February is Raynaud’s Awareness Month, an event organised by the Raynaud’s and Scleroderma Association (RSA). The campaign aims to raise awareness of the disorder and offer help and advice to sufferers, their friends and family.
Raynaud’s is a common condition that affects the blood supply to certain parts of the body, usually in the extremities, ie the fingers and toes. The small blood vessels in these areas are over-sensitive to even the slightest changes in temperature. This causes a Raynaud’s attack where in some cases the fingers or toes can change colour. It can be incredibly uncomfortable and often painful.
According to the RSA, Raynaud’s phenomenon is thought to affect up to 10 million people in the UK.
The condition is usually triggered by cold temperatures, anxiety or stress. It occurs because the small blood vessels go into a temporary spasm, which blocks the flow of blood to an area of the body and once this happens, it becomes ischaemic. This causes the affected area to change colour from white, to blue and then red, as the blood flow returns. Following the temporary halt in blood supply to a body part, patients can suffer numbness, pain and pins and needles. Some patients experience symptoms for just a few minutes but others could suffer for hours at a time.
There are two types of Raynaud’s phenomenon: primary and secondary.
There is no known cause for primary Raynaud’s. It is often hereditary and is not associated with other diseases. Sometimes, however, someone who is thought to have primary Raynaud's develops other symptoms several months or years later and the diagnosis is changed to secondary Raynaud's.
Approximately 1 in 10 people who experience Raynaud’s have the more serious form of the condition, known as secondary Raynaud’s. This is usually linked to an underlying pathology, such as some forms of arthritis, connective tissue diseases, or it can indicate heart or vascular disease.
Secondary Raynaud's requires further investigation and careful monitoring as it could potentially have far-reaching consequences.
There is no cure for primary Raynaud’s but, in many cases, it may be possible to control the symptoms by simply avoiding the cold, wearing gloves and using relaxation techniques when feeling stressed. Stopping smoking can also improve symptoms because of the effect smoking has on circulation.
If a patient is unable to control his or her symptoms, then a medication called Nifedipine may be recommended.
Penningtons Manches’ clinical negligence team has acted for clients who have suffered from Raynaud’s phenomenon but their symptoms have been poorly investigated and the underlying cause of their condition has been missed, which has led to complications due to a delay in diagnosis.
In a previous case, summarised here, the team acted for a client who suffered problems with her right sided upper limb circulation and was diagnosed with Raynaud’s disorder. Investigations identified a cervical rib and thoracic outlet syndrome, which is a condition caused by nerves and blood vessels becoming compressed. The client was advised that her symptoms of Raynaud’s were caused by the cervical rib and she therefore required surgery to remove it. Post-operatively, her symptoms were unchanged and gradually worsened.
After some time she saw another surgeon at a different hospital due to deterioration in her symptoms. The client was advised that she required a vein graft and, during surgery, the surgeon noticed that her artery was being compressed by a sling of muscle, which was the cause for her thoracic outlet syndrome. The surgeon released the artery from the constricting muscle and the client’s symptoms and circulation improved post-operatively.
Arran Macleod, a solicitor in the clinical negligence team at Penningtons Manches, said: “This case demonstrates the importance of properly investigating whether Raynaud’s is the primary condition for a patient’s symptoms, or whether it is secondary to another underlying pathology. If it is a secondary condition, it can be time-critical to identify and treat the underlying cause. A failure to treat a reduction in circulation in a timely manner could result in complications, such as suffering ulcers, scarring and, in the most serious cases, tissue death (gangrene) and the risk of amputation.
“Blood tests performed by your GP should be the first step in identifying whether you have primary or secondary Raynaud’s in order to establish if further investigations should be performed as soon as possible.
“If you have any concerns about the treatment you have received for your Raynaud’s disorder we would be happy to talk with you.”