Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=227409
Story Retrieval Date: 10/21/2014 11:40:37 AM CST

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RAYNAUDS

Mary Stutzman/MEDILL

Common in cold climates, Raynaud's is a condition that drains blood from fingers toes, and other extremities. It leaves white or discolored patches that can take 20 minutes or more to return to normal color.


Recognizing Raynaud’s syndrome: When to warm up white fingers—and when to worry

by Mary Stutzman
Jan 30, 2014


Eileen Kelly, 54, of Wilmette went for a run through her own neighborhood, when something went wrong. As she jogged past the police station, she wondered, “Maybe I should go inside…” Her hands were getting cold and oddly numb.

Laura Oliver, an MBA student at Northwestern, came in from the cold and sat down in her class. She started to take notes, but found she had trouble typing. Her fingers felt frozen and appeared ghostly white.

Raynaud’s is a medical condition brought on by cold weather or emotional stress where extreme constriction of arteries drains blood from fingers, toes, and other extremities. Cold fingers are common in winter, but white ones are sometimes the first sign of something more serious - Raynaud's. Doctors are developing new treatments that can help the condition—once it’s recognized.

People suffering from Raynaud’s are frustrated when they use their fingers for normal things like buttoning a shirt or giving their kid a bath. “They just feel kind of dead,” said Oliver, “you can’t feel anything until you’re feeling them coming back.” That’s when it hurts, with what Kelly called “an aching pain.”

For most people, cold fingers can just be put into pockets. For some, like Eileen and Laura who have mild Raynaud’s, cold fingers are a bit more bothersome. But for patients with severe cases, getting function back in their fingers lets them get back to their life. That’s why a new fat transfer technique, though a relatively small procedure, could be a big help for people suffering from Raynaud’s.

The National Institutes of Health estimate that 5 percent of Americans have Raynaud’s, but most never seek treatment. It’s nine times more common in women and most common in cold winter climates.

“In Chicago if you go outside and your hands aren’t cold—something’s wrong with you,” said Dr. Nadera Sweiss, a rheumatologist and associate professor of medicine at University of Illinois College of Medicine, but advised going to the doctor if it takes more than 20 minutes for white fingers to regain normal color.

The two types of Raynaud’s start with similar symptoms, but have very different consequences.

Primary Raynaud’s, sometimes called Raynaud’s disease, is the most common and more mild version - fingers frequently become cold and blanched, but regain warmth after a while. No one knows what causes Primary Raynaud’s, but doctors agree that the best treatment is prevention.

They recommend hand warmers, wearing mittens instead of gloves and extra layers because maintaining a warm core temperature keeps blood from being drawn away from extremities. Primary Raynaud’s is annoying, but doesn’t usually progress with each cold attack or worsen over time.

Raynaud’s really becomes a problem when fingers refuse to get warm again and affect a person’s daily life because of an underlying condition.

Secondary Raynaud’s, often referred to as Raynaud’s phenomenon, is connected to other auto-immune diseases that affect the arteries and nerves in the hands including, scleroderma, lupus, rheumatoid arthritis, and atherosclerosis. As a result of the systemic disease, fingers get blisters and ulcerations that cause pain and sometimes require amputation; this type of Raynaud’s becomes progressively worse and harder to treat.

“If there is an underlying disease, then we’ve got a problem,” said Dr. Lawrence Zachary, a hand surgeon at Chicago’s Weiss Memorial Hospital, “We can’t just treat one little item and expect that whole disease to be treated.”

Recognizing Raynaud’s and determining the type at an early stage can help both patients and doctors know what steps to take to better control it.

First discovered by French physician Maurice Raynaud in 1862, treatments continue to advance for different stages of the disease.

The first step for patients with cold hands is to get tested by rheumatologist to determine whether they have primary or secondary Raynaud’s then various medications are prescribed. Viagra can increase blood flow to the hand, and Botox blocks pain fibers opening channels in the nerves.

If pain persists after medication, the next step used to be digital sympathectomy, a major hand operation. But an unusual new treatment may be equally effective and far less invasive—fat grafting.

Walking through his clinic one day, Dr. Zachary, got an idea. Having seen how collagen injected into breast cancer patients softened the skin and improved blood flow, he wanted to try a similar treatment in his patients’ cold hands.

“This has never been done before, but there’s no cutting involved, “ he told a patient. “It’s a twofer—you get to lose fat where you don’t want fat, take that and then put it in your hands.”

“Go for it,” she said.

Zachary said his first two patients basically tried the treatment on faith. But now he’s treated 35 patients, about 50 hands, with very encouraging results. A preview of the study published Jan. 17 on PubMed reports reduced pain, fewer cold attacks, decreases in ulcerations and improved patient hand functions.

“The best is when I’ve done one and they come back and say—you’ve got to do my other hand,” Zachary said.