Raynaud’s Phenomenon
Do you have symptoms of Raynaud’s phenomenon?
✔ A significant cold feeling in your fingers and toes
✔ Changes in skin colour
✔ Numbness
✔ Pins and needles
Raynaud’s phenomenon is more than just feeling cold. While symptoms are often temporary, they can sometimes be severe enough to disrupt daily life. In some cases, Raynaud’s may be linked to an underlying condition.
Our goal is to support you in managing your symptoms, restoring your comfort, and helping you feel like yourself again.
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Dr Naveen Bhadauria is a highly experienced Consultant Rheumatologist in London. He is passionate about achieving early and accurate diagnosis for each of his patients in order to provide effective treatment and improve their lives. After all, accurate diagnosis is vital for getting the correct interventions.
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What is Raynaud’s phenomenon?
Raynaud’s phenomenon (also known as Raynaud’s syndrome) is a condition where the small blood vessels in the extremities, usually the fingers and toes, temporarily narrow in response to cold or stress. This causes a change in skin colour, typically starting with blanching (white), followed by cyanosis (blue) and then erythema (red) as blood flow returns. These episodes are usually temporary and reversible.
If you are experiencing these symptoms, we can perform an assessment and look into your medical history and other factors in order to reach a diagnosis.
Types of Raynaud’s
For most people, Raynaud’s phenomenon is mild and manageable with lifestyle changes such as keeping warm and avoiding triggers.
However, in more severe cases, especially in secondary Raynaud’s, the condition can cause complications such as ulcers, infections, or even tissue damage leading to gangrene. In such cases, urgent medical treatment may be needed to prevent permanent damage. As such, it is important to ascertain whether you have primary or secondary Raynaud’s.
Primary Raynaud’s
Primary Raynaud’s is the most common type, occurring in about 80 to 90% of cases. It is not linked to any underlying condition and usually causes mild, symmetrical symptoms. Episodes are reversible and typically do not lead to complications.
Secondary Raynaud’s
Secondary Raynaud’s is less common but more serious. It is associated with underlying conditions such as connective tissue diseases (e.g. systemic sclerosis), vascular diseases, or prolonged exposure to vibrating tools. It often appears later in life (after age 30) and can cause more painful and asymmetrical symptoms. In severe cases, it may lead to complications like digital ulcers (small sores on the fingers and/or toes), tissue damage, or infections. Those with suspected secondary Raynaud’s should be monitored closely and may need specialist care.
When does it go from just having cold hands to being Raynaud’s?
Cold hands are common, especially in colder weather, but Raynaud’s phenomenon goes beyond that. It involves a distinct pattern of colour changes in the fingers or toes – typically turning white (due to reduced blood flow), then blue (from lack of oxygen), and finally red (as blood flow returns). These episodes are often triggered by cold temperatures, anxiety or stress and may be accompanied by numbness, tingling or pain.
If your hands or feet frequently become cold and change colour in response to cold or stress, or if the symptoms are painful, persistent, or asymmetrical, it may be Raynaud’s rather than just sensitivity to cold. Dr Naveen Bhadauria can assess your symptoms and determine whether further investigation is needed.
Raynaud’s symptoms checklist
Do you have:
- Fingers or toes that regularly feel very cold (some people also experience a cold feeling in their nose, ears, lips or nipples)
- Skin that appears white, blue/purple or red
- Feelings of tingling, numbness or pins and needles in your hands or feet
Risk factors for Raynaud’s
Several factors can increase the risk of developing Raynaud’s phenomenon, including:
Primary Raynaud’s (idiopathic) risk factors:
- Gender: It is more common in women than men.
- Age: It typically develops between the ages of 15 and 30.
- Family history: Having a close relative with Raynaud’s increases the likelihood.
Secondary Raynaud’s (due to an underlying condition) risk factors:
- Connective tissue diseases: Conditions like systemic sclerosis, lupus, rheumatoid arthritis, and Sjögren’s syndrome are linked to Raynaud’s.
- Obstructive vascular diseases: Atherosclerosis or other conditions affecting blood circulation can contribute.
- Repetitive trauma or vibration exposure: Regular use of vibrating tools (e.g., drills, jackhammers) or repeated hand injuries (as seen in pianists or typists) can lead to Raynaud’s.
- Medications: Some beta-blockers, migraine medications, chemotherapy drugs and decongestants can narrow blood vessels, triggering Raynaud’s.
- Smoking: Nicotine constricts blood vessels, making symptoms worse.
- Cold exposure: Living or working in cold climates increases the risk.
- Stress: Emotional stress can act as a trigger for episodes.
Getting diagnosed: What’s involved in a Raynaud’s assessment?
Diagnosis is based on a combination of symptoms and medical history. Your rheumatologist will ask you about the areas affected, the symmetry of symptoms, any pain or numbness, how often episodes occur, and possible triggers.
A physical examination of the fingers and toes, and assessment of blood flow and skin appearance, will be performed. Blood tests, including full blood count, inflammatory markers, thyroid function, and ANA (antinuclear antibody) titres, may be arranged to check for secondary causes. It is also important that underlying conditions are ruled out, so Dr Naveen Bhadauria will check for red flags that may point to these conditions.
Treatment for Raynaud’s
Managing Raynaud’s phenomenon involves a combination of lifestyle changes, medical treatments, and, in some cases, addressing underlying conditions. While symptoms are often mild, making small adjustments to your daily routine can help prevent episodes and reduce their severity.
Lifestyle changes
What you can do to help:
- Quit smoking: Smoking constricts blood vessels, reducing circulation and worsening symptoms. Stopping smoking can improve blood flow and reduce the frequency of Raynaud’s episodes.
- Keep warm: Maintain a warm home environment and dress in layers, particularly covering hands and feet with thermal gloves and socks. Heated blankets or hand warmers can also be useful in colder months.
- Avoid sudden changes in temperature: Rapid shifts from warm to cold environments can trigger Raynaud’s episodes. When moving from indoors to outdoors in winter, take time to adjust and wear protective clothing.
- Manage stress: Emotional stress can act as a trigger. Techniques such as deep breathing, meditation, mindfulness, and yoga can help control stress levels and reduce the risk of episodes.
- Regular exercise: Staying active improves circulation and can help reduce the frequency and severity of symptoms. Activities like walking, swimming, and stretching exercises can be particularly beneficial.
- Maintain a balanced diet: Eating a diet rich in fruits, vegetables, whole grains, and healthy fats supports overall vascular health. Omega-3 fatty acids (found in fish, flaxseeds, and walnuts) may also help improve circulation.
- Reduce caffeine: Caffeine can constrict blood vessels, potentially triggering symptoms. Reducing or avoiding caffeine in coffee, tea, energy drinks, and some soft drinks may help manage Raynaud’s.
Medications for Raynaud’s phenomenon
If lifestyle changes are not enough to manage symptoms, medication may help improve blood flow and reduce the frequency of episodes. The choice of treatment depends on the severity of symptoms and whether Raynaud’s is primary or secondary.
- Calcium channel blockers: These medications help relax and widen small blood vessels in the hands and feet, improving circulation. They may also aid in healing sores caused by poor blood flow. Commonly prescribed options include nifedipine, amlodipine, felodipine, and isradipine.
- Vasodilators: These medicines work by relaxing blood vessels to improve circulation. They include losartan (a blood pressure medication), sildenafil (commonly used for erectile dysfunction), fluoxetine (an antidepressant that can also aid circulation), and prostaglandins, which help widen blood vessels.
Procedures for severe cases
For severe or persistent cases that do not respond to medication, medical procedures may be considered. These include nerve surgery and chemical injections injecting local anaesthetics or botulinum toxin (Botox) into the affected areas can block the nerves responsible for excessive narrowing of the blood vessels. Some people may require repeat treatments if symptoms return.
Treatment plans vary depending on individual circumstances.
When to see a rheumatologist
While Raynaud’s phenomenon is often mild and manageable, certain signs may indicate an underlying condition that requires specialist care. A referral may be necessary if:
- Your symptoms are severe or worsening: If your episodes are becoming more frequent, painful, or prolonged, or if they are starting to interfere with daily life, a rheumatologist can help assess whether additional treatment is needed.
- Raynaud’s is significantly affecting your daily activities: If your symptoms make it difficult to perform everyday tasks, such as writing, using your phone or handling objects, treatment options can be explored to improve circulation and reduce discomfort.
- Your symptoms only affect one side of your body: Typically, Raynaud’s usually affects both hands or feet symmetrically. If you notice symptoms occurring on only one side, this could indicate an underlying vascular issue that requires further investigation.
- You experience additional symptoms: If you also have joint pain, skin rashes, muscle weakness, ulcers on your fingers or toes, or swelling in your hands, it could suggest an autoimmune or connective tissue disorder, such as lupus or scleroderma, which requires specialist management.
- You are over 30 and experiencing Raynaud’s for the first time: Raynaud’s that develops later in life is more likely to be secondary to another condition. Tests can be conducted to determine if an underlying disease is causing your symptoms.
If any of these apply to you, it is important to seek medical advice. Early diagnosis and treatment can help prevent complications and improve your quality of life.
FAQs
Cold hands and feet are common, especially in cooler environments. However, if you frequently experience extreme coldness, colour changes, or discomfort, particularly when exposed to mild cold or stress, it may be a sign of Raynaud’s phenomenon. If these symptoms interfere with daily life or worsen over time, it is worth speaking to a healthcare professional.
Raynaud’s can occur on its own (primary Raynaud’s) or as a result of an underlying condition (secondary Raynaud’s). The exact cause of primary Raynaud’s is not fully understood, but it is thought to be linked to an exaggerated response of the blood vessels to cold or stress. Secondary Raynaud’s is often associated with conditions such as autoimmune diseases (e.g. lupus or scleroderma), vascular disorders, or occupational factors like prolonged use of vibrating tools.
For most people, primary Raynaud’s is not serious and can be managed with lifestyle adjustments. However, secondary Raynaud’s can be more severe, as it may be linked to an underlying health condition. In some cases, poor circulation can lead to complications such as ulcers, infections, or, in extreme cases, tissue damage. If you experience severe symptoms, persistent pain, or skin sores that do not heal, it’s important to seek medical advice.
I saw Dr Bhadauria here on Tuesday, and I can honestly say that he is one of the best doctors I’ve ever seen and been assessed by. He listened to every single one of my symptoms, asked through questions and diagnosed me based on the medical history and testing that I have had done in the past. This diagnosis has been a long winded process, with me seeing lots of different doctors and being told that the pain I feel is “in my head”, or that “it must be my hormones”. Dr Bhadauria has put all that to bed, and now I can finally start the path to feel better and have more support in my life. If you are thinking of seeing Dr Bhadauria, I would fully encourage you to do so. Thank you again for all your help.
