Raynaud’s syndrome: symptoms, treatment, causes

Update: December 2018

The complex of symptoms characteristic of acute disorders
blood circulation in limited areas of the body, called
Raynaud’s syndrome. The frequency of the syndrome is higher in countries with cold
climatic conditions. It ranges between approximately 2 and
18%. The disease often affects middle-aged people (40 – 50
years), especially women (4 times more often than men).

Manifestations of Raynaud’s disease and symptoms of Raynaud’s syndrome are very similar.
between themselves. However, they differ in the reason that prompted them
occurrence, and sometimes localization. Great value in choosing
treatment methods has a differential diagnosis.

The mechanism of development and the clinical course of the syndrome

Development mechanism

Organic and functional disorders in
the structure of the vascular wall and the apparatus that innervates the vessels in
as a result, their nervous regulation changes. This is expressed in
bouts of pathological spasms (contractions) of vessels in response to
provoking factors which are mainly long lasting
exposure to cold, severe psycho-emotional reaction, smoking.
Localization – most often the tips of the fingers and toes, the tip of the tongue,
nose or ears, chin, patella area. Characteristic of
Reynaud syndrome of the upper extremities is the asymmetry of the lesion, and
symmetrical – more typical of Raynaud’s disease.

A significant decrease in blood flow to the tissue disrupts them.
trophism (nutrition), which is manifested in numbness and three-phase skin
reactions: blanching followed by cyanosis (blue-violet color
skin and nails) due to lack of blood and oxygen, bright
redness after the end of the “attack” as a result of a rush of blood.
Perhaps the appearance of a mesh vascular pattern. With subsequent
seizures may cause blisters with liquid, light or bloody
content and necrosis (necrosis) of tissues.

Accompanying illnesses

Raynaud’s syndrome, the causes of which are still not completely
studied, usually occurs when:

  • Autoimmune diseases with diffuse connective lesion
    tissues: systemic scleroderma and systemic lupus erythematosus,
    rheumatism and rheumatoid polyarthritis, dermatomyositis, Sjogren syndrome
    (autoimmune lesion of external secretion glands – sebaceous, salivary,
    sweat), periarteritis nodosa.
  • Vascular diseases: lower atherosclerosis obliterans
    extremities, non-specific aortoarteritis (Takayasu’s disease) and
    others.
  • Diseases accompanied by increased blood viscosity:
    cryoglobulinemia (the presence in the blood of “cold” proteins that fall in
    sediment under the influence of low temperature), polycythemia vera
    (absolute increase in blood mass of red blood cells), lesion
    lymphatic tissue, accompanied by high blood viscosity
    (Waldenstroma macroglobulinemia).
  • Syndromes of the carpal tunnel and anterior scalene muscle
    (seldom).
  • Osteochondrosis of the cervical and upper thoracic.

Unlike syndrome, Raynaud’s disease is a manifestation
diseases affecting the central nervous system at the level of the cortex
brain, hypothalamic region, trunk, spinal cord.
This leads to a violation in the centers of the formation of impulses to
vessels.

Contributing factors and symptoms

Development and provoking the disease contribute to: Raynaud's Syndrome: симптомы, лечение

  • prolonged effect of low temperature;
  • emotional stress and fatigue;
  • endocrine disorders (pheochromocytoma, hypothyroidism) and syndrome
    Down’s;
  • side effect of clonidine, beta-blocking, anticancer
    and some other drugs of peripheral action with
    their long reception;
  • vibration disease.

The clinical course of Raynaud’s syndrome, the symptoms of which
distributed in stages, proceeds as a progressive
process:

  • Stage I – angiospastic

– the occurrence of rare short-term, lasting in
few minutes of numbness of the skin expressed by her
blanching and reducing the temperature in the affected area with
subsequent pain breaking nature. At this stage it is possible
the establishment of a provoking factor – cold (washing hands, face or
body cold water), stress, smoking. At the end of the attack
no noticeable changes to these sections are noted.

  • Stage II – angioparalytic

– characterized by frequent seizures that occur without visible
causes and lasting for an hour or more. At the end of the attack
develops a phase of cyanosis – appear blue-violet staining with
subsequent marked hyperemia (redness) and slight
swelling of the affected area.

  • Stage III – Atrophoparalytic

– Dystrophic changes of the skin and nails are initially visible (with
fingers), small scars after small superficial
bubbles. After a long attack on the background of swelling and cyanosis
tissues appear bubbles with serous-bloody contents. After them
autopsy reveals dead (sometimes to the bone) tissue and
usually formed superficial, nonhealing, ulcer. Her
scarring can take a long time. When joining
secondary infection develops gangrenous process. In cases
heavy course of bone resorption occurs, followed by
deformation of the fingers.

Duration of I and II stages is 3 – 5 years. If a
the process occurs on the hands or feet, you can often see
symptoms of all three stages at the same time.

Diagnostics

In Raynaud’s syndrome, diagnosis is based mainly on complaints.
patient and objective data, as well as on additional methods
research. This takes into account inadequate sensitivity to
cold factor (first of all) and color change
affected areas. It is the whitening of the skin that is characteristic and
occurs in 78% of people with this syndrome. Recommended (British
a group of physicians studying systemic scleroderma) determine
the reliability of Raynaud’s syndrome depending on the reaction to cold
following features:

  • Raynaud’s syndrome is absent – skin color does not change;
  • the likelihood of having the syndrome – a change in the color of the skin wears
    single phase and accompanied by numbness or paresthesia
    (disorder of sensitivity);
  • reliable – discoloration of the skin occurs in two phases;
    besides, attacks are repeated.

The reliability and degree of vascular lesions are also determined with
using instrumental methods: capillaroscopy of nail vessels
bed, color Doppler scanning, thermography of the affected area
(the rate of recovery of the original skin temperature after
cooling).

Differential diagnosis of Raynaud’s syndrome and disease:

Symptoms
Raynaud’s Syndrome
Raynaud’s Disease
age over 30 years old в любом ageе
signs of connective tissue diseases (scleroderma, red
lupus and others.)
are characteristic absent
symmetry of defeat uncharacteristic is characteristic
ulceration, tissue necrosis, gangrene Yes not
СОЭ (скорость осеYesния эритроцитов) high fine
enzyme immunoassay for the presence of antinuclear blood
antibodies
positive negative
capillaroscopy (study of the vascular bed) – the most
informative study
deformation of capillary loops, their reduction (neglect) изменения absent
the possibility of vascular crises in the internal organs
(lung, kidney)
Yes not
плетизмография (измерение Yesвления в пальцевой артерии) после
local cooling
Yesвление снижено на 70% и более not changed or reduced slightly
blood flow velocity assessment by laser scanning
Doppler
 very reduced  not reduced

The final diagnosis of Raynaud’s disease can only be made.
as a result of a thorough examination. If a не выявлено других
diseases that caused the occurrence of the symptom complex,
устанавливается диагноз «Raynaud’s Disease».

Treatment

With синдроме рейно инвалидность выYesется в основном в связи с
the main disease (rheumatism, scleroderma, etc.). Но иногYes,
if the patient cannot do the work associated with his
the disability is possible in connection with the syndrome
Rayno II or III stage.

Persons with Stage III Reynaud syndrome are not suitable for military service,
at stage II – limited suitable, at stage I – subject
appeal.

Providing emergency assistance during an attack consists in:

  • Eliminating the factor that triggered the attack
  • Warming the affected area – Massaging
    woolen cloth, hot drink
  • Taking or injecting vasodilators and analgesics
    drugs, antispasmodics (drotaverine, no-spa, platifillin).

With Raynaud’s syndrome, treatment is long lasting. First
it is directed to the treatment of the underlying disease, which
caused the occurrence of the symptom complex.

Smoking should be avoided and exposure should be avoided.
provoking factors at work and in living conditions – contact with
cold air and cold water, vibration effects,
long work on a computer keyboard and with heavy
metal products, contact with various chemical
production substances, psychological stress.

Drugs prescribed:

  • vasodilator action (antagonists and channel blockers
    кальция) — нифедипин (Коринфар, Кордипин, КорYesфлекс, Кальциград,
    Нифедипин, Нифекард, Осмо-аYesлат, Фенигидин), никардипин, верапамил
    (Isoptin, Finoptin, Verogalid)
  • ACE inhibitors – Captopril, Capoten
  • serotonin receptor blockers – ketanserin
  • prostaglandins – Vazaprostan, Vap, Kaverdzhekt, Alprostan
  • improves the physico-chemical properties of blood and microcirculation –
    Агапурин, Трентал, ДипириYesмол, Пентоксифиллин, Вазонит

Drug treatment must be combined with
физиотерапевтическими и notрадиционными виYesми лечения.
Physiotherapy – UHF, mud therapy, hyperbaric oxygenation,
galvanic baths, physiotherapy, reflexotherapy. With
inefficiencies conducted by drug and
physiotherapy treatment possible surgical intervention
– Sympathectomy. One of the modern methods of treating syndrome
Raynaud is a therapy with stem cells that
contribute to the normalization of peripheral blood flow.

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