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October 2016

Questions and Answers about

Raynaud’s Phenomenon

This publication contains general information

about Raynaud’s phenomenon. It describes

what Raynaud’s phenomenon is, who gets it,

and what happens during an attack. It also

explains how Raynaud’s phenomenon is

diagnosed and treated. At the end is a list of

key words to help you understand the terms

used in this publication. If you have further

questions after reading this publication, you

may wish to discuss them with your doctor.

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition that

affects the blood vessels in the extremities –

generally, the fingers and toes. It is

characterized by episodic attacks, called

vasospastic attacks, in which the blood

vessels in the digits (fingers and toes)

constrict (narrow), usually in response to cold

temperatures and/or emotional stress. When

this condition occurs on its own, it is called

primary Raynaud’s phenomenon. When it

occurs with another condition such as

scleroderma or lupus, it is called secondary

Raynaud’s phenomenon.

Who gets Raynaud’s phenomenon?

What happens during an attack?

How does a doctor diagnose

Raynaud’s phenomenon?

What is the treatment for Raynaud’s

phenomenon?

What research Is being conducted on

Raynaud’s phenomenon?

Where can people find nore

information about Raynaud’s

phenomenon?

Key words

Information Box

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Self-Help Reminders

Who gets Raynaud’s

phenomenon?

Although people of any age can have

Raynaud’s phenomenon, the primary form

typically begins before the age of 30 and

often runs in families. Women are more likely

than men to have Raynaud’s phenomenon. It

appears to be more common in people who

live in colder climates. This is likely true

because people with the disorder have more

Raynaud’s attacks during periods of colder

weather. For most, the symptoms are mild

and not associated with any blood vessel or

tissue damage.

Most people with Raynaud’s phenomenon

have the primary form, which is not

associated with any underlying disease. In

fact, in these individuals it is thought to be an

exaggeration of normal responses to cold

temperature and/or stress.

When Raynaud’s phenomenon is caused by

or associated with an underlying disease, it is

referred to as secondary Raynaud’s

phenomenon. Secondary Raynaud’s

phenomenon tends to begin later in life than

the primary form.

It is common for patients with a connective

tissue disease to have Raynaud’s

phenomenon. It occurs in more than 90

percent of people with scleroderma. It is also

common in people with systemic lupus

erythematosus, rheumatoid arthritis, and

Sjögren’s syndrome. Secondary Raynaud’s

phenomenon may also be associated with

diseases of the arteries, smoking, and

overuse and other injuries that cause trauma

to the hands and wrists. And it may be linked

to certain drugs such as chemotherapy

agents or to chemicals such as vinyl chloride.

What happens during an attack?

Attacks of Raynaud’s phenomenon are

caused by an intensification of the body’s

natural response to cold. When a person is

exposed to cold, the body’s normal response

is to slow the loss of heat and preserve its

core temperature. Blood vessels in the

surface of the skin are called

thermoregulatory vessels because they react

to changes in the ambient temperature. To

maintain normal core temperature, these

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specialized blood vessels in the skin surface

constrict and move blood from arteries near

the surface to veins deeper in the body. But

for people who have Raynaud’s

phenomenon, the thermoregulatory vessels

overreact to cold exposure with sudden and

intense spasmodic contractions of these

small blood vessels that supply blood to the

skin of the fingers, toes, ears, face, and other

body areas.

Once an attack begins, a person may

experience three phases (though not all

people have all three) of skin color changes –

typically from white to blue to red – in the

fingers or toes. Whiteness (called pallor) may

occur in response to spasms of the arterioles

(small branches of an artery) and the

resulting collapse of the arteries supplying

the fingers and toes. Blueness (cyanosis)

may appear because the fingers or toes are

not getting enough oxygen-rich blood. Finally,

as the arterioles dilate (relax) and blood

returns to the digits, redness (rubor) may

occur.

During the attack, the fingers or toes may feel

cold and numb as blood flow to them is

interrupted. As the attack ends and blood

flow returns, fingers or toes may throb and

tingle. Typically, the blood flow to the skin will

remain low until the skin is rewarmed. After

warming, it usually takes 15 minutes to

recover normal blood flow to the skin.

How does a doctor diagnose

Raynaud’s phenomenon?

Most doctors find it fairly easy to diagnose

Raynaud’s phenomenon but find it more

difficult to identify the form of the disorder.

Physicians can now distinguish primary from

secondary Raynaud’s phenomenon with a

complete history and physical examination.

Sometimes, special blood testing is needed. If

the evaluation and special testing studies are

normal, then the diagnosis of primary

Raynaud’s phenomenon can be made and it

is unlikely to change into a secondary form.

A few tests can help the doctor distinguish

between primary and secondary Raynaud’s

phenomenon. They are:

Nailfold capillaroscopy. During this

test, the doctor puts a drop of oil on

the patient’s nailfolds, the skin at the

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base of the fingernail. The doctor

then examines the nailfolds under a

microscope to look for problems in the

tiny blood vessels called capillaries. If

the capillaries are enlarged or

malformed, the patient may have a

connective tissue disease.

Antinuclear antibody (ANA) test. In

this blood test, the doctor determines

whether the body is producing special

proteins called antibodies that are

directed against the nuclei of the

body’s cells. These abnormal

antibodies are often found in people

who have connective tissue diseases

or other autoimmune disorders.

Erythrocyte sedimentation rate

(ESR or sed rate). This is a

laboratory test for inflammation that

measures how quickly red blood cells

fall to the bottom of a test tube of

unclotted blood. Rapidly descending

cells (an elevated sed rate) indicate

inflammation in the body.

What is the treatment for

Raynaud’s phenomenon?

The aims of treatment are to reduce the

number and severity of attacks and to

prevent tissue damage and loss of tissue in

the fingers and toes. Most doctors are

conservative in treating patients with primary

Raynaud’s phenomenon because they do not

get tissue damage. For these patients,

doctors tend to recommend nondrug

treatments before moving onto medications.

For patients with secondary Raynaud’s

phenomenon, medications are more often

prescribed, because severe attacks with

ulcers or tissue damage are more likely.

In the most severe cases, Raynaud’s causes

ulcers and serious tissue damage that does

not respond to medications. Doctors may use

a surgical procedure called a digital

sympathectomy with adventitial stripping

(which involves removing the tissue and

nerves around the blood vessels supplying

the affected digits). Although this procedure

may result in reducing symptoms and healing

tissue, it only helps temporarily and therefore

is reserved for difficult cases.

The most common treatments and self-help

measures are described below.

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Nondrug Treatments and Self-Help

Measures

The following nondrug treatments and

self-help measures can decrease the severity

of Raynaud’s attacks and promote overall

well-being.

Take action during an attack. You

can decrease both its length and

severity by a few simple actions. The

first and most important one is avoid

the cold. Warming the body and the

hands or feet is also helpful. If you’re

outside and the weather is cold, go

indoors. Run warm water over your

fingers or toes or soak them in a bowl

of warm water to warm them. If a

stressful situation triggers the attack,

get out of the stressful situation, if

possible, and relax. Although

biofeedback and similar nondrug

methods are used, formal studies

have suggested they are not helpful.

Keep warm. It is important not only

to keep the extremities warm, but also

to avoid chilling any part of the body.

Remember, a drop in the body’s core

temperature triggers the attack.

Shifting temperature (for example,

rapidly moving from 90 degrees

outside to a 70-degree air-conditioned

room) and damp rainy weather are to

be avoided. In cold weather, pay

particular attention to dressing.

Several layers of loose clothing,

socks, hats, and gloves or mittens are

recommended. A hat is important

because a great deal of body heat is

lost through the scalp. Keep feet

warm and dry. Some people find it

helpful to wear mittens and socks to

bed during the winter. Chemical

warmers, such as small heating

pouches that can be placed in

pockets, mittens, boots, or shoes, can

give added protection during long

periods outdoors.

People who have secondary

Raynaud’s phenomenon should talk

to their doctors before exercising

outdoors in cold weather.

In warm weather, be aware that air

conditioning also can trigger attacks.

Setting the thermostat at a higher

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temperature or wearing a sweater

indoors can help prevent an attack.

Some people find it helpful to use

insulated drinking glasses and to put

on gloves before handling frozen or

refrigerated foods.

Do not smoke. The nicotine in

cigarettes causes the skin

temperature to drop, which may lead

to an attack.

Avoid aggravating medications

such as vasconstrictors, which cause

the blood vessels to narrow.

Vasoconstrictors include

beta-blockers, many cold

preparations, caffeine, narcotics,

some migraine headache

medications, some chemotherapeutic

drugs, and some blood pressure

medications. Some studies also

associate the use of estrogen with

Raynaud’s phenomenon.

Control stress. Because stress and

emotional upsets may trigger an

attack, particularly for people who

have primary Raynaud’s

phenomenon, learning to recognize

and avoid stressful situations may

help control the number of attacks.

Many people have found that

relaxation can help decrease the

number and severity of attacks. Local

hospitals and other community

organizations, such as schools, often

offer programs in stress management.

Exercise regularly. Many doctors

encourage patients who have

Raynaud’s phenomenon—particularly

the primary form—to exercise

regularly. Most people find that

exercise promotes overall well-being,

increases energy level, helps control

weight, and promotes cardiovascular

fitness and restful sleep. Patients with

Raynaud’s phenomenon should talk

to their doctors before starting an

exercise program.

See a doctor. People with Raynaud’s

phenomenon should see their doctors

if they are worried or frightened about

attacks or if they have questions

about caring for themselves. They

should always see their doctors if

episodes occur only on one side of

the body (one hand or one foot) and

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any time one results in sores or ulcers

on the fingers or toes.

Treatment With Medications

People with secondary Raynaud’s

phenomenon are more likely than those with

the primary form to be treated with

medications.1 Although there are no drugs

approved by the Food and Drug

Administration (FDA) for Raynaud’s, many

doctors believe that the most effective and

safest drugs for Raynaud’s phenomenon are

calcium channel blockers. These drugs,

which are used to treat high blood pressure,

work by relaxing the smooth muscle and

dilating the small blood vessels.

1 All medicines can have side effects. Some

medicines and side effects are mentioned in

this publication. Some side effects may be

more severe than others. You should review

the package insert that comes with your

medicine and ask your health care provider

or pharmacist if you have any questions

about the possible side effects.

Some patients have found relief with alphareceptor blockers, which are high blood

pressure medications. Other medications

known as phosphodiesterase (PDE)-5

inhibitors have also been used to treat people

with Raynaud’s.

Patients may find that one drug works better

than another. Some people may experience

side effects that require stopping the

medication. For other people, a drug may

become less effective over time. Women of

childbearing age should know that the

medications used to treat Raynaud’s

phenomenon may affect the growing fetus.

Therefore, women who are pregnant or who

might become pregnant should avoid taking

these medications if possible. Interestingly,

Raynaud’s phenomenon gets better or goes

away during pregnancy.

In severe cases, medical procedures or

surgeries may be indicated.

Self-Help Reminders

Take action during an

attack.

Keep warm.

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Don’t smoke.

Avoid aggravating

medications.

Control stress.

Exercise regularly.

See a doctor if questions

or concerns develop.

What research is being conducted

on Raynaud’s phenomenon?

Researchers are studying techniques to

better diagnose Raynaud’s phenomenon and

to predict and monitor its course and

responsiveness to treatment. Scientists

continue to evaluate the use of new

treatments to improve blood flow for those

who have Raynaud’s phenomenon.

Basic research continues on the molecular

mechanisms behind Raynaud’s phenomenon,

the anatomy of blood vessels, and possible

genetic associations. Researchers in

scleroderma and other connective tissue

diseases are also investigating Raynaud’s

phenomenon in relation to these diseases.

More information on research is available

from the following websites:

National Institutes of Health (NIH)

Clinical Research Trials and You

was designed to help people learn

more about clinical trials, why they

matter, and how to participate. Visitors

to the website will find information

about the basics of participating in a

clinical trial, first-hand stories from

clinical trial volunteers, explanations

from researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

conditions.

NIH RePORTER is an electronic tool

that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

patents resulting from NIH funding.

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PubMed is a free service of the U.S.

National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

Where can people find more

information about Raynaud’s

phenomenon?

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

National Heart, Lung, and Blood Institute

Website: http://www.nhlbi.nih.gov

American College of Rheumatology

Website: http://www.rheumatology.org

Arthritis Foundation

Website: http://www.arthritis.org

Lupus Foundation of America

Website: http://www.lupus.org

Scleroderma Foundation

Website: http://www.scleroderma.org (con

información en español)

Scleroderma Research Foundation

Website: http://www.srfcure.org

Sjogren's Syndrome Foundation, Inc.

Website: http://www.sjogrens.org

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Key words

Antinuclear antibody (ANA). An abnormal

protein called an autoantibody that is directed

against the nuclei in the body’s cells. The

presence of these autoantibodies in the body,

particularly at high levels, often indicates a

connective tissue disease.

Arteriole. A small branch of an artery (blood

vessel that carries blood away from the heart)

that leads into many smaller blood vessels

near the skin’s surface.

Beta-blocker. A type of medication used to

treat high blood pressure and other

cardiovascular problems. The medications

work by blocking the effects of stress

hormones on the body’s beta receptors. This

slows the nerve impulses that travel through

the heart. As a result, your heart does not

have to work as hard because it needs less

blood and oxygen.

Biofeedback. A technique that uses

electronic instruments to measure body

functions and feed that information back to

you, teaching you to bring involuntary body

processes, such as blood pressure or skin

temperature, under voluntary control.

Calcium channel blocker. A type of

medication that affects the movement of

calcium within the cells of the heart and blood

vessels, thus relaxing the blood vessels and

increasing the supply of blood and oxygen to

the heart.

Connective tissue disease. Any of a group

of diseases characterized by degeneration of

collagen, a key component of connective

tissues such as skin, muscles, tendons, and

ligaments. Connective tissue diseases

include scleroderma and lupus.

Cyanosis. A bluish discoloration of the skin

and mucous membranes caused by a lack of

oxygen in the blood.

Erythrocyte sedimentation rate (ESR or

sed rate). A laboratory test for inflammation

that measures how quickly red blood cells fall

to the bottom of a test tube of unclotted

blood. Rapidly descending cells (an elevated

sed rate) indicate inflammation in the body.

Lupus. Short for systemic lupus

erythematosus, an inflammatory disease of

the connective tissue, which can affect the

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skin, joints, and internal organs.

Nailfold capillaroscopy. A test used to look

for abnormalities of the tiny blood vessels

called capillaries in the skin at the base of the

fingernails. Enlarged or malformed capillaries

may indicate a connective tissue disease.

Pallor. Paleness of the skin due to reduced

blood flow.

Rubor. Redness of tissue. In Raynaud’s

phenomenon, redness is caused by an

increase in size of the small blood vessels of

the affected extremities.

Sed rate. See erythrocyte sedimentation

rate.

Sjögren’s syndrome. A condition in which

the body’s immune system attacks the

moisture-producing glands, resulting in

uncomfortable and sometimes damaging

dryness of tissues, particularly those of the

eyes and mouth.

Vasospastic attack. An episode of the small

blood vessels going into spasms, temporarily

reducing blood flow to the extremities.

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation and review of previous versions

of this publication: Elizabeth Gretz, Ph.D.,

NIAMS/NIH; Paul Plotz, M.D., NIAMS/NIH;

Gabor Illei, M.D., Ph.D., NIDCR/NIH; Phillip

J. Clements, M.D., University of California,

Los Angeles, CA; Jay D. Coffman, M.D.,

Boston University Medical Center, Boston,

MA; and Frederick M. Wigley, M.D., Johns

Hopkins University School of Medicine,

Baltimore, MD.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services’

National Institutes of Health (NIH), is to

support research into the causes, treatment,

and prevention of arthritis and

musculoskeletal and skin diseases; the

training of basic and clinical scientists to

carry out this research; and the dissemination

of information on research progress in these

diseases. The NIAMS Information

Clearinghouse is a public service sponsored

by the NIAMS that provides health

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information and information sources.

Additional information can be found on the

NIAMS website at http://www.niams.nih.gov.

For Your Information

This publication contains information about

medications used to treat the health condition

discussed here. When this publication was

developed, we included the most up-to-date

(accurate) information available.

Occasionally, new information on medication

is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

http://www.accessdata.fda.gov/scripts

/cder/daf/. Drugs@FDA is a searchable

catalog of FDA-approved drug products.

For updates and questions about statistics,

please contact

Centers for Disease Control and

Prevention, National Center for

Health Statistics

Toll free: 800-232-4636

Website: http://www.cdc.gov/nchs

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin

Diseases (NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

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