What's Up Doc? Cold fingers may be Raynaud phenomenon

Raynaud phenomenon (RP) is an overreaction of the blood vessels to cold, and not just someone being "sensitive" to the cold. In some people this overreaction can also be stimulated by emotional stress. Due to this overreaction the small arteries and arterioles that carry the blood constrict (squeeze and become smaller, hence decreasing the blood flow). This causes a relatively insufficient blood supply, which is responsible for the colour changes of the skin and the other symptoms. RP is actually pretty common, with many studies showing a prevalence of 3 percent to 4 percent in the overall population, although some studies have shown even higher rates. It is most common in women in their teens to their 30s, although it affects men, children and older people as well.

The criteria your doctor will use to determine if you have RP are:Episodic attacks that include skin colour changes, classically white at first then changing to blue, which are brought on by exposure to cold (or emotional stress). People who are just sensitive to the cold may feel their fingers and hands get cold, but they will not have the skin colour changes associated with RP.The attacks usually involve both hands, and in some people can involve the toes/feet as well.RP is usually broken up into two types: primary RP (that is Raynaud phenomenon as an entity unto itself) and secondary RP (with the RP symptoms being one aspect of some other underlying condition). A partial list of diseases that can have RP as a symptom includes autoimmune disorders such as systemic lupus erythematosus (in fact, 30 percent to 40 percent of SLE patients eventually develop RP), connective tissue diseases such as Sjogren's syndrome, rheumatoid arthritis, vascular diseases including vasculitis, vibration-induced conditions (such as some construction jobs that subject the patient to frequent vibrations), as well as certain metabolic, endocrine and even haematological conditions.Despite the many diseases that can be associated with RP, most cases of RP are primary RP, so testing for these other conditions may not be needed. However, if a patient has symptoms of one of these other diseases, has an abnormal nail-fold capillary exam (a special exam to look at the small blood vessels in your nail beds) or has other factors suggesting that their RP may be due to an underlying disorder, then referral to a rheumatologist for further evaluation is indicated.A rheumatology referral should also be considered in patients whose RP begins after age 40, if their attacks are associated with actual damage of the skin or tissues (such as ulcerations), and in those with atypical symptoms (such as asymmetric attacks or symptoms that involve the hands/arms instead of the fingers). Since primary RP is more common in women, a lower threshold to evaluate men for secondary RP is also indicated.Most people with RP can learn how to control their condition by avoiding the triggers that cause the attacks. Preventing sudden exposure to the cold (for the fingers/hands as well as the entire body) by dressing warmly and always wearing gloves is certainly a start. Rewarming your hands, such as by putting your hands under your armpits or running warm water over them, is also useful. There are other factors that can exacerbate RP such as smoking, caffeinated beverages, using vibrating tools and certain medications (such as decongestants, diet pills, herbal medicines with ephedra and many others), and these should be avoided.Most people with primary RP do not need to be treated with medications, as the above treatments are usually sufficient. However, some people with severe refractory symptoms, and many people with secondary RP, do require medications. Many medications have been tried in patients with RP; the most commonly prescribed ones for this condition are a type of blood pressure medication that dilates the blood vessels called calcium channel blockers. There are many other medications that can be tried as well, and consultation with an experienced rheumatologist is indicated for people requiring medication for their RP.Surgery (for example, sympathectomy) has been tried in patients with severe symptoms refractory to all other treatments, but the results may only be temporary and this is usually only considered in extreme cases.So, if you think you may have RP rather than just being "sensitive to the cold" you should see your health care provider to be evaluated. In the meantime, do everything you can to avoid those things that trigger your symptoms.(Source: Dr. Jeff Hersh : Tufts University :January 2007.)