Raynaud Phenomenon | Diagnosis & Treatments

How we diagnose Raynaud’s phenomenon

Primary Raynaud’s phenomenon is often diagnosed by general practitioners. Your child’s doctor will ask about his medical history and symptoms and do a physical exam to help rule out more common ailments like chilblains (cold-induced sores at the tips of digits) or a pinched nerve.

It’s fairly simple to determine if someone has Raynaud’s phenomenon, but it’s tricky to sort out primary from secondary (whose underlying cause can be difficult to spot).

If your pediatrician is concerned your child may have secondary Raynaud’s, she may refer him to a rheumatologist (a specialist in treating immune-mediated diseases of the joints, blood vessels, and muscles). Rheumatologists are experts on the autoimmune diseases that cause secondary Raynaud’s, like scleroderma and lupus.

Tests to determine whether your child’s Raynaud’s is primary or secondary include:

  • Nailfold capillaroscopy: An in-office test where the doctor uses a microscope or other magnifying device to look at the capillaries (tiny blood vessels) at the base of your child’s fingernail. Enlarged or irregular capillaries can be a sign of certain autoimmune diseases.
  • Antinuclear antibody test (ANA): A lab test that checks your child’s blood for the presence of antinuclear antibodies, which are a kind of protein that attacks the body’s own cells. Most autoimmune diseases that occur with secondary Raynaud’s are ANA positive, but many patients with a positive ANA are healthy and will remain so.
  • Erythrocyte sedimentation rate (ESR or sed rate): A lab test that measures how quickly red blood cells fall to the bottom of a test tube. If the cells to clump together and fall more rapidly than normal, it can signal there is inflammation somewhere in your child’s body — which is sometimes a marker of autoimmune disease.

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best next steps.

How we treat Raynaud’s phenomenon

There is no cure for Raynaud's phenomenon — something that can be difficult for a parent to hear. But the good news is that in most cases Raynaud's doesn't do any harm, and shouldn't cause undue concern for you or your child. When symptoms become bothersome, simple lifestyle changes go a long way in helping children with Raynaud's manage their condition. These include:

  • Dress warmly. In cold weather, your child should wear hats, mittens or gloves, and thick socks, but also keep his whole body warm with layers of loose-fitting clothing. In warm weather, he should keep a sweater or jacket handy at all times to guard against chilly air-conditioned spaces.
  • Avoid touching cold items. For instance, your child might want to use insulated drinking glasses for cold beverages, or keep a pair of gloves near the refrigerator to wear when reaching into the freezer.
  • Control stress. You and your child can work together to figure out what situations cause him to feel emotional stress and try to avoid them. Learning relaxation techniques like deep breathing exercises may also be helpful.
  • Stay away from caffeine … and don't smoke! Caffeine (found in things like soda, coffee, and chocolate) and nicotine (cigarettes) can make a Raynaud's attack worse because they constrict blood vessels. So do some common medications like decongestants and ADHD medications — your child's doctor will help you sort out which ones to avoid.
  • Exercise regularly. Not only is this great for overall health, it also boosts blood flow and reduces stress.

In addition, your child can take steps to control an attack once it starts.

  • Get to a warmer area right away.
  • Wiggle fingers and toes and make wide arm circles ("windmilling") to increase blood circulation.
  • Run warm — but not hot — water over the hands and feet.

For children with secondary Raynaud's — the rarer, more serious form — or for children with primary Raynaud's that can't be controlled in other ways, medical treatments can help rein in the frequency and severity of their attacks and prevent tissue damage. Some types of drugs you might hear your child's doctor mention are:

  • Calcium channel blockers, often prescribed for high blood pressure, relax and widen blood vessels by preventing calcium from entering the muscles of the vessel walls. An example is nifedipine (brand names include Procardia and Adalat).
  • Alpha blockers, another kind of blood pressure medication, keep a hormone called norepinephrine from tightening the muscles in the walls of smaller arteries and veins. Example: prazosin (Minipress).
  • Endothelin-1 inhibitors, yet another blood pressure medication, works by stopping the action of endothelin, a protein that causes blood vessels to narrow. Example: bosetan (Tracleer).
  • Phosphodiesterase inhibitors, a type of drug commonly prescribed for erectile dysfunction, help relax blood vessel walls by blocking certain enzymes. Example: sildenafil (Viagra).
  • Selective serotonin reuptake inhibitors (SSRIs), best known as antidepressants, have been shown to alleviate the symptoms of Raynaud's. Example: fluoxetine (Prozac).

Raynaud's patients with extremely severe symptoms may also need surgery or injections to block the nerves that control their blood vessels. But these procedures are very rare.

Coping and support

We understand that you may have a lot of questions when your child is diagnosed with Raynaud's phenomenon, like: Will it affect my child long term? What do we do next? We've tried to provide some answers to those questions in the following pages, along with the reassurance that most children diagnosed with Raynaud's will go on to live perfectly normal lives.

Those with secondary Raynaud's, however, often have underlying autoimmune diseases that can be extremely challenging for both patients and their families to deal with. Boston Children's Hospital offers a range of coping and support services for children with these diseases.

Patient education: From the first office visit, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have: What is treatment like? Are there any side effects? They will also reach out to you by phone, continuing the care and support you received while at Children's.

Parent to parent: Want to talk with someone whose child has Raynaud's or a similar condition? We can often put you in touch with other families who can share their experience.

Faith-based support: If you and your family find yourself in need of spiritual support, we can connect you with the Department of Spiritual Care (chaplaincy). Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your treatment experience.

Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

On our patient resources webpages, you can read all you need to know about:

There are also a number of groups that provide further information on Raynaud's phenomenon and/or related illnesses, and may even be able to connect you with parents across the country. Two are:

  • Arthritis Foundation: The largest private, not-for-profit contributor to arthritis research in the world, the Arthritis Foundation covers more than 100 types of arthritis and related conditions, including Raynaud's phenomenon and many of the diseases found with secondary Raynaud's. It spotlights the latest health and research news, and can connect patients with programs and services available in their own community.
  • Raynaud's Association: This national nonprofit group offers support, advice and resources via its website — which includes a patient forum — and newsletter. It can also help you find or launch a support group in your area.