Raynauds Disease

Raynaud's Disease

Mostly in the Hands of Women

Mary Ann knows she lacks style at times. In early fall, the 50-year-old Philadelphia lawyer can be seen wearing big, fuzzy mittens and a large scarf wrapped around her head babushka-style. And when she entertains colleagues in her suburban home, she doesn't offer to fix the drinks. She asks her guests to do it themselves.

Not very chic, perhaps, but for Mary Ann the habits are a matter of self-defense. She has Raynaud's disease, a disorder in which the hands, and sometimes other body parts, respond abnormally to cold or stress. A slight drop in the temperature or contact with cold objects such as soda cans, water or ice can cause intense pain and color changes in the fingers. The pain may be so bad that any exposure to cold is intolerable. The only way to stop Raynaud's is to stay warm and avoid contact with cold objects.

What's Happening Here?

The body's protective device, the sympathetic nervous system, controls the opening and closing of blood vessels. When most people are exposed to cold, this system tends to constrict the blood supply to the extremities and direct it to the center of the body. With Raynaud's disease, the slightest hint of cold causes an exaggerated contraction of the blood vessels.

It's not clear why, says George Spencer-Green, M.D., associate professor of medicine in the connective tissue disease section at Dartmouth Medical School in Hanover, New Hampshire. Doctors speculate that it could be due to some interference with the sympathetic nervous system or to an abnormality of the vessel itself. They do know that Raynaud's disease is more common in women than in men and that the onset of symptoms is typically between the ages of 20 and 40. Some experts think that female hormones may be a factor, but it's not clear yet how.

You'll know for sure that you have Raynaud's when contact with the cold causes three color changes in your skin--to white, then blue, then red. But three changes are not always required for a diagnosis of Raynaud's, says Leslie Kahl, M.D., assistant professor of medicine in the Division of Rheumatology at Washington University in St. Louis. One color, white, may be enough, she says, but what's key is whether the color change occurs repeatedly. Numbness is another clue, but the best way to find out if it's Raynaud's is to see your doctor.

The Two Types of Raynaud's

Raynaud's comes in two forms. One is Raynaud's disease, which occurs in isolation. The other is Raynaud's phenomenon, which occurs in conjunction with other diseases, including scleroderma, a hardening and shrinking of the skin; lupus, a chronic inflammatory disease that affects the skin, joints, kidneys, nervous system and mucous membranes; and rheumatoid arthritis. Raynaud's phenomenon also commonly occurs in people who use vibrating or hammering tools or instruments.

Your doctor will do blood tests and examine your nail folds, the area right above the cuticle under the skin, to figure out which form of Raynaud's you have.

It's estimated that 5 to 10 percent of Americans have Raynaud's.

We're in the Majority

It's not known why more women than men have Raynaud's, but women get autoimmune diseases such as scleroderma and lupus more than men do, and Raynaud's often develops with these.

Also, smoking may contribute to Raynaud's because the nicotine in tobacco causes blood vessels to constrict. "People are more likely to develop a more severe case if they're smokers. And smokers whom I have convinced to quit have often noticed that their Raynaud's improves dramatically," says Dr. Kahl.

Other products that stimulate the sympathetic nervous system, such as diet pills and cold remedies, may contribute to the development of Raynaud's, says Dr. Kahl.

Medications that women take for other health problems may also contribute to or exacerbate Raynaud's. Women get migraine headaches more than men, and migraine medications, called beta-blockers, can trigger Raynaud's. Beta-blockers are also used to treat high blood pressure, and their use may worsen symptoms or make previously undiagnosed symptoms more apparent, says Dr. Spencer-Green.

Finally, researchers say that there may be a link between women's hormone levels and Raynaud's, though they're not sure what the link is. "Mounting evidence supports the notion that there is a specific relationship between hormones and the immune system," says Joan Merrill, M.D., assistant chief of rheumatology at St. Luke's-Roosevelt Hospital in New York City. "But it's not clear how that works yet," she says.

Our Special Concerns

There's no definitive answer on whether the birth control pill affects Raynaud's. Some doctors say that while there are no large studies to support it, a few of their patients have developed Raynaud's while on the Pill. And Rosalind Ramsey-Goldman, M.D., Dr.Ph., assistant professor of medicine in the Division of Rheumatology at Northwestern University School of Medicine in Chicago, says some researchers believe the Pill may exacerbate Raynaud's in some patients who have increased levels of antiphospholipid antibodies. These antibodies are sometimes associated with spontaneous abortions and other blood-clotting disorders. If you have Raynaud's and are considering the Pill, talk it over with your doctor.

The impact of Raynaud's on pregnancy is also unknown, experts say. Some doctors say women with Raynaud's may actually feel better during pregnancy due to increased blood vessel dilation, yet little research has been done to confirm this. And while pregnancy difficulties have been identified in women with lupus and other autoimmune diseases, less research has been done on Raynaud's phenomenon.

A study of 97 women conducted by Dr. Kahl looked at pregnancy in women with severe Raynaud's phenomenon. She found that women who had Raynaud's before their first pregnancy had smaller babies, although within normal range, and were more likely to have premature babies. "If a woman has severe Raynaud's, then it's fair to say there's a slightly increased risk of premature birth," she says. All women with Raynaud's don't need to be alarmed, though, she says. This study included women with very severe Raynaud's, so the conclusions can't necessarily be applied to women with milder forms of the disease.

There are no studies to prove that the severity of Raynaud's varies during the phases of the menstrual cycle, but some doctors say their patients report changes. The impact of Raynaud's on conception and fertility is also unknown.

Keeping Raynaud's Under Cover

Raynaud's isn't curable, but it is manageable. Here's what you can do.

Be prepared for temperature changes. Don't make drastic changes from warm to cold, says Dr. Ramsey-Goldman. Carry a sweater with you at all times, she says. And keep an extra sweater or leggings in a drawer at work. "People at work tolerate different temperatures, and you may not be allowed to adjust the thermostat," she says.

Don't forget the hat and scarf. Bundle up in cold weather, and this means wearing a hat and scarf, too, says Dr. Kahl. "Women may be savvy enough to wear mittens, but not hats," she says. "Get into stylish hats. Make the hat your signature. Make it a positive instead of a negative," she says.

Slide into silk. One key to keeping warm is to dress in layers, says Dr. Kahl. "Wear silk underclothing. It doesn't add to the bulk, but it will add to warmth," she says. The underwear doesn't have to be long-sleeved, she explains. Even a silk camisole will do. The key is to keep your core body temperature up.

Quit smoking. There are lots of good reasons to give up smoking, but if you've got Raynaud's, now you've got another. Do what you can to quit or cut back.

Use a fridge mitt. The less you subject your hands to cold, the better, and that includes the cold from the refrigerator. "If you're taking something out of the fridge, wear an oven mitt," says Dr. Ramsey-Goldman. Some women even take gloves or mitts to the grocery store with them.

Try biofeedback. Biofeedback is effective for some women, says Dr. Ramsey-Goldman. "By touching the hands with a temperature probe, women can learn to raise the temperature in their fingers by as much as one degree," she says. There are also techniques where patients immerse their hands in cold water and then, through a visualization technique, learn to bring back the circulation in their hands. Ask your doctor about biofeedback possibilities.

Note your response to drugs. Certain drugs such as beta-blockers and blood pressure medications can either trigger Raynaud's or exacerbate it. So watch your response to these drugs. Be a good observer and note any changes in your Raynaud's, says Dr. Kahl. You might want to keep a three-day diary and rate each attack on a 1-to-5 scale in terms of severity. If you notice increased severity, tell your doctor.

Condition your hands. You can fool your blood vessels into staying open by using a technique developed by the Cold Research Division at the U.S. Army Research Institute of Environmental Medicine in Natick, Massachusetts. The method helps increase blood flow and decrease symptoms in nearly all Raynaud's patients, say researchers there.

To use this technique at home, you'll probably have to wait for cold weather. Take two containers large enough to fit both hands in and fill them with hot water, about 104° to 107°F. Put one container in a cold area, around 32°F, and one in a warm area. While dressed for indoors, immerse your hands in the warm water in the warm room for two to five minutes. Then wrap your hands in a towel and go to the cold area. Immerse your hands in the warm water there for about ten minutes. Then go back indoors and repeat the warm-water submersion for two to five minutes. Repeat this method three to six times a day every other day until you've done 50 cycles of three dips each.

Steer clear of frostbite. Avoiding frostbite is really critical, says Dr. Kahl. Frostbite can damage blood vessels and contribute to the development of Raynaud's. Watch for signs of frostbite such as numbness or your skin turning white or pale.

Investigate medical options. Raynaud's can often be controlled without medication, says Dr. Spencer-Green. But in severe cases that are difficult to manage, doctors may recommend prescription medications such as nifedipine (Procardia), diltiazem (Cardizem Tablets) and generic reserpine, which can help control symptoms but are not considered "cures" for the disorder. Topical agents, such as nitroglycerin ointments (Nitro-Bid ointment), are effective in controlling symptoms in some patients.