Raynaud’s Phenomenon

Raynaud’s phenomenon (RP) is a disease when sudden ischemia of the digits appears, generally as a response to small arterial blood vessels going into spasm. Most commonly the underlying cause is cold or emotional stress. The term Raynaud’s is used to describe both a disease and a phenomenon. Raynaud’s disease is symmetrical, most often appears in the fingers, and does not progress to anything serious. Raynaud’s phenomenon (or Raynaud’s syndrome) can be part of a much more serious group of impairments which can affect the esophagus, skin and fingers, and progress to gangrene in its more severe form.

The disease in Raynaud’s is more of an annoyance than a problem. Those affected can complain of sensitivity to the cold, and a pain and stinging feeling in their digits that gradually subsides with no long-lasting effects. It is the more common of the two. Raynaud’s phenomenon is often associated with rheumatic disease (especially systemic sclerosis) and can be quite severe.

RP generally starts slowly with several fingertips involved, but as it progresses, it starts to involve the entire palm. Intense throbbing, numbness and tingling, pain, and swelling then ensue. Numbness and an aching pain can last longer. It is a disease that primarily affects younger women.

RP can evolve and become secondary to many serious rheumatologic diseases. These include collagen vascular disease such as systemic sclerosis, systemic lupus, and
rheumatoid arthritis. Arterial diseases, arteriosclerosis and arterial occlusion can be primary causes. Neurologic disease, blood disorders, certain medications (like ergots given for migraine), and frostbite may also precede or be associated with RP. In other words, the associated conditions are quite concerning.

RP in its benign form is generally easily diagnosed from the short acting symptoms with no sequelae. Men suffer from a similar set of symptoms (particularly male smokers) called Buerger’s disease, but in Buerger’s lower pulses are absent. Frostbite is more easily distinguished by the characteristic exposure to severe cold.

Primary Raymand’s disease generally has no findings in between attacks, and physical findings are absent. When associated with a more ominous disease such as progressive systemic sclerosis, the underlying disease generally becomes apparent in the 24 months after diagnosis. The most common cause of PSS involves a syndrome known as CREST: calcinosis, Raynaud’s, problems with swallowing (esophagus), sclerodactyly (thickening of the skin), and telangiectasia. It may actually eat away bone when the disease is active.

When the diagnosis of the more serious Raynaud’s phenomenon is entertained, a series of specialized blood tests looks to determine the underlying cause. An X-ray of the thoracic outlet, sedimentation rate, CBC, antinuclear cytoplasmic antibody, antinuclear factor (ANF), cryoglobulins, and cold agglutinins blood testing is drawn. An angiogram may have to be performed to look for obstructing lesions. Gangrene and progressive internal organ damage are late and very damaging signs of the disease.

In assessing Raynaud’s phenomenon, underwriters look first and foremost for an underlying condition that may significantly affect mortality. The severity must be assessed, as well as any underlying complications, and prompt and effective treatment. Most simple cases of Raynaud’s disease do not result in any rating and preferred status is available. Raynaud’s phenomenon however is underwritten according to the severity and prognosis of the underlying disease, which may result in rating or decline.

MD, FACE, FLMI, board certified internist and endocrinologist, is medical director for SBLI of Massachusetts. He has extensive brokerage and life insurance experience over 30 years with Pacific Life, MetLife Brokerage and Transamerica Occidental Life.

Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World from 1991 to September, 2021.

Goldstone can be reached by ­telephone at 949-943-2310. Emaill: drbobgoldstone@yahoo.com.