How to manage the pain of Raynaud's disease
Over the last few weeks, the sudden drop in temperatures around the country have made life especially difficult for one particular group of patients – those who suffer from Raynaud's disease.
This condition is named after Dr Maurice Raynaud, a Parisian physician. In 1862, Raynaud noticed that a group of his patients developed painful, discoloured fingers and toes, when exposed to cooler temperatures – this is now known as Raynaud's syndrome.
At least 1 in 20 of us suffer from Raynaud's, and although it is not "serious" or life-threatening, it can cause considerable pain and discomfort, especially during winter months.
In some cases, it can indicate an underlying medical condition, so it is important to discuss with your doctor to make sure you don't fall into this category.
The vast majority of people have this type of Raynaud's. There is no underlying cause, and it is not associated with other medical conditions. It tends to become apparent in teens or 20s, and is nearly always evident prior to turning 30 years of age.
There is often a familial link, with other close relatives being affected too, and it is more common in smokers. Primary Raynaud's isn't fully understood yet, but is thought to be due to an "overreaction" of the blood vessels in the extremities in response to cool temperatures – the blood vessels constrict, causing the dramatic colour changes.
Around 10 per cent of Raynaud's cases will be this secondary type, which means they are linked to some other underlying medical condition. Sometimes Raynaud's is the first sign of this condition, but this is not always the case.
The most common associated diseases are rheumatoid arthritis, lupus erythematosis, scleroderma, other connective tissue diseases and multiple sclerosis. If you have other suggestive symptoms (for example joint pains or stiffness, skin problems, or fatigue), and you also suffer from Raynaud's syndrome, your doctor may suggest further testing to check you don't have anything else going on.
For both types of Raynaud's, the symptoms are very distinctive: fingers, toes and sometimes other extremities including earlobes, nose, nipples and tongue, become suddenly discoloured and painful when exposed to cool temperatures.
The trigger can be environmental, for example drops in temperature in the winter months, but Raynaud's can also be triggered by specific activities such as washing your hands in cold water, or getting something out of the freezer. Interestingly, a small number of people will also get a flare up of their Raynaud's syndrome when they are under emotional stress, regardless of the temperature.
The colour changes of Raynaud's are typically white (as the blood vessels constrict and narrow), to blue, and then finally red. In Primary Raynaud's, classically all fingers of both hands will be affected, but in Secondary Raynaud's often only 1 or 2 fingers or toes will be involved. The area between the affected discoloured skin, and the rest of the hand, is clearly demarcated, giving a very unusual appearance.
The key to managing Raynaud's is to try and avoid any sudden drop in temperature:
* Keep extremities warm – wear good quality, woollen gloves and socks, preferably putting them on when you are warm to try and preserve the optimum temperature.
* Dress warmly – ensure the rest of you is warmly dressed at all times: this will help improve the circulation to your extremities, and reduce the frequency and severity of symptoms.
* Avoid directly touching cold objects, so use a towel for example if you have to remove anything from the fridge or freezer.
* Doing some short exercises regularly will increase your body temperature, reducing the risk of getting symptoms.
* If you do get cold, run your hands and feet under warm water for a few minutes; this can open up the blood vessels for several hours and reduce the severity of any symptoms.
As well as these practical tips, if you are a Raynaud's sufferer ensure you aren't doing anything to make it worse – stop smoking, reduce your caffeine intake, and discuss with your doctor about any medication you are taking: certain medications such as beta-blockers and decongestants can exacerbate the symptoms.
Most people with Raynaud's will have a mild version, and will be able to manage their symptoms without too much distress, but for some that won't be the case.
If symptoms are really frequent or severe, medication can be of benefit, either taken all year round or just during winter months. Nifedipine (a calcium channel blocker) is the one most commonly prescribed, but I would suggest talking to your doctor to discuss the optimal treatment for you.
* Cathy Stephenson is a GP and a medical forensic examiner.