Fingers of the hands or feet, as well as the nose, lips and ears, which suddenly become pale first, then cyanotic, and finally warm again, but the patient may experience intense tingling, pain, a feeling of strong pulsation and even swelling. They might seem to be “harmless” demonstrations, triggered by the cold, which pass without any particular intervention.
“These are symptoms, more common in women, caused not only by the cold but also by stress – explains Professor Carlo Selmi, Head of Clinical Rheumatology and Immunology at the Humanitas Hospital and Professor at the University of Milan – which induce the blood vessels of the extremities to become vasoconstricted rapidly, reducing blood flow. Fingers that become cyanotic may be the expression of Raynaud’s primary disorder, not associated with other diseases or syndromes, or Raynaud’s secondary phenomenon, which is more rare and associated with different diseases. Usually, the disorders are not disabling, but in the most serious cases, they can lead to ulcers and tissue damage.
What are the causes?
“Although the mechanisms that lead to the typical sudden angiospastic seizures are not completely clear – continues Professor Selmi – nevertheless the disturbance and phenomenon have different symptom severity and causes. If the symptoms of Raynaud’s disorder are often so mild that the person, usually between 15 and 30 years, does not turn to a doctor for treatment, in the Raynaud phenomenon the seizures can be more serious. In this case, the symptoms, which arise around 40 years, may be secondary to various connective tissue diseases (systemic sclerosis, systemic lupus erythematosus, Sjogren’s syndrome), vascular diseases, a particular type of hypertension called primary pulmonary hypertension, carpal tunnel syndrome but also to some drugs, such as beta-blockers used in the treatment of hypertension, or some therapies used against migraine or some chemotherapies. Cigarette smoking habits, and activities involving vibrations, such as using a pneumatic hammer or playing the piano, can also cause illness, as can exposure to certain substances such as chloride vinyl, which is generally used to make PVC materials.
How is the diagnosis made?
“Capillaroscopy is the fundamental examination for the diagnosis of the Raynaud phenomenon; this examination allows us to see the morphology, that is the shape and structure of the capillary vessels, which carry blood to the extremities of the body affected by the Raynaud phenomenon,” continued Prof. Selmi.
The examination is non-invasive, but requires that the patient does not put any kind of nail polish on the nails, not even the transparent one, and does not perform manicures for 30 days before capillaroscopy. In addition to capillaroscopy, laboratory tests are carried out to identify the presence of autoimmunity, in particular ANA, anti-ENA, rheumatoid factor, and antibodies to native DNA.