Cardiovascular Medicine, Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
Raynaud's Syndrome is a fairly common problem where people have well demarcated pallor or cyanosis of their fingers, the tips of their nose, tips of their tongue, ear lobes, or toes. What that means is that you can see a line where there's a color change from normal to either white or blue in any of those areas.
So this is vasoconstriction, or clamping down of the blood vessels that can happen in the fingers and toes happens in response to cold. It doesn't have to be cold that happens on your fingers, though. This reflex, it's a neurologic reflex, can happen with cold exposure elsewhere.
And it comes on when people are cold. And then if you warm up, it should go away. The condition can be either primary or secondary. So primary Raynaud's phenomenon is very common in females. And we often see its onset in adolescents.
It occurs in males as well. And for those people, it's really a matter of discomfort. They need to stay warm or their fingers will get cold and achy and they'll not be able to do things that they want to do. The other population of individuals that have Raynaud's phenomenon are older.
The people with secondary Raynaud's phenomenon can have a known injury such as frost bite or they can be jackhammer operators. Or some other reason that they've damaged the blood vessels to their fingers.
There are also people that have rheumatologic diseases that impact blood vessels. And one of the ones that we are most concerned about is individuals with scleroderma.
Because in them, the Raynaud's phenomenon is particularly difficult to take care of.
Diagnosing Raynaud’s Disease
The diagnosis has actually become easier over the years. Because it's really that first image that we showed you. Just a picture of the well demarcated color change that's happening in the digit.
That alone is enough to make the diagnosis of Raynaud's phenomenon. Of course, we need to see that that comes and goes. That it's not fixed. A finger that's blue and cold and painful and you can't get it to be anything other than blue and cold and painful may have an occluded artery. And that would be more of an emergency situation.
Treating Raynaud’s Disease
There are a number of medications that are very useful in the care of patients with Raynaud's phenomenon. The majority of them we can give to people as an outpatient. We have some medicines that do require hospitalization.
Those are really used rarely. And we also have investigational medications available to us that the pulmonary vascular hypertension group brings to the Raynaud's phenomenon practice. And that allows us to actually try to avoid those hospitalizations for medications in patients.
Multidisciplinary Care For Raynaud’s Disease
Here at Brigham and Women's Hospital, we have a great group of doctors that have come together to take care of patients with Raynaud's phenomenon.
We have Vascular Medicine. We have our colleagues from rheumatology. And plastic surgery. We have vascular surgery. And we actually have one of our dermatologists as well. And what happens is that we see the patients in the clinical setting together. We have a defined set of clinical data that we obtain on all the patients, so everyone gets a form that they fill out. That's useful for us for the long term and seeing the impact of some of our newer treatments.
And really getting everybody around the table about what the best care would be for that patient.
One of the clear benefits from providing care in this way is that we have standardized data collection that we're doing so that we can compare findings in the patients that we're seeing in a very standardized fashion. And that allows us to look at how our therapies are working.