Raynaud’s Syndrome and RA

Raynaud’s syndrome is a rare condition that affects the blood vessels called arteries. Arteries carry fresh blood full of oxygen to all areas of the body. With Raynaud’s, the arteries get smaller when exposed to cold temperatures. This process is called vasospasm, which means spasm of the blood vessel. Vasospasm causes the skin to turn white and then blue for a short time.¹

What parts of the body are affected?

Raynaud’s mostly affects the fingers. However, the toes are affected in 4 out of 10 people. The spasms are called Raynaud’s attacks. During an attack, little to no blood flows to that area of the body. The area may feel numb, cold, or painful. When the blood returns, the fingers or toes may turn red and throb, tingle, burn, or feel numb. It is rarer for Raynaud’s to happen in the nose, ears, nipples, and lips.¹

A Raynaud’s attack can be triggered by cold temperatures or stress. These attacks may last for a few minutes or several hours and occur daily or weekly.

Types of Raynaud’s

There are 2 types of Raynaud’s: primary and secondary. Doctors do not know what causes primary Raynaud’s. It is more common and tends to be less severe than secondary Raynaud’s. Primary Raynaud’s often can be controlled with lifestyle changes, such as wearing gloves when taking foods out of the freezer.

Secondary Raynaud’s is associated with another condition like rheumatoid arthritis (RA). Doctors believe RA causes Raynaud’s as it damages the arteries and nerves of the hands and feet. It is harder to control than the primary type.¹

The condition may also be called Raynaud’s phenomenon or Raynaud’s disease.

Doctors do not know what causes primary Raynaud’s. Secondary Raynaud’s is the type found in people with RA.^1-3

How are RA and Raynaud’s connected?

Doctors believe that up to 12 of every 100 people with RA will also have Raynaud’s syndrome. This compares to 5 of 100 people in the general population with Raynaud’s.^2,3

The connection between rheumatoid arthritis and Raynaud’s is not clear. It may be that RA causes the blood vessels to lose the ability to dilate (expand and contract) over time. RA also damages the nerves that control the blood vessels in the hands and feet. Plus, people with RA who also have lupus, scleroderma, Sjogren’s syndrome, and hardening of the arteries may be more likely to develop Raynaud’s.^1,2

Signs and symptoms

When a person with Raynaud’s feels chilly, touches something cold, or is stressed, the fingers or toes will:¹

• Turn pale or white and then blue
• Feel numb, cold, or painful
• Turn red, throb, tingle, burn, or feel numb as the blood flow returns

The attacks may last less than a minute or for several hours. Some attacks begin in 1 finger or toe and then spread to other fingers and toes. Sometimes only 1 or 2 fingers are affected. Sometimes different areas of the body are affected with each attack.¹

Diagnosis

Your primary care doctor or rheumatologist may diagnose Raynaud’s. Your doctor probably will ask:¹

• Whether your fingers or toes feel numb or painful or turn white or blue when exposed to cold
• How long this has been happening

Your doctor will look at the fingers and toes to check the health of your skin and nails and check blood flow to these areas. Next, a cold stimulation test may be used to trigger Raynaud’s symptoms. Often this means dipping your hands in ice water. A device will be used to see how long it takes your fingers to return to their normal temperature. If you have Raynaud’s this may take 20 minutes or longer.¹

Your doctor may also look at the blood vessels under your nails or order blood tests to look for conditions linked to Raynaud’s.¹

Treatments options

If you have rheumatoid arthritis and Raynaud’s, you have many treatment options, including lifestyle changes and medicine.

Lifestyle changes for Raynaud’s mostly involve avoiding things that trigger an attack, such as:¹

• Layering your clothes for extra warmth.
• Wearing a hat, mittens on top of gloves, a scarf, and a warm coat and socks during cold weather.
• Placing warmers in your mittens, socks, and pockets.
• Warming up your car before driving in winter.
• Turning up the thermostat so it is warmer inside in summer.
• Wearing gloves or mittens to take food out of the refrigerator or freezer.
• Limiting caffeine and alcohol
• Quitting smoking

You may also need to avoid stress. Some people find that yoga, tai chi, regular exercise, or meditation helps. Others may need to avoid activities that use the hands over and over again. This includes typing, playing an instrument, knitting, and writing.

Some drugs are known to trigger Raynaud’s attacks. You should work with your doctors to figure out if these drugs make your Raynaud’s worse, such as:¹

• Migraine drugs that include ergotamine
• Cancer medicines cisplatin and vinblatine
• Some over-the-counter cold and allergy drugs
• Beta-blockers
• Birth control pills

If lifestyle changes do not help, your doctor may prescribe medicines, or less often, surgery. The drugs prescribed help improve blood flow to the fingers and toes. Examples of these drugs include:¹

• Calcium channel blockers
• Alpha-blockers
• Prescription skin creams
• ACE inhibitors

Sores that develop due to severe Raynaud’s are rare but must be treated quickly to avoid gangrene. Gangrene is dead tissue and is a serious condition. On rare occasions, severe Raynaud’s is treated with surgery that increases blood flow to the fingers and toes.

Some small studies say that Raynaud’s does not make RA any worse or decrease hand function or strength. Other small studies find Raynaud’s is a sign of more severe RA. More research is needed. Talk with your doctor right away if you have RA and develop signs of Raynaud’s. Quick treatment can help prevent complications.^2,3