herald

Monday 18 December 2017

Are painfully cold fingers and toes worrying symptoms?

I've always had cold hands and feet, but after the recent bad weather I find my fingers now get painful and numb with the slightest change of temperature. What could be causing this, and is it likely to get worse?

It sounds as if you may have Raynaud's disease. This is more than simply having cold hands and cold feet, and it's not the same as frost bite. It is a condition that causes the smaller arteries to narrow in response to cold temperatures or stress. This reduces the blood flow to areas such as your fingers, toes, the tip of your nose and your ears.

Some people with Raynaud's disease also notice that the affected areas often turn white at first, then blue, feel cold and numb. As circulation improves a prickly or stinging sensation and redness can occur before returning to a normal colour. These attacks don't always affect the same fingers or toes and can last for less than a minute or up to a few hours.

Is it just the cold that can bring on an attack?

No. Emotional stress can also cause an episode of Raynaud's.

Can Raynaud's disease do any long-term damage?

For most people, it isn't associated with any other medical problems, but in some cases it can be a more serious disorder. This type of 'Raynaud's Phenomenon' usually first appears at later ages, around 40. Causes include some autoimmune diseases such as Lupus or rheumatoid arthritis, diseases of the arteries, carpal tunnel syndrome or certain medication such as beta-blockers, oestrogen-containing preparations, or migraine tablets containing ergotamine.

Is there a test to tell if you have the more serious type?

Your doctor or rheumatologist can do a test called nail fold capillaroscopy. This involves examining your nail fold for enlarged tiny blood capillaries, which may indicate an underlying disease. Blood tests such as ANA and ESR are useful in diagnosing autoimmune or connective tissue disease. There's no single blood test to diagnose Raynaud's.

What can I do to prevent an attack and is there specific treatment available?

Don't smoke -- this narrows blood vessels. Avoid second-hand smoke and caffeine as these can also aggravate Raynaud's. Regular exercise will improve your circulation. Biofeedback (using your mind to control body temperature) can help decrease the severity and frequency of attacks. It uses guided imagery to increase the temperature of hands and feet, deep breathing and other relaxation exercises. Niacin supplements (vitamin B3) cause blood vessels to dilate, increasing blood flow to the skin. Prescribed medication used to widen blood vessels include calcium channel blockers, alpha blockers and vasodilators. Also, avoid taking over-the-counter cold drugs that contain pseudoephedrine, eg Sudafed.

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