Raynaud's Phenomenon

  • Basics

    Raynaud's phenomenon (RP) is characterized by episodic constriction of the small arteries. The phenomenon is an exaggerated response to cold or other triggers, and eventually results in reduced blood flow to certain areas of the body. The disorder most commonly affects the fingers and toes, the ears, and the tip of the nose, but may affect other areas as well. When Raynaud's phenomenon (RP) occurs as an isolated symptom, it is known as primary RP, or Raynaud's phenomenon, and tends to be harmless. In contrast, when RP occurs as a symptom of an underlying illness (for example, systemic lupus erythematosus), it is known as secondary RP, and is often more severe and more difficult to treat. While there is no cure for RP, symptoms can be controlled, and complications can be prevented. The severity of RP varies widely from patient to patient.

    RP may affect from 5% to 10% of the U.S. population. RP is more common in women than in men. Raynaud's phenomenon is far more prevalent than secondary RP, and most often affects young women between the ages of 15 and 40. The incidence of RP is higher in colder climates and varies among ethnic groups.

  • Causes

    Episodes are often triggered by cold or stress. When exposed to cold, the body's normal response is to constrict blood vessels (a process known as vasoconstriction) in the extremities, thereby shunting blood towards deeper vessels. This response slows heat loss, and maintains the body's core temperature.

    In patients with RP, vasoconstriction is inappropriately exaggerated, and causes the same small arteries to close spasmodically. This is known as vasospasm, and drastically reduces blood flow to tissues supplied by these arteries. The affected tissues may then become starved for oxygen and other nutrients.

    While secondary RP is seen in many other diseases, not everyone with those diseases develops RP. Some of the diseases in which secondary RP can occur include the following:

    • Rheumatoid arthritis
    • Systemic lupus erythematosus
    • Systemic sclerosis
    • Sjögren's syndrome
    • Dermatomyositis and polymyositis
    • Systemic vasculitides
    • Carpal tunnel syndrome and other nerve entrapment syndromes
    • Atherosclerosis
    • Thromboangiitis obliterans (Buerger's disease)
    • Polycythemia

    Certain drugs and toxins have been linked to RP. Some of the more commonly implicated agents include:

    • Beta-blockers
    • Ergot alkaloids
    • Certain cancer chemotherapy agents (particularly bleomycin)
    • Vinyl chloride
    • Pseudoephedrine
    • Phenylpropanolamine (now discontinued by the Food and Drug Administration)
    • Cocaine
    • Caffeine
    • Nicotine

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