Scleroderma

Having a chronic condition like Raynaud’s requires vigilance. Here are five things that you should know about your condition from rheumatologists who treat it.

Stay warm.
Wear gloves and mittens and heavy socks whenever you expect to be in a cold setting. Carry chemical hand warmers, if necessary. Equally critical is keeping your entire core warm, says Dr. Lorinda S. Chung, an assistant professor of medicine in the division of immunology and rheumatology at Stanford. Dress in layers and wear a hat. You can lessen the frequency of attacks by giving up cigarettes, avoiding the use of vibratory tools and steering clear of medications that cause blood vessel constriction such as decongestants and beta blockers for high blood pressure. It’s also important to minimize and manage stress, which triggers spasms in the blood vessels.

Find out what type of Raynaud’s you have.
Determining whether you have primary or secondary Raynaud’s is critical since the secondary form indicates a serious autoimmune disease like scleroderma or lupus. You’re more likely to have primary Raynaud’s if attacks began before the age of 40, you have no other symptoms and your blood work is normal. People with scleroderma or lupus, on the other hand, tend to test positive for antinuclear antibodies (ANAs) in the blood. They’re also more likely to have abnormalities under the nails, like tiny hemorrhages or a loss of capillaries, that can be detected using a nailfold capillary test (capillaroscopy). The test involves placing a drop of oil on the cuticle and looking at the skin under a handheld microscope. Catching a secondary disease before it progresses allows for early treatment of potentially life-threatening complications such as pulmonary hypertension in scleroderma or kidney problems in lupus.

Pay attention to changes in the pattern of your attacks
...Says Dr. Hal Mitnick, a rheumatologist at New York University. Most people with Raynaud’s have attacks that are consistent in terms of color change, duration and frequency. They also have a similar pattern of recovery. But if the pattern changes in any way — for example, if the color changes become more drastic or recovery becomes harder to achieve — talk to your doctor.

Consider taking medications if your attacks become painful or difficult to manage.
Although there are no drugs approved specifically for Raynaud’s, several medications are used. These include calcium channel blockers, often the therapy of choice, which are most commonly prescribed for high blood pressure; phosphodiesterase inhibitors, most often used for erectile dysfunction; and selective serotonin reuptake inhibitors, usually given for depression.

Be on the lookout for ulcers, fissures and other wounds on the tips of your fingers that do not heal.
Ulcers are a serious concern that, if left untreated, can lead to gangrene and amputation. These tiny black spots tend to develop when attacks are more intense, prolonged or involve more blood vessels, Dr. Mitnick says. Fissures, or small splits in the skin, can sometimes turn into ulcers. If you suspect an ulcer, contact your doctor immediately.

Source: Yu, W. (2010), "5 Things to Know About Raynaud’s", The New York Times