Chris Denton is a Professor in the Centre for Rheumatology at the Royal Free Hospital in London and runs the Scleroderma Clinic. He also has a major research programme that spans both clinical and laboratory trials related to scleroderma. He is a medical advisor to the RSA and very grateful for the questions that he is challenged with in our newsletters (Hot News).
Do doctors know the cause of Raynaud’s?
Raynaud’s phenomenon results from excessive spasm of the blood vessels in the extremities (e.g. fingers, toes, ears etc.). This spasm is triggered by cold or emotional stress, which can be a normal response. It causes symptoms in up to 1 in 10 people, so is very common, but usually not associated with any other disease (primary Raynaud’s phenomenon). It probably is caused by complex alterations in the balance of chemicals that narrow blood vessels and those that widen or relax the muscle in the blood vessel wall. Other mechanisms may include an increased sensitivity of nerve endings in the blood vessel wall or damage to the small vessels.
Have any complementary therapies proved to be successful for Raynaud’s?
In a condition which can be brought on by emotional stress, as well as the cold, many people have tried self-hypnosis, biofeedback techniques and acupuncture with some success. Unfortunately there have been very few clinical trials but they do seem to show that although initially the patients claim some improvement, after about a year many patients stop the treatment because they feel no benefit or it takes up too much time.
Do you inevitably develop scleroderma if you have severe Raynaud’s?
The answer is very definitely no. There have been a number of studies which have been undertaken where people have followed up the severity of Raynaud’s in terms of things like the frequency of attacks etc. What does appear to put people at risk are firstly some of the nail capillary changes and also if people have abnormal antibodies. They will have some abnormal proteins in the blood which can sometimes be present for some years and do seem to predict what is going to happen. The key thing is that Raynaud’s can be mild or it can be severe but even amongst those with severe Raynaud’s in terms of the number of attacks only a very small minority will go on to develop scleroderma.
Is there any evidence of reduced or different menopause problems for primary Raynaud’s sufferers, for example, do they suffer less from hot flushes?
The answer is probably no. If you have Raynaud’s you become very cold. The menopause can be variable. Some women can have a lot of hot flushes whilst others just have a few. I therefore don’t think that you can correlate having Raynaud’s with the number of hot flushes. It is very much an individual thing. The menopause can be very distressing. If you are having a lot of menopausal problems it is very important to actually ask someone who is used to dealing with that problem and ask them for their advice and help but it is unlikely that it is directly related to the Raynaud’s.
I have Raynaud’s and my hands swell up – am I developing scleroderma?
Most people with Raynaud’s do not have scleroderma - and swelling of the hands can be normal in Raynaud’s that occurs in otherwise healthy people (primary Raynaud’s). However you should discuss this with your doctor as you may require tests to look at the blood vessels around the finger (nailfold capillaroscopy) and blood tests for autoantibodies. If these tests are normal you are very unlikely to have scleroderma.
My wife suffers from angiosarcoma on her scalp and we wondered if there was any connection with her Raynaud's as both are concerned with small blood vessels in the skin.
I am not aware of any direct connection between these two medical conditions, but interestingly there are some reports in the medical literature of angiosarcoma of the liver associating with Raynaud’s phenomenon in patients exposed to the chemical vinyl chloride. The fact that both conditions involve small blood vessels is probably just coincidence.
My daughter and I have recently been on a walking holiday during which the weather was cold and miserable. A strange thing happened on our return to base on the last day. My daughter who is 42 said her hands were numb and tingling and they had changed colour. She went to the doctor who suggested that Raynaud's could be the problem. Can Raynaud's come on suddenly like that?
Raynaud’s phenomenon occurs when the blood vessels supplying your extremities narrow in response to cold or emotional stress. It leads to colour changes with blanching (white) of the fingers and later blue discolouration and after an attack the fingers can become red. Loss of sensation or altered sensation occurs as the nerves in the hands have insufficient blood supply. These changes reverse when the attack passes. The most common age to develop these symptoms is as a teenage or young adult. However, it can occur at any age. Sometimes there have been mild symptoms for several years and only when you get especially cold or have exercised in cold conditions does the Raynaud’s become obvious. If these attacks persist or if there are any other symptoms then your daughter should see her doctor as Raynaud’s can be the first symptom of an underlying condition such as a connective tissue disease.
My doctor has diagnosed me with Raynaud's. Do I need to see a consultant and if so what kind of consultant?
It is important to clarify whether this is primary or secondary Raynaud’s, the latter associated with underlying diseases such as scleroderma. Most often a rheumatologist is the best person to see as most of the associated diseases are rheumatic, such as lupus or scleroderma. Sometimes vascular surgeons or dermatologists may have a special interest in Raynaud’s.
I have developed Raynaud’s since being on chemotherapy drugs. Is this unusual?
Some of the powerful drugs that are used as chemotherapy for cancer can cause or aggravate Raynaud’s, possibly due to damage that can occur to the lining cells of blood vessels. Fortunately, this often improves once the chemotherapy has been completed and in general most specialists give priority to treating or preventing the cancer.
Why are erythromelalgia and Raynaud’s connected when they appear to show opposite symptoms?
Erythromelalgia is a medical condition in which blood vessels dilate and lead to burning red discomfort and intolerance of warm environments. This can occur after a Raynaud’s attack in some cases and both disorders are due to excessive response of the regulatory blood vessels to change in temperature.
I have heard that Raynaud’s can be linked to miscarriages in women of child bearing age. I am 34 and my husband and I are planning to start a family soon. I wondered if it is true that there is a link and if so, what can I do to minimise the risk? Are there any supplements I can take for example?
Raynaud’s is not directly linked to miscarriages, although it is of course much more common in women. The most common form, primary Raynaud’s phenomenon is not associated with risks in pregnancy and often improves when you are pregnant. Some associated conditions such as SLE or anti-phospholipid syndrome can cause increased risk of miscarriage. If these conditions are found then treatments such as aspirin or heparin can be used to reduce the risk of poor blood flow in the placenta that might lead to miscarriage. However this is something that needs to be discussed with your doctor or midwife. Blood tests can be done to look for these specific medical problems but fortunately they are not common.
Are ulcers a result of Raynaud's, scleroderma or both? Am I destined to get them from Raynaud's?
Ulceration, or breakdown of the skin over the fingertips or over the knuckles, is a complication of scleroderma and some other forms of connective tissue disease such as vasculitis but does not usually occur in cases of Raynaud’s in isolation, called primary Raynaud’s. This is probably because the blood supply between attacks in primary RP recovers enough to keep the skin healthy.
I first developed Raynaud's about a year ago, and it affected all my fingers. In recent weeks it has changed and is affecting only the tip of the index finger on my left hand. Is it normal for only one finger to be affected?
The severity and extent of Raynaud’s attacks and the resulting colour changes can vary depending upon the temperature, emotional stress, medication and other factors including whether there is an associated medical condition such as scleroderma. It is common for only one finger to be affected in some patients with Raynaud’s, especially at the early stages, although more often other fingers later become involved. If in your case the condition has improved spontaneously then this is encouraging.
I am confused as I have been told I have primary Raynaud's and my ANA blood tests are negative. However, I have developed digital ulcers on two of my fingers yet most of the literature I have read says that it is unusual to develop ulcers in primary Raynaud's.
You are correct. Primary Raynaud's rarely leads to such severe problems with finger blood flow such that ulcers or skin breakdown occurs. It is important to look for other associated disease as not all relevant conditions have a positive ANA. In addition it might be necessary to have tests to exclude any problems with the large arteries or heart and you should discuss this with your doctor.