Patient information · Rheumatology
Raynaud's phenomenon
usually harmless — but worth checking which kind you have
Raynaud's is exaggerated narrowing of small blood vessels in response to cold or stress, causing fingers or toes to change colour and go numb. Most cases are primary and benign. A minority are the first sign of an autoimmune condition, sometimes years before anything else appears.
Seek urgent assessment if you have
- an ulcer, sore or blackened area on a fingertip or toe
- an episode that will not resolve on rewarming
- severe pain with a persistently pale or blue digit
- Raynaud's affecting only one hand or one finger
- new onset over the age of 30, particularly if severe
- Raynaud's with joint pains, rash, dry eyes and mouth, or difficulty swallowing
Digital ulceration indicates critical tissue ischaemia and needs urgent specialist assessment to prevent tissue loss. Asymmetric or late-onset Raynaud's suggests a secondary cause and warrants investigation rather than reassurance.
The colour changes
Classically three phases, though not everyone gets all of them: white as blood flow shuts down, then blue as oxygen is used up, then red on rewarming as blood floods back, often with throbbing, tingling and pain. Episodes last minutes to hours. Colour change may be harder to see on darker skin — look for pallor of the nail beds and rely on the numbness and pain.
Primary or secondary
- Primary — the great majority. Usually starts in the teens or twenties, affects both hands symmetrically, is triggered by cold and stress, and causes no tissue damage. Often runs in families and is commoner in women.
- Secondary — caused by an underlying condition, most often scleroderma, lupus, Sjögren's, rheumatoid arthritis or vasculitis. Suggested by later onset, asymmetry, severe episodes, ulceration, and other symptoms.
- Also secondary to vibrating tools (hand-arm vibration syndrome, which is reportable at work), certain medicines including beta-blockers and some migraine treatments, smoking, and thoracic outlet compression.
What we look for
Assessment includes examining the nailfolds — abnormal capillary loops there are one of the strongest predictors of an underlying connective tissue disease — along with blood tests for inflammatory markers, autoantibodies including ANA, full blood count, thyroid function and, where relevant, an assessment of the circulation. A normal set of results in someone with typical primary Raynaud's is genuinely reassuring.
Managing it
Helps
- Layers, and keeping the whole body warm — not just the hands
- Mittens rather than gloves; heated gloves and insoles in winter
- Hand warmers, and warming the car before driving
- Stopping smoking — it constricts vessels directly
- Regular exercise, which improves circulation
Triggers
- Sudden cold — freezer aisles, cold taps, cold drinks in the hand
- Stress and anxiety
- Caffeine in some people
- Beta-blockers and some other medicines — ask us to review
- Vibrating tools without protection
Treatment
- Nifedipine is the usual first-line medicine, taken through the winter or year-round. Headache, flushing and ankle swelling are common early and often settle.
- Other options include alternative calcium channel blockers, and specialist treatments for severe secondary Raynaud's.
- Treat any underlying condition — that is where the real benefit lies in secondary Raynaud's.
- Ulcers need prompt specialist management.
Why come to us. The useful question is which type you have, and that is answered in a single appointment. We examine the hands and nailfolds, take autoantibody screening, inflammatory markers, thyroid and full blood count in-house with results explained face to face, review any medicines that may be contributing, and prescribe treatment where it is warranted. Where results suggest a connective tissue disease we arrange rheumatology promptly rather than leaving you waiting. Seven days a week.
Autoantibody screening in-house, explained in person
One appointment to establish which type you have. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.