February is Raynaud’s awareness month, and so we are shining the spotlight on this condition in our monthly blog. This condition is also highly topical, since we are still in the midst of winter, when many people first notice changes in their hands and feet in response to the cold weather.
The symptoms of Raynaud’s include a biting pain through the fingers and toes when exposed to the cold! Sometimes just one digit can be affected first, with more areas becoming affected over time. The pain is classically accompanied by a sequence of colour changes from pallor to deep blue to bright red. These symptoms are caused by blood vessel spasms which prevent normal blood flow, nutrients, heat and oxygen reaching the areas most affected.
The white colour commonly comes first as the spasm happens and is a result of ischaemia (lack of blood supply), with the blue phase happening due to deoxygenated blood and the red phase coming as blood starts to flow freely again. The pain and colour changes can take time to normalise, and it can be difficult to walk or use the hands/fingers when they are compromised by the cold. Emotional stress and medication or drug-use can also trigger Raynaud’s phenomenon. Having a thyroid condition can also increase the risk.
It is thought 5-20% of women and 4-14% of men may be affected by Raynaud’s at some point in their lives. However, rates do decline with ageing, such that for many, spontaneous remission can occur, perhaps in as many as half of people who have a diagnosis.
There are two types of Raynaud’s; Raynaud’s Disease (Primary Raynaud’s) and Raynaud’s Phenomenon (Secondary Raynaud’s)
Typically begins between the ages of 15 and 30. A benign condition that is typically seen throughout families and is more common in women. Blood tests usually show normal inflammatory markers and negative ANA (anti-nuclear antibodies). There are also no long-term effects from the changes e.g. pitting of nails or tissue changes such as ulceration.
Onset typically is seen over the age of 40 and more in males. There is greater risk of ulceration of the finger and toe tissue with changes to the nail and skin around the nails. This is due to increased capillary changes(capillaries are the small blood vessels at the extremities). Capillary damage is also more likely to be found in other auto-immune conditions such as scleroderma, myositis and other connective tissue diseases. In one study, around 25% of those with Raynaud’s phenomenon and a capillary abnormality developed scleroderma, 35% of those with scleroderma also had antibody presence and those with both an antibody and nail-fold capillary specific change comprised 80% of those with scleroderma.
Raynaud’s phenomenon is therefore frequently seen as the main presenting symptom pattern for several connective tissue conditions e.g. scleroderma and lupus. Around 13-20% of people who have it will goon to develop a connective tissue disease that is auto-immune in nature, so accessing a medical diagnosis can be important for many with Raynaud’s. Most health practitioners will write to a client’s GP when it is considered that a client may have symptoms of Raynaud’s, so that an underlying medical diagnosis is not missed.
The two questions GPs will typically ask are:
1. Are your fingers unusually sensitive to the cold?
2. Do your fingers change colour when they are exposed to cold temperatures?
GPs may also refer patients on for further tests such as testing to look at the tiny blood vessels in your nails. In the over 35s then further auto-immune testing will likely be considered.
We have known about Raynaud’s since 1862 when it was identified by Maurice Raynaud, but more than 150 years later we still don’t know all we need to know about it!
There is also a very personalised element to Raynaud’s with smoking, genetic factors and hormones playing their own part in severity and duration.
What can be done aside from speaking with a GP for further investigations? Avoiding the cold and very abrupt temperature changes is recommended. Smoking and caffeine should also be avoided, especially in the winter, as they can affect severity of symptoms.
Vasodilation support is key for Raynaud’s disease and for Raynaud’s phenomenon there may bean improved effect on symptoms by supporting this physiological pattern alone.
The following nutraceuticals and botanicals may be of benefit in patients with Raynaud’s:
· Gingko biloba (240 mg max a day through three doses) is a natural supplement that is a known vasodilator and supports nitric oxide levels.
· Vitamin D - 2,000 IU daily can also be considered as it is supportive of the immune system and levels have been found to be low in those with systemic sclerosis.
· Vitamin C - 500-1000 mg daily
· Vitamin E- 200-400 mg daily
· GLA – 320 mg daily (e.g. from starflower/borage or evening primrose oil, or from fish oils) - do not take for more than 3 months if you are getting no benefit
· Ginger - 200- 4000 mg daily – improves peripheral circulation
The supplements noted above should be avoided if you are taking blood-thinning medication e.g. warfarin/heparin.
Scleroderma is a group of rare diseases that involve the hardening and tightening of the skin and connective tissues.
Scleroderma affects women more often than men and most commonly occurs between the ages of30 and 50. While there is no cure for scleroderma, a variety of treatments can ease symptoms and improve quality of life.
There are many different types of scleroderma. In some people, scleroderma affects only the skin. But in many people, scleroderma also harms structures beyond the skin, such as blood vessels, internal organs and the digestive tract (systemic scleroderma). Signs and symptoms vary, depending on which type of scleroderma you have.
Lupus also called systemic lupus erythematosus (SLE) is a long-term condition that causes joint pain, skin rashes and tiredness. There's no cure, but symptoms can improve if treatment starts early and include:
· Joint and muscle pain
· Extreme tiredness that will not go away no matter how much you rest
· Rashes – often over the nose and cheeks
Patients might also have:
· Mouth sores
· High temperature
· Hair loss
· Sensitivity to light (causing rashes on uncovered skin)
Private laboratory tests that can be considered, alongside speaking with a GP to better understand wider auto-immunity risk, include; auto-immune antibody testing, intestinal permeability testing and thyroid testing.