(Pause while everyone looks down at their own nails)
I learned to include this little pause during my medical student lectures on Raynaud’s Syndrome and Scleroderma. As opposed to many of the other conditions I treat and teach, there is actually a very high likelihood that a handful in the audience will have Raynaud’s. This isn’t surprising given how common it is, especially amongst women between the ages of 15 and 30. It is when discussing the connection between Raynaud’s and Lupus or Scleroderma, that the wave of concern washes over some faces in the audience. What the audience members are looking for are changes in the nail bed capillaries. These changes, can be a sign that their Raynaud’s Syndrome is part of a larger autoimmune condition. Thankfully, most, if not all, will have perfectly normal nail bed capillaries and be able to sit through the rest of the lecture panic-free. But it is always a reminder that even when speaking to trainees and students, I am speaking to patients.
Raynaud’s is an over-exaggerated vascular response to cold and stress. The healthy response to cold, designed to keep us alive, becomes too strong and lasts too long in those with Raynaud’s. The color changes seen in Raynaud’s, white to blue to red, serve as a reminder of how remarkable our system is.
More than just cold feet
When exposed to cold, our bodies prioritize our organs. Keeping our heart, lungs, liver, kidneys and brain warm is considered more important (biologically speaking) than our thumbs and pinkies. One of the ways our body prioritizes these organs is through rerouting our blood supply. By constricting the blood vessels in our digits, our blood stays in our chest and trunk, keeping our vital organs warm with blood. With Raynaud’s however, the vascular constriction is out of proportion to the cold (or stress) the body is exposed to. We see this when the fingers change color. White is seen with the initial constriction, indicating a lack of blood flow. This is followed by blue, signifying a lack of oxygen. Finally, red shows us the vessels are dilating and blood is returning.
This process is often painful and associated with varying degrees of numbness or tingling. This phenomenon may run in the family, be independent of any other serious conditions and serve as a reminder to keep warm. For others, however, it can be a harbinger of a larger problem. Secondary Raynaud’s (or Raynaud’s phenomenon due to an underlying condition) can be seen with some autoimmune conditions, blood disorders or with certain medications. This is where students start to pay extra attention.
When it is more than Raynaud’s
Occasionally Raynaud’s will need an evaluation by a rheumatologist. What you can expect is a thorough head-to-toe assessment, looking for subtle clues that something larger is lurking. During this exam, people often don’t expect the doc to take out a magnifying glass and stare at their nails. What are they looking for? Exactly what my audience was looking for. Changes in their nail bed capillaries. Studies tell us that those with Raynaud’s and nail bed capillary changes are more likely to develop an autoimmune condition. Rest assured, most don’t have any changes. These changes are not easily seen with the naked eye and require an experienced eye to identify.
The treatment for Raynaud’s centers around two themes. Keep warm and limit the exposure to any triggers. Cold is the most common trigger but stress and nicotine are close behind. With simple behavior changes (wearing gloves, stopping smoking and stress management) the frequency and severity of a Raynaud’s attack can be significantly decreased. When gloves and hand warming isn’t enough, those with Raynaud’s may need medications that dilate blood vessels. The medications typically used to lower blood pressure can be of use in Raynaud’s. If complicated by an autoimmune condition, controlling the underlying autoimmune condition may have a positive effect, but nothing replaces the tried and true glove.
In good health,