Raynaud’s Disease Clinic – Evaluation and Treatment

The Raynaud's Disease Clinic at Brigham and Women's Hospital is one of only a few clinics in New England exclusively dedicated to the evaluation and treatment of patients with Raynaud's disease (Raynaud's phenomenon). A multidisciplinary team of vascular medicine, rheumatology, pulmonary vascular, plastic surgery, and other medical specialists collaborate to provide the most appropriate and effective care for patients with Raynaud's.

What is Raynaud's Disease?

Raynaud’s disease is a disorder that affects blood flow primarily in the fingers and toes, and sometimes the ears, nipples, knees, or nose. It is characterized by vasospasm – sudden contractions of blood vessels that severely reduce blood flow to the extremities – most often provoked by exposure to cold, but also by emotional stress.

Raynaud’s can exist as an isolated condition (Primary Raynaud’s) and is seen more frequently in women and people who live in colder climates. The exact cause of primary Raynaud’s is unknown. It also occurs in men and women who have autoimmune or connective tissue diseases as well as other diseases (Secondary Raynaud’s), including:

• Lupus
• Scleroderma
• Sjögren’s Syndrome
• Rheumatoid Arthritis
• Polymyositis
• Pulmonary Hypertension
• Peripheral Artery Disease
• Buerger’s Disease (thromboangiitis obliterans)

What are the Risk Factors for Raynaud’s?

Although it is uncertain why people develop Raynaud’s, there are some risk factors associated with the disease, including:

• Pre-existing connective tissue or autoimmune disease
• Cigarette smoking
• Repetitive force to the hands, such as from using vibrating (power) tools or typing
• Injury or trauma
• Chemical exposure
• Side effects from certain medications

What are the Symptoms of Raynaud’s Disease?

The following are the most common symptoms of Raynaud's, but each patient may experience symptoms differently.

• The fingers or toes turn white and then blue – usually after being exposed to cold air or objects, or experiencing stress – and subsequently turn red after re-warming.
• In severe cases, sores develop on the tips of the fingers or toes.
• In rare cases, fingers or toes can become infected or gangrenous, which can lead to amputation if not treated.

How is Raynaud’s Diagnosed?

Patients at our Raynaud’s Disease Clinic are initially evaluated by two physicians – a vascular medicine specialist and a rheumatologist. Much of the diagnosis will focus on evaluating symptoms. Along with a complete medical history and a medical exam, our team will typically order at least one type of blood test. A patient also may undergo a cold challenge test to bring out color changes in the hands or feet.

With Secondary Raynaud’s phenomenon, it’s also important to identify – and treat – the underlying autoimmune or other disorder that may be causing Raynaud’s phenomenon.

What is the Treatment for Raynaud’s Disease?

Following a thorough evaluation, the physician team will develop a treatment plan based on the type and extent of the disease, the patient’s overall health, and the patient's preferences.

Although there is no cure for Raynaud’s, it normally can be well managed with appropriate treatment, such as:

Lifestyle Changes

• Limiting exposure to the cold by dressing warmly – gloves, socks, scarf, hat, and layering.
• Quitting smoking to improve circulation and overall health.
• Avoiding use of vibrating tools.

Medical Therapies

• Prescribing alpha blockers, which suppress the sympathetic nervous system response that leads to vasoconstriction (blood vessel narrowing).
• Prescribing other medications that also improve blood flow to the fingers and toes by dilating (expanding) blood vessels, such as calcium channel blockers or phosphodiesterase inhibitors.
• Avoiding use of beta blockers, usually used to treat high blood pressure, which slows the heart rate and reduces blood flow to the extremities.
• For patients who don’t respond well to the above medications, there may be investigational drug options – drugs that are allowed to be used in clinical trials.

Surgery

For patients who are at risk of losing their fingers, plastic surgeon Christian E. Sampson, MD, offers of a variety of surgical techniques. One such innovative technique is to remove the sheath of nerves surrounding the hand’s blood vessels, thereby eliminating the nerves responsible for triggering vasospasms.