As the cold weather returns, I warn my patients frequently about my cold hands. They’re cold during the summer, but much worse during the winter. Like many of my patients, I not only have cold hands, but I have Raynaud’s. When I’m out in the cold, touch a cold steering wheel, or sometimes walk through the freezer section in the supermarket, my fingertips turn white, sometimes blue, then a bit red and usually become painful. It’s considered quite common, as 3-5% of the general population has this phenomenon.
Raynaud’s is thought to be due to constriction of some of the artery to vein connections in the fingers, toes and tip of the nose. Many people have Raynaud’s as their only symptom, also called ‘primary Raynaud’s’. Less frequently, it is ‘secondary Raynaud’s’, as a result of vascular disease or a particular connective tissue disease, scleroderma. Up to half of people with primary Raynaud’s have a first-degree relative with the condition, suggesting that there is a genetic susceptibility. Factors that can worsen symptoms include cigarette smoking, and some medications that are prescribed for migraines and attention deficit- hyperactivity disorder.
As expected, avoidance of cold is the most effective therapy. Keeping the entire body warm with layered clothing, gloves and a hat or large scarf is important. Also, people prone to symptoms should avoid rapid temperature shifts in the summer, as in going from the heat to strong air conditioning. Once symptoms start, rubbing your hands together or running them under warm – NOT HOT – water is helpful. It is important to restore good blood flow to the fingers and toes. The extremities should recover in 15 minutes or less.
Stress management is helpful as well. Stress increases Raynaud’s symptoms by increasing the body’s ‘fight or flight’ response. In this setting, the rush of hormones that cause palpitations and sweating, also causes constriction of blood vessels and can cause the same symptoms as the cold does.
For most of those with Raynaud’s, simple avoidance of the cold is sufficient. In more severe cases, nifedipine, which is a blood pressure lowering agent that dilates blood vessels may be prescribed. Some people can’t tolerate it because it lowers the blood pressure too much. In that case, medications as diverse as sildenafil (Viagra), nitroglycerin, or fluoxetine (Prozac) can be considered, although I haven’t seen them used for this purpose. Research is ongoing for statins and other medications.
According to the article in a recent New England Journal of Medicine article, “There is little evidence to support the use of complementary forms of therapy such as biofeedback, acupuncture, laser therapy and herbal agents.”
For most, the best treatment may be investing in a good pair of gloves and a nice warm cover for your steering wheel. However, I’ve continued to opt out of some outdoor events in the winter, knowing they would be too painful. I’ve unsuccessfully tried gloves and mittens of all sorts, including ones with battery-powered heaters, as well as chemical packs that go between a glove liner and the gloves. Given the population statistics, we should have quite a few readers with Raynaud’s. I’ll gladly take any suggestions. I’m still looking …
Wigley, F, Flavahan, N. N Engl J Med 2016;375:556-65.