What is Raynaud's Phenomenon?
Raynaud's phenomenon is a spasm of the small arteries in the fingers and toes, triggered by cold or emotional stress, causing them to turn white, then blue, then red as blood returns. Most cases are primary and harmless. A minority are the first sign of an autoimmune disease, and nail fold capillaroscopy is the test that tells them apart.
Also called: Raynaud's disease, Raynaud's syndrome
Who gets Raynaud's Phenomenon?
Primary Raynaud's affects up to one in ten people, more often women, and usually begins in the teens or twenties with a family history. Secondary Raynaud's begins later — typically after 30 — is often asymmetrical or more severe, and occurs in systemic sclerosis, lupus, mixed connective tissue disease, dermatomyositis and Sjögren's syndrome. It can also be caused by certain medicines, vibrating tools and smoking.
What are the symptoms of Raynaud's Phenomenon?
Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:
- Fingers or toes turning sharply white on cold exposure, with a clear border
- A blue phase as oxygen is used up, then red and painful as blood returns
- Numbness, tingling or burning during an attack
- Triggered by cold air, cold water, air conditioning, or emotional stress
- Attacks lasting minutes to an hour
- In secondary disease: sores or pits at the fingertips, thickened or puffy skin, or changes affecting only some digits
How is Raynaud's Phenomenon diagnosed?
The history usually establishes that this is Raynaud's. The important question is which type.
Nail fold capillaroscopy is the key test — painless, five minutes, no needles. A normal pattern strongly supports primary Raynaud's. Enlarged, giant or missing capillaries point to a connective tissue disease.
ANA and specific antibodies (anti-centromere, anti-Scl-70) are checked. Inflammatory markers and a full examination look for other features.
Features that raise concern: onset after 30, asymmetry, fingertip ulcers, abnormal capillaroscopy, positive antibodies, or associated symptoms such as reflux, dry eyes, joint pain or breathlessness.
How is Raynaud's Phenomenon treated?
For primary Raynaud's, non-drug measures are usually enough: keeping the whole body warm rather than just the hands, gloves before going out rather than after the fingers turn white, hand warmers, and stopping smoking. Beta-blockers and decongestants can worsen it and may be switched.
Where attacks are frequent or painful, a calcium channel blocker such as nifedipine is the usual first medicine.
For severe secondary Raynaud's with ulcers: PDE5 inhibitors, topical nitrates, intravenous iloprost, and bosentan to prevent new ulcers. Any fingertip ulcer needs prompt assessment because infection and tissue loss can follow quickly.
Living with Raynaud's Phenomenon
Primary Raynaud's is a nuisance rather than a danger and does not damage the fingers. Practical adaptation — warm layers, gloves in air conditioning, avoiding cold drinks and frozen food handling — controls most attacks. Anyone with secondary Raynaud's is monitored for the underlying disease, since capillaroscopy findings can precede other features by years.
When should you see a rheumatologist?
Raynaud's starting after the age of 30, affecting fingers unevenly, causing fingertip sores, or occurring with joint pain, dryness, reflux, rashes or breathlessness should be assessed with capillaroscopy and antibody testing.
Common questions about Raynaud's Phenomenon
Is Raynaud's dangerous?
Primary Raynaud's is not — it is uncomfortable but causes no tissue damage. Secondary Raynaud's, associated with an autoimmune disease, can cause fingertip ulcers and needs both treatment and monitoring of the underlying condition.
How do I know which type I have?
Nail fold capillaroscopy plus antibody testing. A normal capillary pattern with negative antibodies in someone whose symptoms started young is strongly reassuring.
What is the quickest way to stop an attack?
Warm the whole body, not just the hands — put on a jumper, move to a warm room, run the hands under warm (not hot) water, and rotate the arms to encourage blood flow. Prevention works better than treatment: put gloves on before going out into the cold.
Can medicines cause Raynaud's?
Yes. Beta-blockers, some migraine medicines, decongestants and certain chemotherapy drugs can cause or worsen it. Reviewing your medication list is part of the assessment.
This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.