This fall get a sweater. Prevent Raynaud’s disorder flares.
How do I manage Raynaud’s Phenomenon (RP) in my office?
Let’s start from the beginning.
I am a rheumatologist and often see new referrals for blue fingers. While the majority of the cases of RP are benign and very common in society running from 10-20%, there are very rare instances that this condition may require additional work up. What is described as RP is the ischemic phenomenon where the small vessels in the end organs, such as fingers, nose, ears, toes sometimes tongue’s vessels get constricted which may be accompanied by unpleasant sensation of pain, numbness, tingling and discoloration from white, blue, blotchy and finally with the warming phase that extremities, hands, toes become red, then pinkish or natural color again. When I see patients with that in my clinic I wonder if it’s something benign that is called Primary Raynaud’s Disease or is it a secondary condition related to more serious rheumatic disease. The examples of those are scleroderma or lupus. When that gets Involved and in order to diagnose them I need additional information - first of all I start with a great history, family history, good physical exam of fingers, toes, arteries, joints and skin. I’m looking for abnormal capillaries under the special instrument even ophthalmoscope or dermatoscope helps here, the procedure called capillaroscopy and when combined with positive ANA may have large predictive value of developing future connective tissue disease.
There is good news.
Well, good news is the majority of these RP cases are benign and they are often associated with young age female gender, history of migraines, history of anxiety. What I do first is reassure patients, if I have high confidence or low suspicion that there is nothing more serious, and advise patients with a multitude of things that they will need to follow in order to have it under control.
Management.
The first thing is how they care about their body temperature. They need to take care of core temperature making sure that they have a scarf in a winter, warm sweater. It is even more important than gloves and socks. They should avoid things that constrict arteries even more such as coffee, very strong tea, even stressful situations, or getting to the freezer section of the department store or very heavily air conditioned store, even in the middle of hot summer. I had such cases in Dallas, Texas when I studied rheumatology, when patients presented with flare of RP in a matter of warm weather. I also advise patients to consume warm liquids in cool weather, such as soups, herbal teas, especially decaffeinated as any caffeinated liquid (do not forget sodas and soft drinks)may increase the problem. What else can be done? Certainly there are a number of medications that help with this disorder and I always start them with very low doses. The example of those are calcium channel blockers, such as amlodipine, including also anti-depressants such as fluoxetine; other blood pressure managing medications have also been used; nitroglycerin paste which is quite an annoying paste to apply, and occasionally I advise patient to take class medication that’s called PDE5 inhibitors where sildenafil belongs.
Natural and alternative path.
And what else can help? I believe in being in a meditative state, taking a break from hussle, making sure that you exercise so the circulation to your digits is maintained. I think those are not very well studied, but very helpful interventions. I am particularly interested in using meditation to enhance the mood and possibly prevent the flare of the RP.
Below is my cold weather dress code wall. Inside - wools, sweaters, tights and boots, outside - hats, gloves, sport gear and always equipped to follow a great Teds talk or life-balance podcast.
