Raynaud’s phenomenon is a vascular disorder. It is characterized by an intermittent arteriolar massive spasm of the digits. This is most often due to cold temperatures or stress in general. The exaggerated vasoconstriction of the digital arteries, as well as arterioles in Raynaud’s Phenomenon, produces pain. The hands turn white called pallor, then turn blue called cyanosis, and finally red called hyperemia which is the last stage. Although all the three phases of pallor, cyanosis, and hyperemia may not be seen in all individuals.

Raynaud’s phenomenon has been categorized under two headings-

1. Primary Raynaud’s Phenomenon– Primary Raynaud’s Phenomenon is also called Raynaud’s disease. The primary Raynaud’s phenomenon typically follows a less severe course than the Secondary Raynaud’s phenomenon. In this condition, the vasospasm is not associated with ischemic injury or underlying associated disease and no structural abnormality is seen in the arterial wall. This condition is typically diagnosed in women less than 30 years of age. This condition involves all fingers symmetrically excluding the thumbs. In later stages of the disease, thickening of intima may be seen. It is found that patients with this condition do not have a history of peripheral vascular disease or ischemic injury. In this condition nuclear antibody titers and nail-fold capillaries are normal.
2. Secondary Raynaud’s phenomenon- Secondary Raynaud’s phenomena are also called Raynaud’s Syndrome. Raynaud’s Syndrome is usually more severe. The attack is very painful. It is associated with an underlying disease, usually a connective tissue disease with systemic sclerosis being the most common cause.  In this condition, vasospasm is associated with ischemia. This condition is asymmetrical in the digits, and, unlike primary Raynaud’s phenomenon, thumbs are also affected. Digital alterations or necrosis (ulcer-like wounds on the fingers and hands), tuft pits, pterygium inversion (a rare abnormality in which the distal nail bed adheres to the ventral surface with complete eradication of the distal groove), and painful nail-fold capillaries are commonly seen in patients with this condition. 

There are various causes of Raynaud’s Syndrome. The primary reason being a reaction to cold temperatures. When the body feels cold, it slows down the flow of blood to further parts of the body such as fingers and toes by narrowing the arteries in those areas. When the arteries narrow down more than and faster than usual it results in Raynaud’s Syndrome. Patients suffering from Scleroderma, a rare connective tissue disease, get Raynaud’s Syndrome in most cases. Various artery diseases such as atherosclerosis, Buerger’s disease, and hypertension can also cause Raynaud’s Syndrome. Individuals suffering from lupus and rheumatoid arthritis are also at higher risk of getting this disease.  Pressure in nerves in the hand, usually in carpal tunnel syndrome and cubital tunnel syndrome, may also cause this condition. Physical injuries may also cause this condition. India accounts for about 12% of the world’s smokers. Statistics show that Karnataka has a good population of people who smoke regularly. The doctors at the best rheumatology hospital in Bangalore, say that people who smoke are at higher risk of contracting Raynaud’s Syndrome. Some medications for hypertension, ADHD, and chemotherapy may make it more likely to contract this condition.

Treatment of Raynaud’s Syndrome

1. Home treatment– The first thing that is suggested to all patients and the very first line is self-defense. Patients are asked to stop smoking if they do. Patients must guard themselves against cold temperatures. Patients are advised to wear multi-layer gloves and socks. Patients are also asked to exercise which improves blood circulation throughout the body. Patients are also advised to refrain from some medications such as diet pills and migraine-related medicines.
2. Medication-The first-line treatment is with calcium channel blockers, such as nifedipine, amlodipine, felodipine, and isradipine, which are a cross of molecules that increase the vascular beds of the core vasodilators. This could be enough for most patients. If calcium channel blockers are not enough a second line of treatment is added with another vasodilator such as losartan. Some of the strongest positive leaders are phosphodiesterase inhibitors or sildenafil (Viagra and Revatio). These have been used for erectile dysfunction for many years but now they have become part of the treatment pathway for patients right now because they are extremely effective vasodilators.
3. Surgery– If conditions do not improve after home treatment and/or with medication the patient may have to go under the surgical procedure, or they will be at high risk of losing fingers or toes. Sympathetic nerves are responsible for the opening and narrowing of the arteries. A small slit is made in the affected areas and some sympathetic nerves are stripped away. It makes it less sensitive and thus exaggerated narrowing of arteries can be corrected. In some cases, no slit is made, rather chemicals such as anesthesia or Botox are injected into the affected areas to block the nerves. This procedure, in some cases, has to be done multiple times so the conditions do not persist.