Vascular Disease Vascular Disease Basics

The Cold Facts About Seriously Cold Hands

For example, Raynaud's occurs in almost everybody with scleroderma, a chronic connective tissue disease. So, while some people just have Raynaud's syndrome alone with mild symptoms when they get very cold, in people with scleroderma the Raynaud's can be so severe that they develop injury to the tips of their fingers from the lack of blood flow. It becomes such a profound lack of blood supply that they actually can get ulcerations on the fingertips or even autoamputation (detachment) of the digits. In these patients with scleroderma and Raynaud's, the changes to the blood vessels can be seen; there's a thickening of the blood vessels which causes less room for the blood to flow.

How is Raynaud's diagnosed?
Raynaud's is really a clinical description. The only way to diagnose Raynaud's is by getting a good history from the patient and asking them to describe what happens to their hands. If the patient says, "Doctor, on cold exposure or during a stressful situation, my hands turn white and maybe little bluish," it's really just that description that would allow the doctor to diagnose Raynaud's.

Sometimes we'll just see it happen right in front of us. A patient gets nervous as a new doctor walks into the room, or they're in a cold exam room, and it will precipitate Raynaud's, so the doctor can observe it there.

How is the severity of the symptoms determined?
The severity would be determined by how much it bothers the patient, and how much it interferes with their daily life. That really depends on the individual patient and daily demands.

For example, I had a young woman who was a surgical resident and would go into the cold operating room and have the symptoms of Raynaud's there. It really wasn't necessarily a more severe form of Raynaud's than maybe somebody else's, but it interfered with her life more.

I would say it's significant if people are developing attacks where the white phase lasts more than 15 minutes. That really raises a flag that it might be serious Raynaud's, because during that white phase the fingers are not getting blood. That person is probably at higher risk for actually having injury to the tissues in their fingers or feet (but more often fingers) from the Raynaud's. This prolonged white phase signals more serious Raynaud's, and also would make me delve more deeply into whether this might be Raynaud's in the context of a more serious autoimmune or connective tissue disease like scleroderma.

What other diseases are associated with Raynaud's phenomena?
We seem to find that patients with autoimmune diseases have a higher frequency of Raynaud's than the general population. Scleroderma has the strongest association. In phospholipid syndrome, a person has certain blood proteins that predispose them to sluggish blood flow or blood clots that may show up as Raynaud's. We also see Raynaud's in patients with lupus.

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