Raynaud's Phenomenon
Also known as: Raynaud's Disease, Raynaud's Syndrome
Exaggerated blood vessel spasm in fingers and toes triggered by cold or stress, causing color changes and numbness. May be primary (benign) or secondary to autoimmune disease.
Key Facts
- Affects up to 5% of the population, more common in women and cold climates
- Primary Raynaud's is common and benign — no underlying disease
- Secondary Raynaud's can be the first sign of scleroderma, lupus, or other connective tissue disease
- Nailfold capillaroscopy can identify patients who need closer monitoring
- Digital ulcers in Raynaud's indicate more severe disease requiring aggressive treatment
What is Raynaud’s phenomenon?
Raynaud’s phenomenon is a condition in which blood vessels in the fingers and toes constrict excessively in response to cold temperatures or emotional stress. This vasospasm causes characteristic color changes — typically white (pallor), then blue (cyanosis), then red (reperfusion) — along with numbness, tingling, and sometimes pain.
Raynaud’s is classified as primary (occurring on its own, usually benign) or secondary (occurring alongside an autoimmune disease such as scleroderma, lupus, or mixed connective tissue disease). Secondary Raynaud’s can be more severe and may lead to digital ulcers or tissue damage.
Symptoms
- Color changes in fingers or toes with cold exposure or stress (white → blue → red)
- Numbness or tingling during episodes
- Pain or throbbing during reperfusion (warming)
- Episodes lasting minutes to hours
- In secondary Raynaud's: digital ulcers, skin thickening, or prolonged/severe episodes
How we diagnose it
- Clinical history — Characteristic episodic color changes with identifiable triggers
- Nailfold capillaroscopy — Microscopic examination of the small blood vessels at the base of the fingernail. Abnormal capillary patterns suggest secondary Raynaud's associated with autoimmune disease.
- Blood work — ANA, specific antibodies (anti-centromere, anti-Scl-70, anti-RNP), inflammatory markers to screen for underlying connective tissue disease
- The critical question — Is this primary or secondary? Primary Raynaud's is common and benign. Secondary Raynaud's may be the first sign of scleroderma or another autoimmune condition that requires monitoring.
How we treat it
- Avoidance of triggers — Keeping hands and core warm, minimizing cold exposure, avoiding vasoconstricting medications
- Calcium channel blockers — Nifedipine or amlodipine to relax blood vessel walls and reduce vasospasm
- Topical nitroglycerin — Applied to affected fingers for severe episodes
- PDE-5 inhibitors — Sildenafil for severe, refractory cases
- Treating underlying disease — If secondary to scleroderma or lupus, managing the autoimmune condition is essential
- Monitoring — Periodic reassessment for development of associated autoimmune disease, especially in younger patients with new-onset Raynaud's
At Synergy Rheumatology
Our priority with Raynaud's is determining whether it's primary or secondary — a distinction with significant implications. We perform nailfold capillaroscopy and targeted blood work to screen for underlying autoimmune disease, and monitor patients over time if risk factors are present.
Have questions about raynaud's phenomenon?
Schedule an appointment to discuss your symptoms, diagnosis, or treatment options with Dr. Fellows.