Cold hands: Could it be Raynaud’s?

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I used to enjoy cold weather and cold-weather activities. Not anymore. These days I find it harder and harder to keep my hands warm when I’m outside, even with an excellent pair of gloves. Sometimes my fingers turn white and become numb.

Those are the hallmarks of Raynaud’s syndrome (or disease or phenomenon). Named after the French physician who first described it in 1862, Raynaud’s is a problem in the body’s arteries. In most people with Raynaud’s, small arteries that bring oxygen-rich blood to the fingers spasm and close down in response to cold or stress. This reduces or cuts off blood flow to the fingers. Without a steady supply of warm blood circulating through them, the affected fingers become pale. Raynaud’s can also affect the toes, nose, lips, ears, nipples, and other body parts.

Recognizing Raynaud’s

Everyone’s hands get cold from time to time. Raynaud’s is different than just getting cold. The affected body part

• feels cold
• changes from its normal color to a whitish or bluish hue
• feels numb

When the spasm ends and the arteries reopen, allowing blood to flow again, the finger, toe, or other body part turns pink or red. It may throb or tingle.

Who gets Raynaud’s?

Experts don’t really know why some people have Raynaud’s and others don’t. Clearly these people have unusually strong reactions to cold. Beyond that it’s still a medical mystery.

There are two types of Raynaud’s:

Primary Raynaud’s. This is the most common form. It isn’t caused by some other medical condition that causes arteries to spasm.

Secondary Raynaud’s. Although less common than primary Raynaud’s, this type tends to be more serious. The signs and symptoms are the same, but they are caused by some other health problem. These include

• a connective tissue disease such as scleroderma
• lupus
• rheumatoid arthritis
• Sjogren’s syndrome
• cholesterol-clogged arteries (atherosclerosis)
• carpal tunnel syndrome

Taking certain medications can also trigger Raynaud’s. Culprits include beta blockers, some migraine medications, attention-deficit/hyperactivity disorder medications, some chemotherapy agents, and over-the-counter cold medications that constrict blood vessels.

Coping with Raynaud’s

Prevention is the best medicine for Raynaud’s. I try to stay out of the cold, and bundle up when I go out. Keeping the whole body warm—and that includes the head—can help prevent blood vessels in your skin from constricting. I wear insulated gloves when I go outside, and use fingerless gloves when I work inside. You can now buy battery-powered gloves for outdoors and gloves powered by USB cables for typing. For some people, reaching into a refrigerator or freezer without gloves is enough to provoke an attack. Air conditioning can do it for others.

It’s possible to cut an attack short by running your hands under warm water or waving your arms in circles to get the blood flowing. Reusable gel warming packets are another option.

Some people get Raynaud’s attacks when they feel stressed. For them, relaxation techniques can help prevent or halt stress-induced episodes.

Another treatment option that works for some people is thermal biofeedback. This technique uses sensors placed on the fingers that feed temperature information to a video screen. While connected, you use relaxation and other techniques to try to warm your fingers, aided by feedback from the sensors. When you are having an attack, you can then “think” your fingers warm.

Some people, usually those with secondary Raynaud’s, may need to take a medication to prevent or control attacks. Drugs that dilate blood vessels such as calcium-channel blockers are often effective. An ongoing clinical trial is exploring whether taking sildenafil (Viagra) can prevent attacks. This makes sense, because sildenafil started out as an artery-opening blood pressure drug; it works to create erections by opening arteries in the penis. Botox injections are another possible option.

 How Raynaud’s progresses

In a Raynaud’s attack, fingers turn white (A) as small arteries in the fingers (arterioles) tighten, restricting the flow of blood to the skin. As oxygen in the blood is depleted, the fingers turn blue (B) and become painful. Eventually, the arterioles relax, and blood once again enters the fingers, warming the skin and turning it red (C).