Fibromyalgia and Raynaud’s Syndrome

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 Many individuals with Fibromyalgia experience increased sensitivity to cold, and some individuals have symptoms that are severe enough to be classified as Raynaud’s syndrome.

 Raynaud’s is a very rare disorder that affects the arteries (blood vessels that carry oxygen-rich blood away from your heart to your body). It is characterized by brief episodes of vasospasms, or narrowing of the arteries. When the cause of Raynaud’s is unknown, it is referred to as Raynaud’s disease or “primary Raynaud’s.” When a specific disease, condition, or other factor causes Raynaud’s it is referred to as Raynaud’s phenomenon or “secondary Raynaud’s.” Regardless of which type you have cold temperatures and stress can both trigger a Raynaud’s attack. Temperature changes do not have to be drastic – even mild or brief change can cause the onset of symptoms. Movements such as reaching into the freezer to retrieve food or washing your hands in cold water can trigger an attack. When an attack occurs, little or no blood flows to the affected parts of the body.

Symptoms

Regardless of type, an attack of Raynaud’s is usually brought on by stress or exposure to cold. The attacks usually target the fingers and toes, but occasionally may involve the nose, ears, nipples, or lips. When an attack occurs, the arteries briefly narrow temporarily restricting blood flow to the body part. For example, if an artery in the index finger narrows, blood flow will be cut off to that finger. As a result of the blockage of blood flow the skin may turn white and even blue for a brief period of time. As the blood flow returns to the affected body part, you may feel the area turn red, throb, tingle, and even burn or feel numb. Attacks usually affect only one finger or toe at a time, but occasionally they may spread to other fingers and toes, or affect different areas at different times.

Causes

 The risk factors for primary Raynaud’s include female gender, age over 30, family history of Raynaud’s disease, and living in a cold climate. The risk factors for secondary Raynaud’s include age over 30; presence of a disease that directly damages the arteries or nerves; injuries to hands or feet; chemical exposures (particularly vinyl chloride which is frequently used in the plastics industry); repetitive motions such as typing and use of vibrating machinery; certain medications used to treat migraines (ergotamine), cancer (cisplatin and vinblastine), and blood pressure (“beta blockers”); nicotine from cigarettes; and living in a cold climate.

Co-Morbidities

Those who suffer from Fibromyalgia can also have Raynaud’s phenomenon. Stress is a trigger for the symptoms of both conditions; therefore it can be difficult to determine if Raynaud’s is a symptom of Fibromyalgia or if the Fibromyalgia is causing the Raynaud’s. In addition, d­­iseases such as systemic scleroderma (an immune disease involving changes in the skin, blood vessels, muscles and organs) and lupus (a long-term immune disease that affects the skin, joints, kidneys and brain) can cause secondary Raynaud’s. In fact, 9 out of 10 people with scleroderma and 1 out of 3 people with lupus have Raynaud’s. Raynaud’s is also common in patients with thyroid problems, and can occur with pulmonary hypertension (elevated blood pressure in the lungs).

 In severe cases of secondary Raynaud’s, deformity, skin sores or gangrene can result due to the death of body tissues as a result of the blocked blood flow. This is very rare.

Treatment

 There is no cure for either primary or secondary Raynaud’s. Treatments are available to reduce the number and the severity of attacks.

 Lifestyle changes are a mainstay of treatment for individuals with primary Raynaud’s. Avoiding cold temperatures and minimizing stress play a large role. For those with secondary Raynaud’s, medication may be required in addition to lifestyle modifications such as avoiding chemical and pharmaceutical triggers. Surgery or shots may even be needed.

Below is a brief list of things that can be done to prevent attacks:

  • Dress appropriately for cold weather (hat, mittens, socks, layered clothing)
  • Monitor air conditioning temperatures
  • Warm up the car before getting in to drive
  • Use gloves or an oven mitt to remove items from the refrigerator or freezer
  • Manage stress effectively
  • Avoid medications that trigger attacks
  • Wear protective gear around chemical triggers
  • Stay physically active (warms the body and improves blood flow)

Medications and surgery

Medicines commonly used to treat Raynaud’s include calcium channel blockers, alpha blockers, and prescription skin creams. Surgery may be needed in severe cases where gangrene has occurred, or to block the nerves in problem areas. Surgery performed to block nerves only fixes the problem temporarily; unfortunately the symptoms usually reoccur in months or years.

Research Studies Related to Fibromyalgia and Raynaud’s Syndrome

A 1991 study by Bennett et al. questioned twenty-nine patients with Fibromyalgia about the presence of symptoms related to cold intolerance and the presence of Raynaud’s syndrome. The researchers also measured the blood pressure in the small veins and capillaries of each subject’s fingers when they were exposed to cold (called a Nielsen test). The researchers found that 41% (12 patients) had abnormal Nielsen tests, suggesting abnormal or reduced blood pressure in the fingers. In addition, 38% had elevated levels of certain blood factors involved in the process of constricting the arteries (a process that reduces blood flow). Based on the findings of this study, the authors hypothesized that some patients with Fibromyalgia may have an exaggerated response to cold due to increased numbers of these blood factors. This study was important to help researchers understand how cold sensitivity and Fibromyalgia may be related.

 A 2005 study by Morf et al. was conducted to look at the structure and function of the very smallest blood vessels in the body – the capillaries – in patients with Fibromyalgia. Capillaries are the sites at which oxygen from the blood is deposited into our tissues. They are an essential part of our body’s blood circulation.

 The researchers evaluated 10 women with a confirmed diagnosis of Fibromyalgia and compared them to 30 “control” subjects divided into three groups: 10 women who had rheumatoid arthritis (long term inflammation of the joints and surrounding tissues), 10 who had systemic scleroderma, and 10 who were considered healthy. All 40 women underwent testing to see how dilated their capillaries were at normal room temperature (which was maintained at 71° to 73°F). The researchers also measure the blood flow in the capillaries to see if it was abnormal in any of the groups. 

 When compared to the healthy control subjects, the women with Fibromyalgia had fewer capillaries in their nail fold but it was found that their capillaries were much more dilated. In addition, they found that the women with Fibromyalgia had increased numbers of irregularly-formed capillaries. With regard to blood flow, the study found that women with Fibromyalgia had decreased blood flow in the capillaries when compared to the healthy control group, but not when compared to the systemic scleroderma group. The findings are important because they suggest that disrupted functioning of the capillaries may be due to changes in their structure and function. This is an important finding because it can help other researchers learn more about how Fibromyalgia and Raynaud’s phenomenon are related.

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References

1.        Bennett RM, Clark SR, Campbell SM, Ingram SB, Burckhardt CS, Nelson DL, Porter JM. Symptoms of Raynaud’s syndrome in patients with Fibromyalgia. A study utilizing the Nielsen test, digital photoplethysmography, and measurements of platelet alpha 2-adrenergic receptors. Arthritis Rheum. 1991;34(3)264-269.

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