When the Diagnosis Is Raynaudʼs

Abstract

First, there is blanching as the result of a sudden vasospasm. Then cyanosis occurs, as hemoglobin releases oxygen to the tissues. Finally, the color changes to bright red as reactive hyperemia occurs. During these color changes the involved body parts-usually the fingers-are at first cold and numb; this is quickly followed by throbbing pain, tingling, and swelling. This sequence of events is Raynaud's phenomenon. The phenomenon may be secondary to various systemic disorders or, if no underlying cause is found, primary. When primary the disorder is called Raynaud's disease(1). In general, people with Raynaud's disease or phenomenon must learn to live with it. Attacks are intermittent and are usually triggered by cold, but can be triggered by emotional stress. Thus, people who have this peripheral vascular disorder must make adaptations in their lives that involve avoiding cold and cold things and reducing emotional stress. Health care providers can offer many practical suggestions to clients who are attempting to adjust to this, at best, inconvenient and, at worst, debilitating problem. The fact that there is both a Raynaud's disease and a Raynaud's phenomenon can lead to confusion, particularly since the two terms are often used interchangeably. Technically Raynaud's phenomenon is the broader term, with Raynaud's disease being its major cause. Other causes of Raynaud's phenomenon include the occlusive arterial diseases and the collagen diseases, notably scleroderma. Raynaud's phenomenon also occurs as a result of occupations that tend to traumatize the hands, for example, using a jackhammer and even typing or piano playing.(1). It is not always easy to differentiate between the disease and phenomenon, but, in general, Raynaud's disease occurs primarily in women, while the phenomenon is seen in both sexes. The onset of the disease can occur at any time between ages 18 and 40, but it usually begins in the teens or early twenties. The phenomenon tends to occur later, usually after age 30. In the isease the symptoms are usually bilateral and symmetrical, while in the phenomenon they may be unilateral and asymmetrical. When a person develops symptons-particularly after age 30-he may need to be followed for several years in order to determine whether the symptoms are primary or secondary. This is because signs of an underlying disorder may appear years later. For example, Raynaud's disease has preceded the diagnosis of scleroderma by 12 years(1).