Keeping Cozy: How Lupus Patients Cope with Raynaud's Phenomenon

In the United States, about 30 to 40 percent of lupus patients have been found to also suffer from Raynaud's phenomenon. Raynaud's causes a constriction in the arteries supplying blood to the extremities—mostly the fingers and toes, but sometimes also the ears, nose, lips and chin. This causes blood circulation to become limited, causing these parts of the body to feel numb.

Stress and the cold climate often aggravate a Raynaud's attack. Under these conditions, most people have the typical body response of trying to retain body heat and maintain a normal core temperature. However, for Raynaud's sufferers, these responses become over-reactive and extreme. Fingers and toes become pale, blue, or purple in color, and they feel numb, tingly, or prickly. When warmed, the blood flows back, and the body becomes reddish, possibly feeling a stinging pain or becoming swollen.

How serious is Raynaud's?

When left undiagnosed or without a care towards preventing attacks, Raynaud's can cause small arteries and capillaries to thicken, leading to complications in blood flow and supply. This condition may also bring about tissue damage and deformity in one's fingers and toes. Ulcers of the skin and gangrene may also be a risk should the supply of oxygen be cut off. The most severe of cases has led to the amputation of the affected body part.

Nevertheless, in most cases, Raynaud's phenomenon is not considered life-threatening. Mostly, it affects one's quality of life, requiring lifestyle checks. The best treatment involves avoiding conditions that trigger an attack. Especially during the winter months, this means keeping warm in the following ways:

Bundling Up for Winter

An estimated 5-10 percent of Americans suffer from Raynaud's. It could be in the form of an idiopathic, primary disease with an unknown cause or as a secondary phenomenon resulting from diseases that damage the blood vessels, activities that impair the nerves, medications to control blood flow and pressure, and certain injuries to the hands and feet. With the onset of winter, everyone would find these hacks useful, but they would be particularly beneficial to anyone suffering from Raynaud's.

The National Heart, Lung and Blood Institute recommends these ways for cold-weather protection:

• When going outdoors, bundle up from head to toe. Wear a hat, ski goggles, ear muffs, face mask, scarf, mittens (not gloves since they let cold air get between one's fingers), thermal underclothes, coat, cuffs, socks, and warm shoes. Don on several layers to keep your core temperature up. Avoid tight clothes though, as these hamper your blood from circulating. Go for looser-fit clothes.
• Get even cozier with hand and foot warmers. The choices abound like charcoal packs or those with metal disks that release heat when bent. There are even some organic grain packs that can be heated in the microwave or gel-filled packs that are USB-powered.
• When staying indoors, protect hands from freezer burn with oven mitts. Use double-walled cups or use napkins when handling cold glasses. In bed, keep snug in mittens and socks, pile on flannel sheets and heated electric blankets. Lack of sleep can sometimes also bring about an attack of Raynaud's.
• Turn air-conditioning down, or heaters up, especially before going for a drive in your car.

Other handy tips for the frosty weather include:

• Stay nourished and hydrated. The body needs food as energy sources. Fluids then aid in transferring this and the needed nutrients to the whole body. With the cold depleting the body's caloric hoard at a faster rate, it becomes most important to replenish these fuel stores. It may help to add spices like ginger, peppers, or cinnamon to food items as they seem to release a certain warmth.
• Avoid standing or sitting too long, or crossing your legs while sitting. These positions restrict blood flow. Instead, make an effort to get more exercise. Try hot yoga or tai chi because they assist in blood circulation. To aid blood flow, move, shake and wiggle the hands, fingers, feet, and toes.
• While it's tempting to warm up with a few puffs on a cigarette or a couple of sips of caffeinated java, keep these at bay. Smoking— even inhaling second-hand smoke— and caffeine-packed foods (coffee, chocolate and carbonated drinks) constrict the blood vessels and worsen Raynaud's symptoms. Choose to warm up by soaking hands and feet in warm water or sipping low caffeine teas instead.
• Some Raynaud's sufferers have sworn by long, up-to-the-elbow gloves piled with wool or fur-lined mittens or heated gloves, and even waterproof mittens when going out into the snow.

Snuggling in the Spring, Summer, and Autumn

With the end of the winter months though, having Raynaud's still necessitates changes to one's lifestyle. There may no cure for the condition, but its triggers may be avoided and its symptoms can be managed.

The most basic prevention involves maintaining an appropriate body weight. Obesity can be detrimental to bodily functions, particularly to one's blood circulation.

In addition, protect the hands and feet from bruises and cuts. Avoid wearing accessories that prevent proper blood flow like tight rings or wristband, constrictive stockings or footwear. Prevent dry skin and cracked heels with moisturizers, oils, and lotions.

For a more holistic approach, The Raynaud’s Association endorses certain supplements. Vitamin B complex is known as the "anti-stress" vitamin group. Studies show that niacin can aid blood circulation. Fish oil, a form of omega 3 fatty acids, may aid the body in tolerating coldness. Calcium and magnesium can be taken to reduce stress while vitamin E helps with circulation.

Beyond the home, triggers in the workplace include having to do repetitive hand motions, using tools that vibrate, or using certain chemicals. Strive to have moments to rest your hands and fingers in between periods of playing the piano or typing. Try also to limit the use of electric hand mixers, drills, or other power tools as much as possible. Lastly, wear good protective clothing and gear when handling industrial chemicals.

Stress often goes hand-in-hand with being in employment. However, Raynaud's sufferers should remember to avoid situations that make them feel stressed or upset. For unavoidable circumstances, methods like biofeedback (a technique that helps one achieve awareness and control of one's body functions with the use of electrical instruments and sensors) could be beneficial. Meditation practices like mindfulness have some track record of being helpful. Some believe that breathing techniques like sending warming breath and sensation from the body’s core to the extremities, could also support stress management or curb the onset of Raynaud's symptoms.

Most primary Raynaud's—those unassociated with an underlying illness—could be managed with the preventive measures mentioned above. But with secondary forms, medical conditions could bring complications. Moreover, certain medications contribute to the narrowing of arteries. Heart patients receiving beta blockers benefit from a slower heart rate and lower blood pressure, yet in exchange suffer from a constriction of the blood vessels. Cancer chemotherapies, such as those of cisplatin or vinblastine-based, have also been linked to Raynaud's phenomenon.

In these severe cases, medical practitioners would then prescribe drug therapies. Currently, all medications used for Raynaud's are those FDA-approved for other medical conditions. For example, calcium channel blockers that are used primarily to control blood pressure are the most popular and practical medication to reverse constriction in the arteries. They have been proven most effective in controlling the severity, frequency, and duration of Raynaud's attacks. Phosphodiesterase inhibitors like Viagra (used for erectile dysfunction) and fluoxetine-based medication like Prozac (used to treat depression) could also help manage attacks. Alpha-blockers (certain skin creams) and to a lesser degree, ACE inhibitors have had varying degrees of success in treating Raynaud’s symptoms. In cases wherein blood flow has been totally limited, doctors have resorted to injecting prostaglandins intravenously to immediately dilate the blood vessels.

Digital sympathectomy

Surgery is the last resort for the severest cases of Raynaud's that do not respond to any of the other medications. Known as digital sympathectomy, this type of surgery involves cutting through sympathetic nerves attached to the arteries involved. That even when the body feels cold, it is not communicated to the blood vessels in the extremities. This fools the body's system to not recognizing the coldness, preventing an attack of Raynaud's. Studies show that although this procedure relieves symptoms, its effectiveness lasts only a few years. The procedure would have to be redone should symptoms recur.