Raynaud's Disease

Introduction

What should I know about Raynaud's Disease?

Raynaud's Disease has been around for over 100 years and yet we still have little information about what to do with it. In 1862, Maurice Raynaud described episodes of discoloration of the skin of the digits on exposure to cold, and he thought this was due to increased sensitivity of the sympathetic nervous system. This condition, which is limited to the skin, came to be termed Raynaud’s disease. (1)

An episode typically begins when one or more of the digits appear white as the individual is exposed to a cold environment or touches a cold object. This changing of color of the skin is considered to be the phase when the blood supply to the digits becomes deficient. This is caused by vasospasms, or spasms of the blood vessels that lead to the affected area. After the discoloration, the sensation of cold and sometimes numbness follows. If the affected digit is again warmed, then the blood supply returns to the area. Sometimes this is painful and there is a throbbing sensation.

This series of events is referred to as Raynaud's Phenomenon. The name changes to Raynaud's Disease when other causes of the symptoms are ruled out. Over 50 percent of people with Raynaud’s phenomenon have Raynaud’s disease. Women are affected about five times more often than men, and the age of presentation is usually between 20 and 40 years. (2) One interesting group of people with Raynaud’s symptoms comprises those whose occupations involve routine use of vibratory equipment, or frequent exposure to cold temperatures. From 40 to 90 percent of loggers and 50 percent of miners using vibratory equipment have been diagnosed with Raynaud’s disease. Heredity may also play a role in the development of this disease. (3) Frequency also seems to be increased in pianists and typists, and electric shock injury or frostbite may also predispose a later development of Raynaud’s phenomenon. Raynaud’s phenomenon occurs in 80-90 percent of patients with systemic sclerosis (scleroderma) and is the presenting symptom in 30 percent. It may be the only symptom of scleroderma for many years. (4)

Other causes of secondary Raynaud’s phenomenon include atherosclerosis of the extremities (frequently seen in men over age 50), collagen vascular diseases, arterial occlusive diseases, pulmonary hypertension, neurogenic lesions such as carpal tunnel syndrome, and certain blood diseases.

Statistic

Raynaud’s and Scleroderma Association, 2005.

  • Raynaud’s disease affects between 3-20% of the adult population worldwide.

The National Arthritis and Musculoskeletal and Skin Diseases Information Clearing House(NAMSIC)/ National Institutes of Health, 1997.

    Although estimates vary, recent surveys show that Raynaud's phenomenon may affect 5 to 10 percent of the general population in the United States. Women are more likely than men to have the disorder. Raynaud's phenomenon appears to be more common in people who live in colder climates. People with the disorder who live in milder climates may have more attacks during periods of colder weather. Approximately 75 percent of all cases are diagnosed in women who are between 15 and 40 years old.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

Raynaud's disease causes the fingers to turn white or pale looking when touching a cold object, or when going outside into the cold. Sometimes fingers may look bluish in color and may feel cold, numb, or have a tingling feeling. As fingers are rewarmed the color changes to bright red. A throbbing or burning feeling may happen as the fingers are rewarmed. The symptoms usually exist for at least 2 years and occur without being caused by any diagnosable disease.

General

  • Fingers turn white or pale looking when touching a cold object, or when going outside into the cold
  • Sometimes fingers may look bluish in color and may feel cold, numb, or have a tingling feeling
  • As fingers are rewarmed, color changes to bright red

Treatment Options

Conventional

For the majority of people with primary Raynaud’s disease, or secondary Raynaud’s phenomenon, conservative measures are all that may be necessary. The most important of which are avoidance of cold temperatures, tobacco, emotional situations, and certain drugs. These individuals should dress warmly and use lined gloves if they must go out in the cold. They should protect the trunk, head, and feet with warm clothing to prevent additional complications. Drug treatment should be reserved for severe cases.

Nutritional Suplementation


Magnesium

One study reported that women with primary Raynaud’s phenomenon have lower magnesium levels than healthy individuals during the winter months, which is the time when the symptoms of this condition are likely to be worse. (5)


Antioxidant Nutrients

One study reported that patients with Raynaud’s disease had lower levels of vitamin C and selenium compared to the healthy control group. (6) Since inadequate levels of antioxidant nutrients increases the risk of oxidative tissue damage, using antioxidants may lessen the damage associated with Raynaud's.


Vitamin B3

Niacin in the form of inositol nicotinate, provides mild vasodilation effects, which can provide some symptomatic improvement in individuals with Raynaud’s disease. (7) , (8) However, it has been suggested that the benefits from inositol nicotinate are not solely the result of vasodilation. (9) The results of another study reported that continuous long-term therapy for 9 months provided greater improvements in peripheral circulation compared to the benefits obtained in short-term therapy. (10)


Folic Acid, Vitamin B6

A study has reported that individuals with Raynaud’s disease have homocysteine levels that are substantially higher compared to those who do not. (11) Elevated homocysteine can lead to other problems which could affect the circulatory system. It is well documented that folic acid, vitamin B6, and vitamin B12 are required to metabolize homocysteine.


Omega-3 Fatty Acids

Omega-3 fatty acids are known to have beneficial effects on aspects of coagulation and circulation. These beneficial effects could be therapeutically useful to someone with Raynaud’s disease. To study this possibility, a group of patients with Raynaud’s disease were instructed to take either 12 fish oil capsules daily, containing 3.96 grams of EPA and 2.64 grams of DHA or 12 placebo capsules containing olive-oil. After initial baseline measurements, progress was assessed after 6, 12, and 17 weeks of therapy. Consumption of the omega-3 fatty acids provided substantial increases in the time interval before the onset of Raynaud's episodes and improved tolerance to cold. (12) These results suggest that supplementation with omega-3 fatty acids from fish oils can be an important part of therapy programs for Raynaud’s disease.


Arginine

Arginine is a precursor for the production of nitric oxide in humans. Because nitric oxide is a vasodilator, it helps to improve blood supply and oxygenation to tissues. (13) This relationship between arginine and nitric oxide explains why arginine is sometimes recommended as a natural product in the treatment of Raynaud’s syndrome. (14) However, some studies have reported that arginine supplementation does not result in improved digital circulation. (15) , (16)

Herbal Suplementation


Hawthorn

Hawthorn is used as a vasodilator and circulatory stimulant. (17) It has been used extensively by doctors in Europe in its standardized form in various cardiovascular and circulatory conditions. Studies have reported a reduction in blood pressure due to arteriosclerosis and chronic nephritis with the use of hawthorn. (18) It is also used for peripheral vascular diseases, such as Raynaud’s disease.


Ginkgo

Ginkgo is among the oldest living species on earth and has been used extensively as a medicinal agent worldwide for centuries, and is the most frequently prescribed medicinal herb in Europe. The most dramatic benefits are reported in improving circulation in the elderly. (19) , (20) Ginkgo may foster vasodilation. (21) It may also stimulate venous tone. (22) Gingko reportedly acts as a tonic for the circulatory system.


Grape Seed Extract

Proanthocyanidins (PCO's), the active constituent in grape seed, are a flavonoid-rich compound which are being heavily touted as some of the most potent free radical scavengers to date. They have been reported to enhance the absorption of and work synergistically with vitamin C. (23) PCO's have been reported to inhibit the release of mediators of inflammation, such as histamine and prostaglandins, and for protection of the microvascular system. (24) , (25)


Cayenne

Cayenne pepper (chili pepper) has been used as a spice for foods in many cultures and as a traditional medicine for centuries, especially with the Native American culture. It has been used historically to treat asthma, pneumonia, diarrhea, cramps, toothache, flatulent dyspepsia without inflammation, and peripheral circulation insufficiency. (26) Externally, topical preparations of capsicum oleoresin (0.25-0.75%) is used for pain associated with arthritis, rheumatism and cold injuries. Taken orally, capsicum has been reported to increase peripheral circulation and improve digestion.

References

  1. Talbert RL. Peripheral Vascular Disease. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 4th ed. Stamford, CT: Appleton & Lange; 1999:383-387.
  2. Creager MA, Dzau VJ. Vascular diseases of the extremities. In: Fauci AS, Braunwald E. Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998:1401-1402.
  3. Coffman JD. The diagnosis of Raynaud’s phenomenon. Clin Dermatol. 1994;12:283-289.
  4. Creager MA, Dzau VJ. Vascular diseases of the extremities. In: Fauci AS, Braunwald E. Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998:1401-1402.
  5. View Abstract: Leppert J, et al. The concentration of magnesium in erythrocytes in female patients with primary Raynaud's phenomenon; fluctuation with the time of year. Angiology. Apr1994;45(4):283-8.
  6. View Abstract: Herrick AL, et al. Micronutrient antioxidant status in patients with primary Raynaud's phenomenon and systemic sclerosis. J Rheumatol. Aug1994;21(8):1477-83.
  7. View Abstract: Belch JJ, Ho M. Pharmacotherapy of Raynaud's phenomenon. Drugs. Nov1996;52(5):682-95.
  8. View Abstract: Belch JJ, Ho M. Pharmacotherapy of Raynaud's phenomenon. Drugs. Nov1996;52(5):682-95.
  9. View Abstract: Holti G. An experimentally controlled evaluation of the effect of inositol nicotinate upon the digital blood flow in patients with Raynaud's phenomenon. J Int Med Res. 1979;7(6):473-83.
  10. View Abstract: Ring EF, Bacon PA. Quantitative thermographic assessment of inositol nicotinate therapy in Raynaud's phenomena. J Int Med Res. 1977;5(4):217-22.
  11. View Abstract: Levy Y, et al. Elevated homocysteine levels in patients with Raynaud's syndrome. J Rheumatol. Nov1999;26(11):2383-5.
  12. View Abstract: DiGiacomo RA, et al. Fish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study. Am J Med. Feb1989;86(2):158-64.
  13. View Abstract: Morikawa E, at al. L-arginine infusion promotes nitric oxide-dependent vasodilation, increases regional cerebral blood flow, and reduces infarction volume in the rat. Stroke. Feb1994;25(2):429-35.
  14. View Abstract: Agostoni A, et al. L-arginine therapy in Raynaud's phenomenon? Int J Clin Lab Res. 1991;21(2):202-3.
  15. View Abstract: Khan F, Belch JJ. Skin blood flow in patients with systemic sclerosis and Raynaud's phenomenon: effects of oral L-arginine supplementation. J Rheumatol. Nov1999;26(11):2389-94.
  16. View Abstract: Kahn F, et al. Oral L-arginine supplementation and cutaneous vascular responses in patients with primary Raynaud's phenomenon. Arthritis Rheum. Feb1997;40(2):352-7.
  17. View Abstract: Petkov V. Plants and Hypotensive, Antiatheromatous and Coronarodilatating Action. Am J Chinese Med. 1979;7:197-236.
  18. Racz-Kotilla E, et al. Salidiuretic and Hypotensive Action of Ribes-Leaves. Planta Medica. 1980;29:110-14.
  19. View Abstract: Kleijnen J, et al. Ginkgo biloba for Cerebral Insufficiency. Br J Clin Pharm. 1992;34:352-58.
  20. Kleijnen J, et al. Ginkgo biloba. Lancet. 1992;340(8828):1136-39.
  21. View Abstract: Auguet M, et al. Effects of Ginkgo biloba on Arterial Smooth Muscle Responses to Vasoactive Stimuli. Gen Pharmacol. 1982;13(2):169-71.
  22. View Abstract: Bauer U. 6-Month Double-blind Randomised Clinical Trial of Ginkgo biloba Extract Versus Placebo in Two Parallel Groups in Patients Suffering from Peripheral Arterial Insufficiency. Arzneim-Forsch/Drug Res. 1984;34(6):716-20.
  23. Maffei Facino R, et al. Regeneration of Endogenous Antioxidants, Ascorbic Acid, Alpha Tocopherol, by the Oligomeric Procyanide Fraction of Vitus vinifera L:ESR Study. Boll Chim Farm. 1997;136(4):340-44.
  24. View Abstract: Maffei Facino R, et al. Procyanidines from Vitis vinifera Seeds Protect Rabbit Heart from Ischemia/Reperfusion Injury: Antioxidant Intervention and/or Iron and Copper Sequestering Ability. Planta Med. 1996;62(6):495-502.
  25. View Abstract: Maffei Facino R, et al. Free Radicals Scavenging Action and Anti-enzyme Activities of Procyanidines from Vitis vinifera. A Mechanism for Their Capillary Protective Action. Arzneim-Forsch/Drug Res. 1994;44(5):592-601.
  26. Newall CA, et al. Herbal Medicines: A Guide for Health Care Professionals. London: The Pharmaceutical Press; 1996:28-30.