Raynaud's disease is a disease in which the arterial blood supply of the hands or feet is disturbed. The disease is paroxysmal and usually affects the upper limbs symmetrically. Women are sick more often than men.
As a rule, Reynaud's syndrome is a secondary phenomenon that develops in various diffuse connective tissue diseases( primarily scleroderma), cervical spine, peripheral nervous system( gangliopathy), endocrine system( hyperthyroidism, diencephalic disorders), digital arteritis, arteriovenous aneurysms,additional cervical ribs, with cryoglobulinemia.
If there are no specific reasons for the development of Raynaud's syndrome, then talk about Raynaud's disease, her indispensable symptom is the symmetry of the lesion of the limbs.
Causes of Reynaud Syndrome
Why does Raynaud's disease occur, and what is it? For the first time this disease was described by the French physician Maurice Reynaud in 1862.He noticed that the hands of many women who daily had to wash clothes in cold water had a cyanotic color. The female workers complained of frequent numbness and unpleasant tingling in the fingers.
Reynaud concluded that prolonged cooling of the hands leads to prolonged vasospasm and circulatory disorders. However, the French doctor and his followers did not succeed in revealing the mechanism of the disease development.
However, there are factors that can contribute to the onset of the disease. These include:
- Disorders of the endocrine system;
- Frequent stressful situations;
- Constant supercooling of the limbs;
- Professional factors( such as vibration);
- Injury to fingers;
- Any rheumatic diseases( these include rheumatoid arthritis, systemic lupus erythematosus, nodular periarthritis and some other disorders);
- Autoimmune hemolytic anemia with complete cold antibodies.
- Hereditary factor.
The disease manifests itself periodically under the influence of provoking factors - negative emotions or low temperatures. It is necessary for a person to go out into the cold or to be nervous, as there is a spasm of small arterial vessels of hands( less often - a stop, ears, nose).The fingers are white, they have a feeling of numbness, tingling, sometimes pain.
Symptoms of Raynaud's Disease
Depending on the stage of Raynaud's syndrome, the symptoms of the disease will progress( see photo):
- Angiospastic .There are short-term cramps of the vessels of the terminal phalanges of the fingers of the hands( usually the 2nd and 3rd), and less often - the third toe of the fingers. Spasms are quickly replaced by the expansion of blood vessels with reddening of the skin and warming of the fingers.
- Angioparallel .It is characterized by frequent attacks that occur for no apparent reason and last for an hour or more. At the end of the attack, the phase of cyanosis develops - a blue-violet staining appears with consequent hyperemia( redness) and a slight swelling of the affected area.
- Tropharopathy .Constantly increasing attacks with a long time of spasm lead to the fact that the structure of the skin of the extremities is disturbed. On the fingers can be formed heavily healing ulcers and necrosis of skin areas. Sometimes patients even begin gangrene. This stage is called trophoparalytic and is the most serious stage of Raynaud's disease.
In the case of Raynaud's disease, the earliest symptom is the increased chilliness of the fingers - more often the hands, which are followed by blanching of the terminal phalanges and pain in them with elements of paresthesia. These disorders have a paroxysmal character and disappear completely after the attack.
The distribution of peripheral vascular disorders does not have a strict pattern, but more often it is the II-III fingers of the hands and the first 2-3 toes of the feet. The distal parts of the arms and legs are involved in most of the process, and the other parts of the body, earlobes, and the tip of the nose, are much less involved.
The course of the disease is slowly progressing, however, regardless of the stage of Raynaud's syndrome, cases of reverse development of the process are possible - at the onset of menopause, pregnancy, after childbirth, changes in climatic conditions.
Diagnosis of Reynaud Syndrome
With Raynaud's syndrome, diagnosis is based primarily on patient complaints and objective data, as well as on additional research methods. During the diagnosis, capillaroscopy of the patient's nail bed is performed. It allows you to visualize and study the functional and structural changes in the arteries of the extremities. Another stage in the diagnosis of Raynaud's disease is cold tests to assess the state of the limbs after immersion in water with a temperature of 10 ° C for 2-3 minutes.
Also in Raynaud's disease, the diagnosis includes evaluation of the following criteria:
- level of circulatory disorders in the limbs,
- symmetry of the sites with angiospasm,
- presence of other phlebological diseases,
- duration of manifestation of Raynaud's symptoms at least 2 years.
Laboratory methods used in the diagnosis of Raynaud's syndrome:
- general blood test;
- biochemical blood test;
- coagulogram( blood clotting parameters);
- Immunoassays( immunity studies);
- general urine analysis.
Diagnosis of this disease is established using clear medical criteria. Attention is drawn to vascular spasm, which occurs during the action of cold or stress, the symmetry of manifestation of the symptoms of the disease and the recurrence of spasms, which has been present for several years.
Treatment of Reynaud's disease
When symptoms of Raynaud's disease appear, treatment can be divided into two groups - conservative and surgical.
- Conservative methods of include the use of vasodilator drugs( eg, phentolamine).Drug therapy with Raynaud's disease continues throughout the life of the patient. It should be noted that with prolonged use of these drugs, complications inevitably develop.
- When attacks of angiospasm of the extremities become not sensitive to vasodilator drugs, is recommended. Surgical treatment of Raynaud's disease - sympathectomy .It consists in removing or arresting the nerve fibers of the sympathetic trunk causing arterial spasms. The least traumatic type of surgical treatment of Raynaud's disease is endoscopic sympathectomy. During it, the patient under general anesthesia is given a clip on the sympathetic trunk in the chest or neck area.
An important part of treating Raynaud's disease is limiting the patient's contact with provoking factors. With a high negative emotional load, sedatives should be taken. If you need to contact a cold and damp environment, you should dress warmer than usual, especially carefully warm your hands and feet.
If the specialty assumes long or even short-term work in the street in any weather, the question of changing working conditions should be raised. The same applies to the work associated with a constant nervous tension.
A new word in the treatment of Raynaud's syndrome is stem cell therapy, aimed at normalizing peripheral blood flow. Stem cells promote the discovery of new collaterals in the vascular bed, stimulate the regeneration of damaged nerve cells, which eventually leads to the cessation of paroxysms of vasoconstriction.
Forecast
In Raynaud's syndrome, the prognosis depends on the progression of the underlying pathology. The course of the syndrome is relatively favorable, attacks of ischemia can spontaneously stop after changing habits, climate, profession, sanatorium treatment, etc.
Prevention of
To prevent an attack, certain precautions should be taken, eliminating provoking factors:
- smoking;
- supercooling;
- work related to the stress of the hands;
- contacts with chemicals that are the root cause of vascular spasms.
When, after stress or hypothermia, a person feels numbness in fingertips and sees a change in the shade of the skin of the limbs, it is necessary to show the doctor. Do not self-medicate. Harmless at first glance, pathology can lead to irreversible effects in the body.