fingers and/or toes become white and/or blue, and may become red on re-warming.

Photo: Severe attack of Raynaud's in a systemic scleroderma patient with both blue and white fingers (and also calcinosis on one finger).

How do you pronounce "Raynaud's"? Raynard, Raynod, Raynoze, RAYnadds, Raynaws, Raynowds, RAYnoz, Rayners, or Raywhatsit? ISN's Sclero Forums discussion.
Raynaud's Disease and Phenomenon. Merck Manual.
Raynaud Phenomenon. eMedicine Journal.
Raynaud's Disease and Phenomenon. (CNN.com) Mayo Clinic.
Blunted increase of digital skin vasomotion following acetylcholine and sodium nitroprusside iontophoresis in systemic sclerosis (SSc) patients. This study showed a selective abnormality of the endothelial, sympathetic and myogenic-dependent finger skin vasomotion in SSc patients, consistent with a parallel endothelial, sympathetic and myogenic macrovascular dysfunction. M. Rossi. Rheumatology. April 22, 2008. (Vasomotion is cyclic variation in vascular diameter) (Also see: Digital Ulcers)
Maximum blood flow and microvascular regulatory responses in systemic sclerosis. SSc patients have abnormal microvascular regulatory responses compared with PRP and controls. This study also suggests that the degree of endothelial dysfunction may be related to the degree of peripheral vascular involvement. Rheumatology 2007 46(7):1079-1082.
Capillaroscopic patterns in rheumatic diseases. Microvascular damage is a typical feature of Systemic Sclerosis (SSc) and more than 95% of the patients present architectural disorganization, giant capillaries, haemorrhages, loss of capillaries, avascular areas and neovascularization, as main microvascular abnormalities. These sequential capillaroscopic changes characterize the "scleroderma pattern" and reflect the SSc microangiopathy. PubMed. Acta Reumatol Port. 2007 Jan-Mar;32(1):29-36. (Also see: Common Medical Tests)
Raynaud’s Disease: the Reason Behind Cold, White Fingers and Toes. Exposure to cold normally results in slowing of blood flow to fingers and toes. Small arteries in extremities narrow, reducing blood flow and preserving the core body temperature. For people with Raynaud’s disease, the response is exaggerated for unknown reasons. Newswise. Mayo Clinic Health Letter. 05/09/07.
Feeling the chill: Raynaud's phenomenon sufferers battle cold hands, feet - and misconceptions. The New York-based Raynaud's Association, an international support group of about 2,500 patients, estimates that 5 percent to 10 percent of Americans experience the phenomenon, though many may not know they have it. The Eagle-Tribune. 04/23/07.
Raynaud's phenomenon in dermatology: Part 1: Pathophysiology and diagnostic approach. Raynaud phenomenon is characterized by recurrent spasms of small digital arterioles/arteries at fingers and toes, usually triggered by cold and emotional stress. PubMed. Hautarzt. 2006 Sep;57(9):819-830.
Raynaud's phenomenon in dermatology: Part 2: Therapy. While primary Raynaud's phenomenon (RP) only rarely leads to complications, secondary RP when associated with systemic sclerosis frequently results in necrosis, ulcers or even gangrene. Therefore timely therapeutic intervention is required. PubMed. Hautarzt. 2006 Oct;57(10):927-942. (Also see: Raynaud's Treatments)
Raynaud’s awareness. This common and debilitating condition affects the blood supply to the body's extremities and when an attack strikes, sufferers experience numbness and pain as their feet and hands become white and dead-looking. As the blood returns, the extremities in turn become bright red, with further pain and loss of feeling. SUR in English. 02/09/07.
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. 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). Among the CTDs, systemic sclerosis has the highest frequency of RP. PubMed. Reumatismo. 2004 Apr-Jun;56(2):77-81.
Photos of Raynaud's Attacks
Most Raynaud's attacks are not this visible. Usually attacks cause the skin to go dead white. However, atttacks that incur blue fingers are much more dramatic and photogenic. In between attacks, the hands look normal.
Raynaud's Attack, Blue Fingers, by ISN Photo RepositoryISN Photo Repository: Raynaud's (Alexandra M.) ISN.
ISN Photo Repository: Raynaud'sISN Photo Repository: Raynauds (Joyce) ISN.
Raynaud's (Judith)ISN Photo Repository: Raynauds (Judith). ISN.
Raynaud's in Fingertips by ISN Photo RepositoryISN Photo Repository: Raynaud's (Shelly S). ISN.
Gangrene and Amputations. ISN.
ISN Photo Repository: Finger Ulcers. ISN.
ISN Photo Repository (Main Page). ISN.
Raynaud's Disease vs. Raynaud's Phenomenon (or, Secondary Raynaud's)
When Raynaud's appears by itself, without any other medical condition, it is called Raynaud's Disease. About 1 in 20 adults have primary Raynaud's, whereas only one in 4,000 have Scleroderma. When it appears along with autoimmune diseases such as Scleroderma, Systemic Lupus Erythematosus, and Rheumatoid Arthritis, it is called Raynaud's Phenomenon (or, Secondary Raynaud's.)
In primary Raynaud's, the blood vessels return to normal afterwards. However, in Raynaud's with Scleroderma there may be blood vessel scarring which can make medication ineffective. Digital (Finger) Ulcers are caused by the lack of oxygen to skin cells.
Transition From Primary To Secondary Raynaud’s Phenomenon (PRP / SRP): Identification By Nailfold Videocapillaroscopy During The Follow-Up. We showed the progression from PRP to SRP in 14.6% of the analyzed patients. We suggest the capillaroscopic analysis twice a year in presence of PRP, in order to early detect the transition to SRP in patients showing at the beginning a normal pattern or not-specific nailfold capillary abnormalities, as assessed by NC. A. Sulli OP0138 EULAR 2007. (Also see: Nailfold Capillaroscopy)
Transition from primary Raynaud's (RP) phenomenon to secondary Raynaud's phenomenon identified by diagnosis of an associated disease. Patients diagnosed initially as having primary RP may actually comprise 1 of 3 groups: those with idiopathic RP, those with a rather benign disease course, and those with a more severe course of the disease. Arthritis & Rheumatism Journal. Vol 54, Issue 6:1974-1981 June 2006.
Raynaud's phenomenon. Excluding Raynaud's of occupational origin, the most common cause of secondary Raynaud's is a connective tissue disease (particularly scleroderma). PubMed. Rev Med Liege. 2004 Jun;59(6):378-84. (Also see: What is Scleroderma?)
Raynaud's phenomenon in undifferentiated connective tissue disease (UCTD). Our study indicates that patients with UCTD would seem to have a benign form of Raynaud's, since they show the absence of cutaneous complications, the existence of a mild microvascular damage and a stable nailfold capillary pattern. PubMed. Clin Rheumatol. 2004 Sep 4. (Also see: Overlap/UCTD)
Raynaud's phenomenon in children. It is important to distinguish primary Raynaud's phenomenon, which is usually benign, from Raynaud's phenomenon secondary to connective tissue disease. PubMed. Arch Pediatr. 2004 Jan;11(1):74-7. (Also see Juvenile Scleroderma)
Raynaud's and Scleroderma
Just 5 to 20 percent of people with Raynaud's phenomenon subsequently develop scleroderma, but nearly 90-95 percent of scleroderma patients experience this extreme cold sensitivity with red/blue flashes in their hands and feet as a primary manifestation of their disease.
In fact, Raynaud's is often the first symptom of scleroderma, and may precede the onset of Scleroderma by months or years.
Serum nitric oxide (NO)) metabolites and disease activity in patients with systemic sclerosis. Serum NO(x) in SSc patients were elevated compared to healthy controls. Serum NO(x) level was determined by multiple factors including age, prednisolone use, and elevated pulmonary arterial pressure. (PubMed) Clin Rheumatol. 2008 Mar;27(3):315-22. Epub 2007 Aug 15. (Also see: Nitric Oxide)
Hand vascular involvement assessed by magnetic resonance angiography in systemic sclerosis. Impairment of the microcirculation is a cardinal feature of systemic sclerosis (SSc). Magnetic resonance angiography (MRA) has improved the assessment of vascular lesions of the hand. The aim of this study was to evaluate vascular abnormalities in the hands of patients with SSc, using MRA. (Wiley InterScience) Arthritis & Rheumatism.Volume 56, Issue 8 , Pages 2747 - 2754. July 30 2007. (Also see: Digital Ulcers)
Therapeutic management of acral manifestations of systemic sclerosis. Acral manifestations of systemic sclerosis include Raynaud's phenomenon, calcinosis cutis, and sclerodactyly. In the later stages of the disease, contractures of the skin and joints as well as obliterative vasculopathy leading to digital ulcers and necrotic lesions may occur. PubMed. Med Klin (Munich). 2007 Mar 15;102(3):209-18. (Also see: Calcinosis, Sclerodactyly, Digital Ulcers, and Skeletal Involvement: Joint Contractures)
Long Term Follow Up of a Cohort of Patients With Positive Antinuclear Antibodies (ANA) and Raynaud’s Phenomenon (RP) in the Absence of Connective Tissue Disease at Initial Evaluation. Initial evaluation indicates that there is a subset of patients who remain with only positive ANA and RP and do not develop a defined CTD. Marie S. O'Brien. 1881/553 ACR 2006. (Also see: Antibodies)
Pack to aid 'blue hand' sufferers. Raynaud's Disease, a condition of circulatory problems in which blood flow to the extremities shuts down due to small changes in temperature could affect up to one sixth of Halton's population and there are an estimated 10 million sufferers in the UK, almost twice the number of asthmatics. icCheshireOnline. 08/24/06. (Also see: Scleroderma Association UK)
Abnormal microvascular response is localized to the digits in patients with systemic sclerosis (SSc). This study suggests that SSc has no effect on microvascular perfusion in the dorsum of the hand, and that the abnormal microvascular response is localized to the digits, affecting both smaller and larger vessels. Arthritis & Rheumatism Journal. Vol 54, Issue 6:1952 - 1960 June 2006. (Also see: Digital Ulcers)
Smokers With Systemic Sclerosis Risk Severe Digital Vascular Complications. Patients with systemic sclerosis (SSc) who smoke are three to four times more likely than are never-smokers to incur digital vascular complications, researchers in England have found. Doctor's Guide. 1/24/03 Arthritis & Rheumatism 2002;46:12:3312-3316. (Also see: Digital Ulcers)
Raynaud's Phenomenon of the Nipple
Thorough Patient History Can Pinpoint Raynaud of the Nipples. The pain from this vasospasm of the nipples while breast-feeding usually is bilateral, severe, and a spasm-like throb. The nipple usually turns very white but may be blue, purple, or red. Rheumatology News. Volume 6, Issue 9, Page 12 (Sept 2007)
Raynaud's Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding. Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding. Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, it is often mistaken for Candida albicans infection. PubMed. Pediatrics. 2004 Apr;113(4):E360-4.
Raynaud's in the Lungs
Raynaud's may also affect the tip of the nose, earlobes, cheeks, chin, or lungs. Breathing cold air can cause a coughing attack if there is Raynaud's in the lungs. The lungs are the internal organ most frequently affected by Raynaud's.
Raynaud's phenomenon (RP) is correlated with elevated systolic pulmonary arterial pressure (PASP) in patients with systemic lupus erythematosus (SLE). In patients with SLE, the presence of RP was associated with elevation in PASP. Further investigation is needed to clarify the significance of this relation. Lupus (2007) 16, 505—508. (Also see: Lupus)
Doubles Risk of Coronary Artery Disease and Stroke
A 1998 study indicated that people who have Raynaud's may have double the risk of coronary artery disease and stroke. "Hopkins: Is Raynaud's a Predictor of Heart Disease?" by Fredrick M. Wigley, M.D., Professor of Medicine and Director of Molecular and Clinical Rheumatology, Johns Hopkins School of Medicine, August 19, 1998, Aetna InteliHealth.
Coronary Artery Disease HeartPoint Gallery
Raynaud's Phenomenon (RP), Systemic Sclerosis (SSc), and Macrovascular Peripheral Disease. In this sample of atherosclerotic patients, patients with RP were five times more prone to coronary disease, compared to patients without RP, which could suggest cardiac Raynaud's. SSc was more frequent than expected. J. F. J. Olmedo. AB0284 EULAR 2006. (Also see: Cardiac Involvement)
Importance of Controlling Raynaud's
Scleroderma and Raynaud's can in some instances become so severe as to require amputation of fingers and/or toes, so keeping "aggressively warm" plus promptly treating all Raynaud's attacks is essential for all Scleroderma patients. As Raynaud's  progresses, slight drops in temperature may trigger it with longer duration of the attacks.
Additionally, recent research indicates that Raynaud's might be part of how the disease process advances in Scleroderma, due to the oxygen deprivation caused by Raynaud's spurring an abnormal chemical reaction which produces oxygen radicals. Therefore, taking great precautions to prevent Raynaud's attacks could be of paramount importance for Scleroderma patients.
Management of cutaneous vascular complications in systemic scleroderma: experience from the German network. Management of Raynaud's Phenomenon and ulcerations in SSc were heterogeneous at initiation of the network, reflecting a sometimes insufficient use of the diagnostic and therapeutic possibilities. (PubMed) Rheumatol Int. 2008 Mar 5. (Also see: Digital Ulcers)
Other Ways Scleroderma Can Affect Hands
Raynaud's isn't the only way in which Scleroderma can affect the hands. Hand involvement may include skin tightening and hardening, finger contractures, Telangiectasia, Calcinosis, and arthritis. See Skin Involvement.
Raynaud's in Children
Raynaud's phenomenon in children: a retrospective review of 123 patients. RP in children, as in adults, principally affects girls and is frequently free of association with connective tissue disease. Antinuclear antibody positivity and abnormal nailfold capillaries correlate with secondary disease. Antiphospholipid antibodies are surprisingly common, a new finding of uncertain implications. PubMed. Pediatrics 2003 Apr;111(4 Pt 1):715-21. (Also see: Juvenile Scleroderma)
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