Raynaud's Syndrome and Raynaud's Phenomenon - The two types of this painful circulatory condition require different treatment approaches.

Q: What is the cause of Raynaud's, and is it considered serious? What is the treatment and is there a cure? Is it true it's sometimes linked to wheat allergy?

A: The cause depends upon the type of Raynaud's. The primary form occurs by itself, is not related to other diseases or conditions, and has no known cause. Its symptoms are usually mild and may be prevented by simple measures that keep the fingers and toes warm and dry. In contrast, the secondary form has the potential for serious complications and may be caused by another disease, such as rheumatoid arthritis and scleroderma; injury; or lifestyle choices such as tobacco smoking. While there is no cure, treatment is aimed at controlling the underlying cause as well as minimizing its symptoms.  

Wheat allergy is not known to trigger Raynaud's disease. However, some individuals with celiac disease develop an inflammatory and/or autoimmune reaction to gluten, which is one of the proteins contained in wheat. This raises the possibility of a link between the two, since autoimmune disorders may trigger the symptoms associated with secondary Raynaud's. That said, testing for celiac disease may be part of your medical evaluation.

Reynaud's symptoms

Picture yourself in the cold weather without gloves, socks or shoes. In a matter of minutes, the circulation to some of your fingers and toes begins to shut down, causing them to turn pale before transitioning into a purple-blue hue. As the affected digits get colder, they eventually become numb. If the interruption in blood flow continues, pain in the affected area may result.

You quickly go inside to re-warm your fingers and toes. Slowly, the circulation begins to improve as the digits tingle, turn pink to bright red and throb with sharp bursts of pain. If all goes well and there is no permanent damage, your fingers and toes will return to their normal color and the numbness will disappear.

Imagine the above process happening multiple times per day and lasting a few minutes to several hours each time one of Raynaud's "triggers" is set into play. If you can picture that, you have an idea of what a person affected with Raynaud's disease might feel when the symptoms reappear. (Please note that the response tends to be milder in those with primary Raynaud's.)

Causes of vasospasm

Raynaud's disease is an exaggerated response (vasospasm) of the blood vessels as they are exposed to "triggers" such as cold temperatures or emotional stress. This is a reversible process that more often affects women than men and most often occurs in one or more of the fingers and toes. Rarely, it affects the knees, nipples, ears, lips and/or nose. There are two types:

Primary Raynaud's (Raynaud's syndrome) is the most common form. Symptoms are usually mild and more annoying than painful. While the cause is unknown, exposure to cool or cold temperatures (surfaces, air, wind, water, etc.) and emotional stress tend to trigger symptoms. Preventive measures, such as wearing protective clothing, and medical treatments tend to work well.

Key points:

• Symptoms often begin before age 30
• Affects both hands or feet
• May run in families
• Does not lead to skin ulcers or gangrene

While less common, secondary Raynaud's (Raynaud's phenomenon) has symptoms seen in reaction to triggers such as cold air or stress that may be more severe. This may be due to a secondary condition or disease that damages the arteries and/or nerves and causes the blood vessels to go into spasm. These conditions include but are not limited to:

• Connective-tissue, autoimmune and/or inflammatory disorders such as scleroderma, lupus, Sjogren's syndrome and rheumatoid arthritis. (Blood tests that include a rheumatoid factor, erythrocyte sedimentation rate and antinuclear antibodies may be suggested.)
• Circulatory disorders such as atherosclerosis and Buerger's disease
• Blood disorders (polycythemia and others)
• Thyroid disease
• Repetitive stress to the hands and feet over an extended period of time. This may include typing, playing a keyboard instrument, or use of a vibrating tool such as a jackhammer
• Medications such as beta-blockers, diet pills, decongestants, antihistamines, birth control pills, certain medications to fight cancer, as well as migraine drugs that contain ergotamine. (It's always best to speak with your doctor and pharmacist to find out if your medication is contributing to your symptoms.)
• Previous injury, especially frostbite
• Tobacco smoking (because it narrows blood vessels)
• Exposure to the chemical vinyl chloride

Key points:

• Symptoms are painful and usually begin after age 30
• May affect one (or both) hands and/or feet
• Has the potential to cause more serious damage such as ulcers or gangrene
• Medical testing often reveals another disease or condition that may contribute to the symptoms

Prevention is the best treatment

The key is to figure out your personal Raynaud's triggers, then take action to decrease the frequency and severity of its "flares." While lifestyle measures are often all that is needed for primary Reynaud's, the secondary form may require a medical approach.

Suggestions include:

• Boosting circulatory function through regular exercise
• Quitting the tobacco habit and limit the use of caffeinated products
• Maintaining body warmth, especially the hands and feet. Dress in layers and wear a hat when outside, mittens when reaching into the refrigerator, rubber gloves when washing dishes, and socks while sleeping.
• Stopping the stress reaction through relaxation techniques (controlled deep breathing and biofeedback)
• Taking prescription medications that help to improve circulation. These include calcium- channel blockers (felodipine, others), niacin (only after consultation with your physician), alpha blockers (doxazosin, others) and topical nitroglycerin. There are other medications your doctor may consider, including the category of angiotensin II receptor antagonists like losartan, as well as those used to treat erectile dysfunction.

In the meantime, if symptoms occur despite the above measures, take action and warm up. Massage the fingers and toes, move them and gently shake them, place fingers under the armpits for warmth, and soak the affected areas in warm water.

For further information, please speak with your physician and read more from the American College of Rheumatology (http://www.rheumatology.org/) as well as the International Scleroderma Network (www.sclero.org).

More on MSN Health & Fitness:

• Exposure to Peanuts May Build Tolerance to Allergy
• In Depth: Lupus
• In Depth: Celiac Disease
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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)