What is Raynaud's Syndrome?

Raynaud's syndrome develops as a result of the contraction of blood vessels, leading to episodes in the extremities and is characterized by the interruption of blood flow. In Raynaud's syndrome, which generally requires the use of vasodilator medications for treatment, blood flow to structures such as the fingers or toes, ears, and nose can be disrupted. This condition, which occurs in episodes, is defined as vasospasm. Raynaud's syndrome is classified into two groups: primary (or idiopathic) and secondary. In primary Raynaud's syndrome, there is no underlying condition causing the episodes, whereas in the secondary form, attacks can occur due to conditions such as arthritis, frostbite, or various autoimmune diseases. You can follow the continuation of the text for more information about other topics related to Raynaud's syndrome.

What is Raynaud's Syndrome?

Raynaud's syndrome describes the phenomenon where there is a color change, primarily to blue or white, in the fingers or toes of the patient, followed by a bright red color. This color change occurs due to the contraction of small blood vessels in the hands and feet and can last for a time period ranging from a few seconds to hours. Episodes generally last about 15 minutes on average (2).

What are the Types of Raynaud's Syndrome?

Raynaud's syndrome is classified into two types: primary and secondary. Primary Raynaud's syndrome accounts for approximately 80-90% of individuals diagnosed with Raynaud's syndrome. Patients in the primary group do not have any underlying condition that could cause the syndrome, thus it is also described as idiopathic.

In secondary Raynaud's syndrome, the contraction of blood vessels occurs due to a specific underlying medical condition. Therefore, the underlying condition must be identified and treated first for effective management. Some conditions that can cause secondary Raynaud's syndrome include:

• Connective tissue diseases
• Peripheral artery diseases
• Carpal tunnel syndrome
• Repetitive movements over a long period
• Prolonged exposure to vibrations
• Tobacco use
• Trauma to the hands and feet

What are the Causes of Raynaud's Syndrome?

The exact cause of Raynaud's syndrome is not currently well understood. Generally, it is observed that the blood vessels in the hands and feet are extremely sensitive to cold and stress in individuals with this condition. When exposed to cold or stress, the blood vessels in the fingers and toes of those with Raynaud's syndrome can constrict. In some cases, certain blood vessels can constrict so strongly that they prevent blood flow altogether. Exposure to cold is among the strongest triggers for episodes.

What are the Triggers of Raynaud's Syndrome?

Raynaud's attacks may not always be predictable; however, it is advisable to avoid the following factors that can trigger episodes in this condition:

• Going outside in cold weather
• Contact of the hands with cold water
• Holding a cold drink
• Exposure to various stressors, particularly emotional stress

What are the Symptoms of Raynaud's Syndrome?

The symptoms associated with Raynaud's syndrome can be imperceptible in some individuals, while in others, they can significantly impair quality of life. Generally, it is observed that the hands are affected in most cases, while approximately 40% of cases involve the toes (2). The symptoms that arise after the vasoconstriction, a type of blood vessel contraction, in the fingers of individuals with Raynaud's syndrome can be described step by step as follows:

1. Initially, the fingers exhibit “pallor,” or whiteness.
2. Due to the interruption of blood flow and deprivation of nutrients and oxygen, the fingers take on a cyanotic blue color.
3. With the re-expansion of the blood vessels and return of blood flow, the fingers exhibit a bright red color known as “rubor.”
4. During the color change, tingling, swelling, and pain may occur in the fingers.
5. These symptoms can affect one or more fingers, but involvement of the thumbs is rare.

How is Raynaud's Syndrome Diagnosed?

As with any medical condition, the diagnostic approach for Raynaud's syndrome begins with obtaining the patient's medical history and evaluating physical examination findings. Following these stages, various tests may be ordered by the physician.

A test known as nail bed capillaroscopy is used to differentiate between the primary and secondary forms of Raynaud's syndrome. During this test, any abnormal findings, such as edema in the blood vessels at the base of the nail bed, are assessed using a microscope.

Various blood tests may be requested to identify underlying autoimmune or connective tissue diseases associated with Raynaud's syndrome.

• Antinuclear antibody test (ANA): A positive ANA test indicates that the individual's immune system is mistakenly attacking its own body tissues. This condition, known as an autoimmune reaction, can be positively detected in connective tissue diseases and autoimmune disorders.
• Erythrocyte sedimentation rate (ESR): This test examines the rate at which red blood cells settle at the bottom of a tube of blood. A high sedimentation rate may indicate an underlying inflammatory or autoimmune disease.

There are no specific tests that definitively confirm the presence of Raynaud's syndrome. In addition to the aforementioned tests, examinations may also be conducted to determine if there is any arterial disease present, if necessary.

How is Raynaud's Syndrome Treated?

Currently, there is no specific treatment method available for Raynaud's syndrome. The aim of the approaches implemented in the treatment plan is to help control the symptoms that occur during the disease. For individuals with moderate Raynaud's syndrome, preventing skin contact with cold air when transitioning from warm to cold environments is a beneficial approach. If an attack occurs, submerging the hands or feet in warm water that is not too hot can have a preventive effect on worsening symptoms. In cases where stress is a triggering factor, stress management techniques are recommended.

For individuals with severe Raynaud's syndrome, various medications may be prescribed by physicians. Some of these medications include:

• Alpha-1 blockers
• Dihydropyridine derivative calcium channel blockers
• Topical creams containing nitroglycerin
• Various other vasodilator (blood vessel dilating) medications

In cases where medication treatment does not adequately control symptoms, more invasive interventions may be considered. The blood vessel contractions that occur in Raynaud's syndrome are controlled by sympathetic nerve cells in that area. Although surgically separating the nerve cells from the blood vessels can reduce the frequency and severity of attacks, it should be noted that this procedure does not always yield successful results.

Blocking sympathetic activation can also be achieved through various chemical injections. Local anesthetic or Botox injections in this context have been found to be beneficial for some individuals. However, it should be remembered that the benefits provided by these agents are temporary.

What Should People with Raynaud's Syndrome Pay Attention To?

In individuals with Raynaud's syndrome, attacks can develop over a variable duration ranging from a few minutes to several hours. Various measures can be taken, under the guidance and advice of your physicians, to prevent attacks:

• Avoiding caffeine
• Wearing protective clothing and equipment against cold exposure
• Not using tobacco and tobacco products
• Engaging in regular exercise
• Learning stress management techniques

The course of the syndrome in individuals with Raynaud's can vary depending on their overall health condition. Generally, the secondary form tends to have a more severe course than primary Raynaud's syndrome. Individuals with secondary Raynaud's syndrome are generally more susceptible to infections, skin ulcers, and gangrene. If you observe symptoms and signs of this condition in yourself or those around you, it is recommended to seek support from healthcare institutions. Wishing you healthy days ahead.