Raynaud’s phenomenon is common and may antedateother symptoms by months or years. SLE can present withRaynaud’s phenomenon, along with arthralgia or arthritis.Secondary Raynaud’s phenomenon associated with SLE andother AICTDs needs to be differentiated from primary Raynaud’sphenomenon, which is common in the general population (up to5%).¹

It is a disease of young women and commonly the upper limbs are affected specially the fingers (the thumb is generally escaped).^{2, 3}

Clinical Features

1. Features in favor of secondary Raynaud’s phenomenoninclude age at onset of over 25 years, presence of a familyhistory of Raynaud’s phenomenon
2. Due to an abnormal response tocold temperature, the vessels constrict and then dilate. Thisproduces a classic triphasic color change; pallor, cyanosis followed by redness of the digits. This is often accompanied bypain.Raynaud’s syndrome shares the clinical features of Raynaud’sdisease but is much more severe. It is generally a manifestationof collagen vascular disease. It may also follow the use ofvibrating tools and is then known as ‘vibration white finger’.³
3. In severe cases, these two attacks are repeated till patches of anemic ulceration appear at the finger tips which are known as the stage of local gangrene. The pulses remain unaffected, as this is the disease which affects arterioles. Troublesome sweating is sometimes associated with this condition.²

Signs

1. Examination of capillary nail-fold loops using an ophthalmoscope(and oil placed on the skin) can show loss of the normal looppattern, with capillary ‘fallout’ and dilatation and branching ofloops; these features support either a diagnosis of systemicsclerosis or severe primary Raynaud’s phenomenon.¹
2. If Raynaud’sphenomenon is severe, digital ulceration can occur. This is a universal feature and can precede other features bymany years. Involvement of small blood vessels in the extremitiesmay cause critical tissue ischaemia, leading to localized distalskin infarction and necrosis.¹
3. Theperipheral pulses are normal.

Triggering factors: Trauma, vibration injury, hammer hand syndrome, electric shock, cold injury,typing, piano playing⁴

Management

Treatment is primarily directed at the underlying condition.³

Avoidance ofcold exposure, use of thermal insulating gloves/socksand maintenance of a high core temperature all help.¹

Homeopathic totality based medicines are found to effective to reduce the frequency and severity of the events. There are acute medicines which also help tremendously to manage the acute attack and reduce the severity and regress the condition at the acute attack event. Medicine should be taken in consultation with a skilled homeopathic practitioner.

Few Homeopathic Medicines for Raynaud’s Disease⁵

Agaricus Muscarius 

Chillblains like ice cold or very hot needles.

Arsenicum Album

Itching, burning, swellings; oedema, eruption, papular, dry, rough, scaly; worse cold and scratching. Malignant pustules. Ulcers with offensive discharge. Urticaria, with burning and restlessness. Scirrhus. Icy coldness of body. Gangrenous inflammations.

Camphor

Cold, pale, blue, livid. Cannot bear to be covered (Secale).

Carbo Vegetabilis

Blue, cold ecchymosed. Marbled with venous over distension. Itching; worse on evening, when warm in bed. Moist skin; hot perspiration; senile gangrene beginning in toes; bed sores; bleed easily. Falling out of hair, from a general weakened condition. Indolent ulcers, burning pain.

Ferrum Phosphoricum

Whitlow. Palms hot. Hands swollen and painful.

Rhus Toxicodendron 

Red, swollen; itching intense. Vesicles, herpes; urticaria; pemphigus; erysipelas; vesicular suppurative forms. Glands swollen. Cellulitis.

Secale Cornutum

Shriveled, numb; mottled dusky-blue tinge. Scleraema and oedema neonatorum. Raynaud’s disease. Blue color. Varicose ulcers. Burning sensation; better by cold; wants parts uncovered, though cold to touch. Formication; petechiae. Slight wounds continue to bleed. Skin feels cold to touch, yet covering is not tolerated. Great aversion to heat. Formication under skin.

Sepia Officianalis 

Herpes circinatus in isolated spots. Itching; not relieved by scratching; worse in bends of elbows and knees. Chloasma; herpetic eruption on lips, about mouth and nose.Urticaria on going in open air; better in warm room. Ichthyosis with offensive odor of skin.

Silicea Terra 

Felons, abscesses, boils, old fistulous ulcers. Delicate, pale, waxy. Cracks at end of fingers. Rose-colored blotches. Scars suddenly become painful. Promotes expulsion of foreign bodies from tissues. Every little injury suppurates. Long lasting suppuration and fistulous tracts. Dry finger tips. Eruptions itch only in daytime and evening. Crippled nails. Abscesses of joints.  Coppery spots.

Beneficial Foods⁶

No studies have been carried out to reveal howspecific foods affect Raynauds syndrome, butcertain dietary habits may help to lessen the symptoms. Eating nutritious snacks betweenmeals helps to maintain blood sugar levels andprevent hypoglycaemia, which can otherwiselend to cold extremities and worsen symptomsof Raynaud’s. A diet high in protein, low incarbohydrate, and free of caffeine may also help.

Oily fish, such as mackerel and salmon, containfatty acids known as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Thesehelp in the production of prostaglandins, whichare involved in dilating blood vessels.

Citrus fruits, berries, and fruit juices are richin vitamin C. People with Raynaud’s have beenfound to have low levels of this vitamin.

Ginger stimulates the circulation. Add 10g ofginger to 600ml of cold water and simmer for anhour. Strain the liquid, then drink hot or cold.

Foods to Avoid⁶

Frozen foods and cold drinks can worsensymptoms if handled by those with Raynaud’s.

Basic care⁶

• Get out of the cold and move to a warmer area
• Place your hands under your armpits or between your thighs to warm them up
• Numbness in toes and fingers is a common symptom so wiggle your fingers and toes and if this fails try doing windmill motions with your arms, and jogging on the spot. Movement will help to keep the blood flowing properly.
• Run your fingers and toes under some warm water
• Massage your hands and feet this improves blood circulation
• Avoid wearing things that may constrict blood flow to these extremities such as tight rings, tight socks or wrist bands
• Smokers are advised to give up the habit,as smoking worsens symptoms of this condition.
• Regular exercise may improve the circulationand help to lessen symptoms.
• Evening primrose oil and flax seed oil are richin gamma linolenic acid (GLA), which isthought to have a positive effect on circulation.

References

1. Ralston S.H., Penman I.D., Strachan M.W.J., Hobson R.P. Davidson’s, Principles and Practice of Medicine. 23^rdrev.ed. Edinburgh; Churchill Livingstone/Elsevier; 2018. 1417p.
2. Dr. Das S. A manual on Clinical Surgery. 13^threv.ed. Kolkata: Dr. S. Das; 2018. 648p
3. API Textbook of Medicine. 9^threv.ed. Mumbai: The Association of Physicians of India, Jaypee Brothers Medical Publishers (P) Ltd; 2012. 2066p
4. Kasper D.L., Fauci A.S., Hauser S.L., Longo D.L., Jameson J.L., Loscalzo J. Harrison’s Manual of Medicine. 19^th rev. ed.   United States:  McGraw Hill; 2016. 1222p.
5. Boericke W. Pocket Manual of Homoeopathic Materia Medica. New Delhi: B. Jain Publishers (P) Ltd.; 2011.
6. URSELL A. The Complete Guide Healing Foods. 1^strev.ed. London: Dorling Kindersley Ltd., 2000. 256p.