Diagnosis of Raynaud’s Phenomenon
There is no single test to diagnose Raynaud’s phenomenon. Doctors usually diagnose it based on symptoms, in particular, on a description of a typical attack upon exposure to cold. Your doctor will likely also take a medical history and perform a physical exam.
Your doctor may perform additional tests to distinguish between the two forms of the condition. These include:
- Nailfold capillaroscopy. During this test your doctor uses a magnifier to look at the base of your fingernails for signs of changes in capillaries (tiny blood vessels), a sign of secondary Raynaud’s phenomenon.
- Blood tests. If your doctor suspects that you have the secondary form, they may order blood tests that may indicate you have a disease that has been linked to Raynaud’s phenomenon, such as lupus or scleroderma. One of the more common of these tests is the antinuclear antibody (ANA) test and a thyroid stimulating hormone (TSH) test.
Treatment of Raynaud’s Phenomenon
The goals of treatment for Raynaud’s phenomenon are to:
- Reduce how many attacks you have.
- Make attacks less severe.
- Prevent tissue damage.
For most people with Raynaud’s phenomenon, avoiding getting cold prevents attacks and keeps symptoms under control. But if this is not enough, medications and, in some cases, surgical procedures can help.
Secondary Raynaud’s phenomenon is more likely to be serious and to need more aggressive therapy, such as prescription medications.
Preventing Attacks
- Medications. While there are no medications approved by the U.S. Food and Drug Administration for Raynaud’s phenomenon, medications that have been approved for other conditions are routinely used to treat it. Some medications, including stimulants, can make Raynaud’s phenomenon worse and may be stopped if they are contributing to this condition.
- Surgery. If you have severe Raynaud’s phenomenon, your doctor may recommend a procedure called a sympathectomy to destroy the nerves that trigger blood vessel narrowing in the affected areas. This is usually done by incision or injections. The procedure often relieves symptoms, but it may need to be repeated after a few years.
Treating Tissue Damage
In serious cases, repeated attacks can lead to skin sores or gangrene (death and decay of tissue). If this happens, the person may need to be admitted to the hospital for a few days for imaging studies and intravenous medications to rapidly improve blood flow and to treat infection. Wound care services may be needed. In rare cases, the person may need surgery to remove dead tissue and provide pain relief.
Who Treats Raynaud’s Phenomenon?
Raynaud’s phenomenon is primarily treated by:
- Rheumatologists, doctors who treat diseases of the joints, muscles, and bones. Rheumatologists are also specialists in autoimmune diseases. They treat Raynaud’s phenomenon because it sometimes occurs in association with rheumatic diseases, like lupus.
Other specialists who may be involved in your care include:
- Cardiologists, who specialize in treating heart and blood vessel problems.
- Dermatologists, who specialize in conditions of the skin, hair, and nails.
- Mental health professionals, who can help people cope with difficulties in the home and workplace that may result from their medical conditions.
- Primary care doctors, such as family physicians or internal medicine specialists, who coordinate care between the different health care providers and treat other problems as they arise.
- Surgeons, including hand specialists, who may be orthopaedists, plastic surgeons, or vascular surgeons.
Living With Raynaud’s Phenomenon
In most people, Raynaud’s phenomenon can be controlled by making lifestyle changes. The following tips can decrease the number and severity of attacks you have.
- Keep warm. Keeping your hands and feet, as well as your entire body, warm is important. Often, it is not enough to keep your hands and feet warm; you need to keep your “core body” (chest, abdomen, and head) warm, too.
- If it is cold outside, try not to go out.
- If you go out when it is cold, dress warmly, wearing several layers of clothing. Be sure to use a hat or hood, because you lose a lot of body heat through your head. Consider heated gloves or hand warmers.
- Protect your hands with gloves when you handle cold or frozen items.
- Bring a sweater or jacket if you go to an indoor setting that may be air-conditioned.
- If you smoke, talk to your doctor about making a plan to quit. Nicotine in cigarettes and some vaping solutions can cause blood vessels to narrow, increasing the chance of an attack. Smoking also may cause permanent damage to blood vessels, which is particularly dangerous for people with Raynaud’s phenomenon.
- Some medications can bring on attacks, so talk to your doctor about those you take and before starting any new ones. Medications that can bring on attacks include:
- Decongestants that contain phenylephrine or pseudoephedrine.
- Appetite suppressants (diet pills) that contain pseudoephedrine.
- Beta blockers for high blood pressure.
- Migraine medications that contain ergotamine.
- Certain stimulant medications, such as methylphenidate, for attention deficit-hyperactivity disorder.
- Act quickly to end an attack. If an attack occurs, place your hands or feet in a warm place, such as under warm (not hot) water or under a heating pad. You can also warm your hands by whirling your arms in a windmill pattern or placing them under your armpits.
- Cope with stress. Because stress can bring on an attack, learning how to manage it is important. Meditation, deep breathing, or other relaxation techniques may help. Seek help from a mental health professional if these approaches do not work and you continue to experience high stress levels.
- Regular exercise and a healthy diet can help you deal with stress and improve blood flow.
- Pay attention to your skin. Keep your hands clean and dry, use a moisturizer regularly, and treat any cracks or sores promptly.
Remember to visit your health care providers regularly and to follow their recommendations.