November 10, 2021

Raynaud’s can be an early symptom of systemic sclerosis

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Here’s what to look for with this phenomenon and when to see a physician.

Raynaud’s is a condition that most often affects the blood vessels in the hands and feet, causing them to narrow, usually in response to cold or stress. Color changes of the affected areas are classic signs. And the change in color is often associated with pain, as well. Raynaud’s can occur by itself or as part of something else.

“Oftentimes people think this is just a normal way that their body acts,” says Tracy Frech, M.D., M.S., a rheumatologist at Vanderbilt Lung Institute. “However, it can be the very first sign of an autoimmune disease.”

What does Raynaud’s look like?

“I always tell patients,” Frech said, “that if they’re concerned their hands are painful and changing colors, they should look up an image of Raynaud’s to see if that’s what their fingers look like.”

Although anyone’s hands can appear a little discolored when cold, with Raynaud’s there’s usually a “cutoff” line. The affected area will at first look white, while the rest of the skin will remain its relatively normal color. Then the area will turn blue, followed by red as oxygen returns.

“That three-part color change is more easily visualized if the cold has touched the fingers,” she added. “But anything that would shunt blood away from the fingers to the central core can cause those same symptoms, including stress.”

Raynaud’s and connective tissue disease

If you suspect you have Raynaud’s, you should talk to your doctor about your symptoms, as it could be a sign of an underlying condition. “One of the first things a physician will do is look at the base of the fingernails where blood vessels come up and change direction,” Frech said.

If the blood vessels appear to be under stress when viewed under magnification, then Raynaud’s could be an early sign of an inflammatory connective tissue disease, such as systemic sclerosis (scleroderma), lupus, inflammatory myositis or another condition.

Frech said that if you have Raynaud’s to watch for these red flags: puffy hands or fingers or changes at the base of the fingernails that look like little red marks. Also keep an eye out for symptoms of connective tissue disease, such as significant morning stiffness, unexplained weight loss, joint pain or swelling. “If we see those,” Frech said, “then we recommend bloodwork, we work toward a diagnosis, and once you have a diagnosis, you can implement treatment for the underlying condition.”

Treatment and prevention for Raynaud’s

Low doses of calcium channel blockers that are used to treat high blood pressure can help relax the smooth muscles around the blood vessels to improve blood flow to the hand. People with low blood pressure may not be able to tolerate those medications, so sometimes selective serotonin re-uptake inhibitors (SSRIs) are prescribed instead. “We want to get patients on the right treatment,” Frech said, “so that the Raynaud’s episodes don’t occur and don’t cause pain and damage.”

In addition to medical treatment, patients should avoid stimulant medications, avoid smoking and keep themselves warm. “If you keep your core warm then the blood doesn’t want to shunt away from the hand,” Frech said. “A hat and vest can be very effective, in addition to gloves.” Plus, stress management techniques can also help if stress drives your Raynaud’s episodes.

The Vanderbilt Lung Institute brings together experts in diagnosing and treating lung disease from pulmonary medicine, thoracic surgery and allergy. This unique approach gives hope through coordinated, personalized and compassionate care for even the most complex conditions that affect the lungs and breathing.

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