Symptoms

Raynaud's syndrome is classically characterised by a change in the colour of the extremities, often the fingers or fingertips. This colour change occurs in three phases:

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1. initially the finger turns white. This is known as the ischaemic phase.
2. in the second phase, the skin can turn blue-purple because the blood flow slows down. This is also known as the deoxygenation phase.
3. in the last phase, the tissue is better supplied with blood again. This is characterised by reddening of the fingers or fingertips. This is also known as the reperfusion phase [4,5].

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This sequence of colours is also known as the tricolour phenomenon.Typical seizures can last less than an hour or several hours. They may also be accompanied by pain or motor impairment.

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Primary and secondary Raynaud's syndrome

A distinction is made between primary and secondary Raynaud's syndrome.

Primary Raynaud's syndrome** occurs as a stand-alone syndrome that is usually triggered by cold or stress [5].

The cause of primary primary Raynaud's syndrome has not yet been conclusively explained. Recent studies assume that genetic factors may explain circulatory disorders in Raynaud's syndrome [6]. Circulatory disorder means that blood vessels are not supplied with blood over a longer period of time, which causes the symptoms of Raynaud's syndrome.

In its primary form, Raynaud's syndrome can therefore be a harmless circulatory disorder. It is not caused by another underlying disease.

Raynaud's syndrome is referred to as secondary Raynaud's syndrome, **** if it occurs as a concomitant symptom of other causes. These are often rheumatic diseases such as

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• Rheumatoid arthritis
• Scleroderma
• Sjörgen syndrome
• Lupus erythematosus
• Polymyositis
• Vascular diseases, e.g. arteriosclerosis
• Trauma or overloading

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More rarely, medication (e.g. beta blockers, cytostatics) or toxins can also trigger the symptoms.

In secondary Raynaud's syndrome, pain in the extremities is the main symptom [3].

As a secondary form, however, it can also be a sign of an underlying disease. For this reason, a doctor should always clarify which form of the syndrome is involved.

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Diagnostics

There is no specific Raynaud's syndrome test. Typically, treating physicians first ask about the symptoms. This includes

• Unusual sensitivity to cold in the fingers
• colour changes in the fingers at cold temperatures and
• whitish and/or bluish colour changes in the limbs

A physical examination of the hands and feet and a blood test can also be carried out to clarify the causes. Blood tests can be used to detect autoantibodies in the blood, for example, which may indicate an autoimmune disease as the cause. These include, for example, testing for rheumatoid factors and CCP antibodies.

If a connective tissue disease is suspected, a so-called capillary microscopy can be performed. This examines the small blood vessels (capillaries) in order to recognise any structural changes.

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Therapy

The treatment of Raynaud's syndrome depends on the cause and the severity of the symptoms.

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Treatment of primary Raynaud's syndrome

If the syndrome only occurs rarely or is not perceived as a burden, cold protection measures are generally recommended as a preventative measure. This means protecting yourself from the cold, wet and wind with gloves and pocket warmers, for example. Avoiding specific triggers, such as stress, can also be helpful.

For more severe symptoms, medication can be used to dilate the blood vessels and thus improve circulation. These are, for example, so-called calcium channel blockers.

Drug therapy should always be carried out in close consultation with the treating doctor.

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Treatment of secondary Raynaud's syndrome

Secondary Raynaud's syndrome may require more intensive and specialised treatment.

This will depend on the underlying condition causing the Raynaud's syndrome and the severity of the symptoms. Treatments should be discussed with the practitioner.

If medication is taken under medical supervision, it is advisable to record the progress and course over time.

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Raynaud's diary

A symptom diary describes the regular, structured recording of symptoms. It should document which symptom occurs where and when. These structured records help those affected and, if necessary, those treating them to develop a better understanding of symptoms and influencing factors.

A symptom diary can also help to better assess the success of a therapy.Factors that can be included in a Raynaud's diary are

• Occurrence of symptoms
  When do symptoms occur (e.g. feeling cold, skin discolouration)? How long do symptoms last? A subjective assessment of symptom severity on a scale of 1-10 can also be helpful.‍
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• Influencing factors
  e.g. How high is the current stress level? How hot or cold is it? What medication are you taking? Have there been any medication changes?‍
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• Phases of improvement and deterioration
  How does a symptom change compared to e.g. yesterday?