Raynaud's Phenomenon: An Overview

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Raynaud's Phenomenon: An Overview




Guest:  Dr. Edwin Smith – Rheumatology & Immunology

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Edwin Smith, who is Professor of Medicine in the division of Rheumatology here, at MUSC.  Dr. Smith, you have lots of different interests and one of them is Raynaud’s phenomenon.  Can you describe what that is?


Dr. Edwin Smith:  Raynaud’s phenomenon is color changes that people notice in their extremities, particularly the end part of their fingers or toes turning blue or very pale, usually when they get into a cold environment or there’s a change in temperature that they’re exposed to.  All that it really takes to have a diagnosis of Raynaud’s is a color change in the cold.


Dr. Linda Austin:  What causes this?


Dr. Edwin Smith:  It is caused by blood vessels.  When the fingertips go white, there is no blood in those fingertips.  The blood vessels have constricted, closed off, so there’s no blood flow to the fingertips.  The blue happens when the blood out there doesn’t have any oxygen in it.  So, there is blood in those fingers, but there’s no oxygen in that blood because the blood flow is so slow. 


Dr. Linda Austin:  Is it uncomfortable?


Dr. Edwin Smith:  It can be very painful.  It can cause numbness.  It can cause pain.  It can cause inability to function.


Dr. Linda Austin:  Now, we discussed, in another podcast, that this can be a warning sign for scleroderma, but that it’s not necessarily associated with scleroderma, correct?


Dr. Edwin Smith:  Most everybody who has scleroderma has Raynaud’s phenomenon.  However, the vast majority of people who have Raynaud’s do not have scleroderma, because, as we talked about previously, in that podcast, scleroderma is very unusual.  It’s, maybe 1 in 1000.  Whereas, we know, here, in South Carolina, that five percent of the population has Raynaud’s phenomenon.  Almost all of those people are completely healthy.  They do not have a connective tissue disease.


Dr. Linda Austin:  How do you go about treating this phenomenon?


Dr. Edwin Smith:  The main treatment for Raynaud’s phenomenon is to keep warm, to keep your body from losing heat.  That means, not just in the extremities, not just gloves and warm socks, but also scarves and sweaters and hats, because we lose a lot of the heat from our body through our head.  So, having a ski-type cap, if it’s cold, can be very helpful, keeping the temperature up in the house.  And, if you’re going to a really cold environment, the use can be of electric gloves, electric socks or boots.  There are also medicines that can be used to open up blood vessels, calcium channel blockers.  People might be familiar with Procardia (nifedipine) or Norvasc.  We know those things can be helpful too.


Dr. Linda Austin:  So, even though you feel it in your fingers and toes, it’s not just that the fingers and toes get cold.  The rest of your body gets cold.  In other words, could you be wearing gloves and socks, and so forth, and, if your head gets cold, you might still have the phenomenon occur?


Dr. Edwin Smith:  That is true, because our body’s response to getting cold is to decrease blood flow to the extremity parts, to our fingers and toes, to try to keep the blood flowing to our vital organs.  So, that’s a normal thing, but people with Raynaud’s have that to an exaggerated extent than others.  So, yes, any time you’re getting cold, it doesn’t mean you have to put your hand into the freezer to have Raynaud’s phenomenon.  A lot of my patients will say that one of the most inciting causes of this is to walk from outside into a grocery store or go to the frozen foods section of a grocery store, where it’s always cold.


Dr. Linda Austin:  Who gets Raynaud’s?


Dr. Edwin Smith:  It is more common among women than men, almost always, at least, people who are teenagers or older, but it can occur at any age. 


Dr. Linda Austin:  And, once you get it, do you have it for life?  Does it ever spontaneously go away?


Dr. Edwin Smith:  It can spontaneously go away.  The most common thing I’ve seen make it go away spontaneously is weight gain or pregnancy.  I’ve seen it happen in women who become pregnant, they don’t have Raynaud’s phenomenon but, once the baby’s born, the Rayaud’s phenomenon comes back.  I don’t know if that’s just because of the weight gain or there’s something about the blood vessels in pregnancy.


Dr. Linda Austin:  It sound is if, generally, this is not serious, but it can be a true annoyance and a very uncomfortable experience.


Dr. Edwin Smith:  It can be an annoyance.  And, we know that the most common times of day this happens to people are the commuting times, getting in the car in the cold to go to work and when you’re coming back, getting out and going into the car to get back home in the evening.  There are peaks of Raynaud’s phenomenon at those times. 


Dr. Linda Austin:  You mentioned that scleroderma can sometimes be heralded by Raynaud’s.  Is there anything that a person can do to make them less susceptible to getting scleroderma if they have Raynaud’s? 


Dr. Edwin Smith:  No.  There’s nothing we know about.


Dr. Linda Austin:  Nothing?  Dr. Smith, thanks so much for talking with us about this.


Dr. Edwin Smith:  You’re welcome, Dr. Austin.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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