History Symptoms Prevalence Epidemiology Raynauds? Treatment References

Raynauds treatment

Treatment options are dependent on the type of Raynaud's present. Raynaud's syndrome is treated primarily by addressing the underlying cause, but includes all options for Raynaud's disease as well. Treatment of primary Raynaud's focuses on avoiding triggers.

General care of Raynauds

  • A patient should avoid environmental triggers, e.g. cold, vibration, etc. Emotional stress is another recognized trigger; although the various sources of stress can not all be avoided, it is possible to learn healthier, more effective ways of dealing with them, which will reduce stress and its damaging physical effects.
  • A patient should keep his/her hands, feet and head warm—especially fingers, toes, ears, and nose — by wearing mittens, insulated footwear, a ski mask; or using hand and foot warmers, etc.
  • The patient must never smoke.
  • The patient must decrease the consumption of caffeine and other stimulants and vasoconstrictors. Caffeine is found not only in coffee and tea, stay-awake pills, soft drinks, and candies, but also in some cosmetics, soaps, and shampoos(shower shock caffeinated bar and alpecin shampoo).
  • Hormones and drugs that regulate hormones, such as hormonal contraception may aggravate Raynaud's. Contraception which is low in estrogen is preferable, and the progesterone only pill is often prescribed for women with Raynaud's.
  • Calcium channel blockers can be helpful for the treatment of Raynaud's phenomenon.

Emergency measures

  • If white finger (Raynaud's) occurs unexpectedly and a source of warm water is available, allow tepid to slightly warm water to run over the affected digits while you gently massage the area. Continue this process until the white area returns to its normal, healthy color.
  • If triggered by exposure in a cold environment, and no warm water is available, place the affected digits in a warm body cavity - arm pit, crotch, or even in the mouth. Keep the affected area warm at least until the whiteness returns to its normal, healthy color. Get out of the cold as soon as possible.
  • A useful method exists to take measures ensuring circulation is restored quickly, though this should not be attempted if other circulatory issues are present that disallow fast or vigorous movement. This method is achieved by "windmilling" the arms (swinging them in large circles) reasonably fast to force the blood to the hands and fingers. This can cause dizziness, so it should be attempted only for a short time before stopping for a minute and subsequently continuing. A less effective (but less conspicuous) variation is to swing the arms back and forth in a part of a circle to achieve the same results. This variation does take longer, though, and requires swifter movement of the arms, so it is advised to use the first variation if possible.
  • Keep heated clothing handy, with charged batteries, for emergency use.

Drug therapy

  • Treatment for Raynaud's phenomenon may include prescription medicines that dilate blood vessels, such as calcium channel blockers (nifedipine) or diltiazem. It has the usual common side effects of headache, flushing, and ankle edema; but these are not typically of sufficient severity to require cessation of treatment.
  • There is some evidence that Angiotensin II receptor antagonists (often Losartan) reduce frequency and severity of attacks, and possibly better than nifedipine.
  • Alpha-1 adrenergic blockers such as prazosin can be used to control Raynaud's vasospasms under supervision of a health care provider.
  • In a study published in the November 8, 2005 issue of Circulation, sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilatory therapy. The authors, led by Dr Roland Fries (Gotthard-Schettler-Klinik, Bad Schönborn, Germany), report: "In the present study, capillary blood flow was severely impaired and sometimes hardly detectable in patients with Raynaud's phenomenon. Sildenafil led to a more than 400% increase of flow velocity."
  • Fluoxetine, a selective serotonin reuptake inhibitor, and other antidepressant medications may reduce the frequency and severity of episodes if caused mainly by psychological stress.
  • RayVa is a topical cream for the treatment of Raynaud's phenomenon. It contains prostaglandin E1 as the active ingredient and a permeation enhancer DDAIP which facilitates the delivery of the drug into the blood stream.

Surgical Intervention

  • In severe cases, a sympathectomy[18] procedure can be performed. Here, the nerves that signal the blood vessels of the fingertips to constrict are surgically cut. Microvascular surgery of the affected areas is another possible therapy. Infusions of prostaglandins, e.g. prostacyclin, may be tried, with amputation in exceptionally severe cases.
  • A more recent treatment for severe Raynaud's is the use of Botox. The 2009 article[19] studied 19 patients ranging in age from 15 to 72 years with severe Raynaud's phenomenon of which 16 patients (84%) reported pain reduction at rest. 13 patients reported immediate pain relief, 3 more had gradual pain reduction over 1–2 months. All 13 patients with chronic finger ulcers healed within 60 days. Only 21% of the patients required repeated injections. A 2007 article[20] describes similar improvement in a series of 11 patients. All patients had significant relief of pain.

Alternative and Experimental (Research) Approaches

  • The Ayurvedic oil preparation Mahanarayan Oil has been used very successfully in many cases as a vasodilater when applied daily to affected areas.
  • The extract of the Ginkgo biloba leaves (Egb 761, 80 mg) may reduce frequency of attacks.
  • Two separate gels combined on the fingertip (somewhat like two-part epoxy, they cannot be combined before use because they will react) increased blood flow in the fingertips by about three times. One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid. The milliliter of combined gel covered an area of ~3 cm². The gel was wiped off after a few seconds.
  • Piracetam, a nootropic drug, can be useful as a long-term treatment for vasospastic disorders.
  • Arginine, which increase nitric oxide acts as a vasodilator.[citation needed]
  • Milder cases of Raynaud's can often be addressed by biofeedback or other techniques to help control involuntary body functions like skin temperature.
  • Fish oil supplements which contain long-chain omega-3 fatty acids may help to control symptoms of primary Raynaud's. There are few studies in the medical literature dealing with this subject. However, in one 1989 controlled, double-blinded study of 32 patients, consumption of roughly 6.5 grams of long chain omega-3 fatty acids in the form of fish oil significantly increased the time to onset or entirely prevented symptoms in response to cold in patients with primary Raynaud's. Lower doses of fish oil such as may be commonly available from commercial vendors have not been studied and may not be as effective.

Mitigating Approaches

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