Raynaud’s, Scleroderma, and Associated Disorders
What is Raynauds?
Raynaud is a common condition in which the blood supply to the extremities is cut or decreased. This usually affects the fingers and toes, but occasionally the nose or ears as well.
Attacks are usually triggered by cold or a sudden change in temperature. During an attack, the affected part of the body turns white first, then blue as the tissues deplete the oxygen, and finally bright red as the arteries relax and fresh blood enters.
Raynauds can vary in shape, from very mild to severe cases – which may require treatment.
Anyone at any age can have Raynaud’s, but younger women are more likely to have it. It seems to be a change in temperature, not just cold, causing an attack. Although this is worse in winter, it can also occur in summer.
Stress or anxiety can also provoke a Raynaud attack. Some cases of Raynaud are associated with some other diseases (called secondary Raynaud).
What is Scleroderma?
Although over 95% of people with scleroderma have Raynaud, the chances of someone with Raynaud developing scleroderma are slim – less than 2% women and 6% men.
The word scleroderma means hardening of the skin, although the condition is not limited to the skin. It is a disease of the connective tissue that holds our bodies together.
Therefore, not only the skin but also the internal organs can be affected. The majority of people have the mild form in which the skin is only partially affected, usually on the hands and feet, and becomes stiff and shiny. The esophagus can also be affected, making eating and swallowing difficult.
Some people also build tiny deposits of calcium under the skin (calcinosis) that can cause ulcers. In the more severe form, diffuse scleroderma, large areas of the skin and internal organs such as the lungs, intestinal heart and kidneys are affected. Localized scleroderma can be divided into two types:
- Morphea Scleroderma
- Linear scleroderma
How are these conditions diagnosed?
The history of the disease is most important. Blood tests can be helpful, as well as examining the small blood vessels at the base of the nail called a nail fold capillaroscopy.
Is it hereditary?
There is currently no evidence that Raynaud’s or scleroderma are directly inherited. However, there is a genetic make-up, so the likelihood of being affected is greater if a relative has the problem.
How are they treated?
Your GP or specialist can prescribe a vasodilator, a drug that relaxes blood vessels. Occasionally, your specialist may think that surgery called a sympathectomy can be beneficial. This involves either cutting or destroying the nerves that cause the arteries to narrow. This surgery is more successful for Raynaud’s feet, but is not recommended in most cases as it usually does not provide any long-term benefits.
People who develop Raynauds as teenagers often have a shape that is benign and disappears with age. Unfortunately, this is not the case in all cases, and sometimes Raynauds persists.
There is currently no cure for scleroderma, but there are many effective treatments available to relieve certain symptoms. Each case is different, so these questions should be discussed with your doctor.
How can I help myself?
There are several ways that can be helpful. The most important thing is to stop smoking, exercise regularly, and keep warm.
Smoking: If you are a smoker, you must make a sincere and determined effort to give up completely. Tobacco is harmful because it narrows blood vessels and reduces blood flow to the fingertips. Your primary care doctor should be able to discuss strategies to quit smoking or see a smoking cessation counselor. Nicotine replacement can also be helpful and you should discuss this with your doctor or pharmacist.
Eating for warmth: Eating and drinking can help you keep warm. Try to have plenty of small meals to keep your energy levels up. High protein foods, milk, meat, fish, and fresh vegetables are best. Warm meals and plenty of hot drinks are essential.
Exercise: Gentle exercise helps your circulation. Avoid long periods of sitting. Get up and walk around the room, moving your arms and legs to keep blood circulation going. However, don’t let your fingers or toes get cold. Exercise indoors in cold weather.
Clothing: Tight clothing should be avoided as this can restrict blood flow. Hands and feet should always be adequately covered. A scarf should be used to keep the face warm in cold weather, and a hat and several layers of clothing should be used to keep the head and torso warm. The feet are particularly prone to cooling, so a good thick pair of socks is essential. Wet shoes and clothes should be changed as soon as possible.
Associated Terms
Vibration White Finger (VWF)
Those who work with vibrating tools tend to develop Raynauds, especially when the vibration is coarse and low frequency. This can become permanent even after the work is finished. VWF is an industrial disease that may be compensated for.
Chilblains
These usually appear on the extremities – fingers, toes, and ears. The skin may be itchy at first, then red, swollen, and very tender. Chilblains are caused by circulatory disorders when exposed to cold. Rubbing clothing should be avoided.
Rheumatoid arthritis
Arthritis affects the lining of the joints. This lining produces a fluid that lubricates the joint, which in rheumatoid arthritis becomes inflamed and swollen. More fluid is produced, resulting in a red, painful, swollen joint. About 10% of rheumatoid arthritis patients have Raynaud’s secondary education.
Systemic lupus erythematosis
This is characterized by a rash that sometimes appears on both the cheeks and the bridge of the nose, as well as chronic inflammation of the blood vessels and connective tissue of the body. There is associated fatigue, joint pain, mouth ulcers, hair loss and Raynauds.
Erythromyalgia
This is a chronic condition characterized by persistent warmth, pain, and redness that primarily affects the feet and lower legs. The majority of those affected also suffer from Raynaud’s symptoms.
Chemical or drug induced
Some chemicals at work (vinyl chloride) or medications such as beta blockers, migraine pills, or the oral contraceptive can make Raynauds worse. If you are prescribed medication and experience Raynaud-type symptoms, see your general practitioner who may be able to change your medication.