Raynaud's disease (syndrome)
Content:
- Raynaud's disease symptoms
- Causes of Raynaud's disease
- Diagnosis of Raynaud's disease
- Raynaud's disease treatment
Raynaud's disease is a disease from the group of angiotrophoneuroses, which is characterized by acute disturbance of arterial circulation in limited areas of the body (in the feet and hands). The disorder develops as a result of the influence of exogenous and endogenous factors. Raynaud's disease is also called angiotrophoalgic syndrome, vascular-trophic neuropathy, vasomotor neurosis.
The disease is more common in countries with cold climates. 5 times more often it affects female representatives aged 40 to 50 years.
It is necessary to distinguish Raynaud's disease from Raynaud's syndrome, since despite the similarity of symptoms, they differ in etiological factor. The fact is that after Maurice Reynaud described the signs and etiology of the disease, it was found that it can develop as an independent disease due to dysfunction of the central nervous system, and can act as a syndrome of some other pathologies. This is the reason for the difference between the two concepts.
Raynaud's disease symptoms
The symptoms of Raynaud's disease can be considered depending on the stage of the pathological process:
Symptoms of the first stage of Raynaud's disease. The affected area can be the surface of the feet or hands, and sometimes the auricles, lips, nose, begin to turn pale, become cold when touched. Sensitivity in the affected area disappears, or significantly decreases.
The duration of an attack varies widely and can take from a minute to several hours. As the vasospasm is removed, the skin returns to its normal state.
The frequency of occurrence of attacks varies, but they will be repeated more often, the more the disease progresses. Over time, in addition to a violation of sensitivity, a person will begin to experience pain.
Paresthesia, cold fingers, whitening of the skin at this stage most often occur as a result of exposure to cold, due to excitement, when smoking, etc.
Symptoms of the second stage of Raynaud's disease (angioparalytic). At this stage, in addition to vasospasm, the phenomena of asphyxia are added. During an attack, the skin acquires a blue-violet color, in parallel there are severe pains, sensitivity completely disappears. After the end of the attack, the skin on the affected areas becomes bright red, and a vascular pattern in the form of a mesh is possible.
To start an attack at the second stage of the development of the disease, there is no longer any need for the influence of any factor; it occurs spontaneously and lasts a long time.
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Symptoms of the third stage of Raynaud's disease (trophoparalytic). Asphyxia increases over time, resulting in blisters appear on the affected cyanotic and edematous areas of the body. Bloody contents can be seen inside them. When the bladder opens, areas of necrotic tissue are found under it. If the disease is severe, muscles may be damaged, down to the bone. Over time, the ulcerated surface is scarred.
The first and second stages can last from 3 to 5 years. If the affected area is the palms or the surface of the feet, then a combination of symptoms of all three stages at the same time is often observed.
Raynaud's disease has a tendency to relapse. The difference between the disease and the syndrome in terms of the severity of the symptoms lies in the fact that in the syndrome, gangrene of the affected area is more often observed, trophic disorders are more pronounced, areas of necrosis are formed, damage to the nail plates and their deformation join.
Causes of Raynaud's disease
The causes of Raynaud's disease cannot be considered separately from the mechanism of development of the disease. It is based on violations of the organic and functional plan, affecting both the vascular walls and the apparatus responsible for their innervation. As a result, a violation of the nervous regulation of blood vessels occurs, so they react to various influences with spasms, followed by increasing atrophy.
Rein's syndrome causes:
- Autoimmune diseases affecting connective tissue: systemic lupus erythematosus, systemic scleroderma, rheumatoid polyarthritis nodosa, rheumatism, Sjogren's syndrome, dermatomyositis, periarteritis.
- Vascular diseases are Takashyu's disease, atherosclerosis obliterans of the legs, etc.
- Lesions of peripheral nerves in the presence of diabetes mellitus (polyneuropathy).
- Intoxication of the body with lead, arsenic salts, cytostatics and ergotamine.
- Violations of blood viscosity: cryoglobulinemia, polycythemia vera, Waldenstrom's macroglobulinemia.
- Osteochondrosis of the upper thoracic and cervical spine.
- Prolonged exposure to vibration with the development of vibration disease.
- Lack of autonomic nervous regulation - syringomyelia.
- Disorders in the functioning of the adrenal glands, thyroid and parathyroid glands.
- Less commonly, Rein's syndrome provokes an accessory cervical rib syndrome, carpal tunnel syndrome, and scalene anterior muscle syndrome.
In turn, the causes of Raynaud's disease lie in the pathologies of the central nervous system and the spinal cord with the involvement of the hypothalamus, brain stem and cortex in this process. These pathological processes lead to the fact that the impulses that regulate the work of blood vessels are transmitted with impairments.
Diagnosis of Raynaud's disease
Diagnosis of Raynaud's disease is reduced to the analysis of patient complaints, and is also based on the collection of anamnesis. The primary role is played by an inadequate reaction with a change in the color of the skin of the feet and palms to the effects of cold. Asbestos whitening of limited skin areas when exposed to low temperatures is observed in 78% of cases in patients with Raynaud's disease.
The following diagnostic criteria for assessing the patient's response to a cold test in the period between attacks have been identified:
- The skin does not change color - the syndrome is not confirmed;
- The skin changes color, there is a feeling of numbness, paresthesia - there is a possibility of a syndrome;
- The skin changes color to bluish, followed by redness, attacks are repeated - the syndrome is confirmed.
In addition, the following instrumental examination methods are used, such as: thermography of the affected area, Doppler flowmetry, angiography of the peripheral vascular bed, capillaroscopy of the vessels of the anterior surface of the organ of vision and the nail bed.
In order to identify a patient's Raynaud's disease or Raynaud's syndrome, the following differential features are used:
| Raynaud's syndrome | Raynaud's disease | |
| Age of disease onset | 30 years and older | Doesn't matter |
| Systemic connective tissue disease | Revealed lupus erythematosus, scleroderma, etc. | No |
| Limb lesions are symmetrical | Yes | No |
| Trophic changes, necrosis, tissue atrophy | There are | Absent |
| Capillary results | There are morphological changes in the microvascular pattern | No changes |
| ESR | Increased | Within normal limits |
| ELISA of blood for antinuclear antibodies | Positive | Negative |
| The presence of vascular spasms (crises) in the lung tissue and kidneys | There are | Absent |
| Cold test plethysmography | Pressure reduced | The pressure is normal, or slightly reduced |
| Doppler flowmetry | Blood flow is greatly reduced | Within normal limits |
Raynaud's syndrome is confirmed by the presence of other diseases for which it acts as a symptom complex. Raynaud's disease is presented as a diagnosis if such diseases are absent, as well as on the basis of a thorough diagnosis.
Raynaud's disease treatment
Treatment of Raynaud's disease primarily comes down to eliminating all possible factors that contribute to the occurrence of spasms. These are smoking, hypothermia, exposure to vibration, and other exogenous influences.
It is important to establish the underlying disease that triggered Raynaud's syndrome, if such a diagnosis is confirmed. Depending on this, a person will be assigned a certain disability group. However, if the patient is incapable of working, then disability may be attributed due to Raynaud's syndrome.
Emergency assistance during an attack of vasospasm is reduced to the following:
- Protect a person as much as possible from the influence of a provocateur.
- Warm the affected area - perform a massage, offer the patient an abundant hot drink.
- Inject or take an antispasmodic drug orally (Platafillin, No-shpu, Drotaverin). For severe pain, an analgesic should be taken.
At the discretion of the attending physician, the following drugs are prescribed:
- Vasodilators based on nifedipine (Nifedipine, Cordaflex, Osmo-adalat, Corinfar, Cordipin, Nifecard, Fenigidin), as well as Nicardipine and verapamil-based agents (Isoptin, Finoptin, Verogalid).
- The drugs are angiotensin-converting enzyme inhibitors (Capoten, Captopril).
- Ketanserin as a blocker of the effects of serotonin.
- Preparations for normalizing blood composition, for improving its microcirculation - Trental, Agapurin, Pentoxifylline, Dipyramidol, Vasonit.
- Preparations from the group of lipid physiologically active substances - Vap, Vazaprostan, Alprostan, Caverject.
It is imperative to supplement conservative therapy with physiotherapy methods of treatment. Procedures such as galvanic baths, mud therapy, UHF, hyperbaric oxygenation, reflexology have proven themselves well. On the recommendation of a specialist, a complex of exercise therapy should be performed.
If conservative methods do not give an effect, then it is possible to carry out an operation - sympathectomy, or gangliectomy.
The progressive methods of treating Raynaud's syndrome include therapy with stem cells, which helps to normalize blood flow.
The prognosis for life is generally favorable, however, it largely depends on the progression of the underlying disease. In addition, spontaneous termination of ischemic attacks is possible with a change in lifestyle, after quitting smoking, with a change in climate and working conditions.
There are no primary preventive measures for Raynaud's disease, and secondary preventive measures are reduced to the maximum elimination of provoking factors.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".
