Raynaud's syndrome: symptoms and treatment

Reynaud's syndrome is a pathological condition known to medicine since 1862. It is based on paroxysmal spasm of the blood vessels of the peripheral parts of the extremities, the face. Spasm occurs, for example, in response to cold, vibration or severe stress. As a result, a person feels pain in the place of spasm, numbness, a feeling of crawling. The affected area becomes white at first, and then turns blue. The skin becomes cold by touch. When the attack ends, the skin becomes red, and heat is felt in this area. With the long existence of the disease, trophic disorders develop. To confirm the diagnosis, a thorough examination of the patient with the use of instrumental methods of investigation is necessary. The treatment of Reynaud's syndrome is complex, requires the use of medical and physiotherapy methods. Sometimes even surgical intervention is advisable. Let's talk in more detail about the causes, symptoms, methods of diagnosis and ways of treating Reynaud's syndrome.

The disease is not accidentally called Raynaud's syndrome. "Reynaud" - in honor of the French doctor Maurice Reynaud, who first described this condition. But the term "syndrome" with respect to this situation is of a collective nature, as it reflects the following fact: the clinical manifestations are most often the result

otherdiseases. And there are a lot of such diseases (according to the latest data - more than 70). Along with the formulation "Reynaud's syndrome" in medicine there is the concept of "Raynaud's disease." Raynaud's disease has the same clinical signs as the syndrome, but there is no apparent cause (or so they say, when the cause can not be established), that is, this is the primary condition. According to statistical data, Raynaud's disease accounts for about 10-15% of all cases, and the syndrome - 85-90%. Therefore, the term "syndrome" is used more often than "disease".

Causes

The main cause of Reynaud's syndrome is a sudden vascular spasm, as a result of which blood flow, nutrition and tissue trophism are disturbed. With Raynaud's disease, the origin of spasm for the medical profession is still a mystery, but Reynaud's syndrome, as a secondary condition, most often occurs when:

• connective tissue diseases (systemic lupus erythematosus, scleroderma, rheumatoid arthritis, dermatopolymiosis, nodular periarteritis, thromboangiitis obliterans, Sjogren's disease and so on);
• vascular diseases (obliterating atherosclerosis, thrombophlebitis);
• blood diseases (thrombocytosis, cryoglobulinemia, multiple myeloma, paroxysmal hemoglobinuria);
• oncological and endocrine diseases (paraneoplastic syndrome, pheochromocytoma, increased thyroid function, diabetes mellitus);
  exposure to harmful environmental factors (vibration, chronic intoxication with chlorovinyl, polyvinyl chloride, heavy metals, the use of certain medicines, such as adrenergic receptor blockers (Propranolol, Metoprolol, Egilok and others), antitumor drugs (Vincristine, Cisplatin), ergotamine (Nomigren), serotonin);
• neurological diseases (the consequences of strokes in the form of plethysy (lack of muscle strength) in the limbs, carpal tunnel syndrome, lesions of intervertebral discs, syndrome of anterior staircase and so on).

Because Raynaud's syndrome has a paroxysmal course (vascular spasm occurs from time to time), that is, a number of factors provoking its manifestation. They include:

• exposure to cold: for the occurrence of a characteristic attack of Raynaud's syndrome, 10 minutes of freezing or prolonged washing of hands under cold water is sufficient;
• smoking;
• emotional overstrain.

It is assumed that not the least role in the onset of Reynaud's syndrome has a genetic predisposition.

Symptoms

Raynaud's syndrome is much more common in female patients (about 5 times more often than in men). In general, the first manifestations of the disease occur already at a young age - from 15 to 30 years, in 25-27% of cases - after 40 years. It is estimated that about 3-5% of the world's population suffers from this ailment. Naturally, in countries with a walking climate, the disease is much more common.
For Raynaud's syndrome, paroxysmal course and staging are characteristic. As the spasm seizes the peripheral vessels, the symptoms often appear in the hands, rarely in the feet, the tip of the nose and tongue, the chin, and the earlobes. How is the typical attack of Raynaud's syndrome? Let's find out.

As a result of vasoconstriction (vasoconstriction), the blood flow in the peripheral regions (more often it is for example the index and ring fingers) slows down. The blood circulates worse, which is accompanied by a blanching of the fingers (up to the color of the alabaster). Poor blood supply causes a lack of nutrition of tissues, a metabolic disorder at the local level, which is accompanied by pain. Along with pain (or instead of it) there may be numbness, tingling, crawling sensations in the fingers, which is also associated with a deficiency of nutrients. The skin feels cold to the touch. On average, this condition lasts about 10-15 minutes. Then the phase of vasoconstriction is replaced by the second phase, cyanotic (cyanotic).

The cyanotic phase has this name due to the changing color of skin subjugation: blanching of fingers is replaced by their cyanosis. This is due to the stagnation of blood in the veins, which have a bluish tinge. Vein overflows with blood and causes, as it were, blue fingertips. The fingers of the hands remain cyanotic until the spasm of the arteries is over. The second phase is more associated with a feeling of numbness and tingling, rather than with a pain syndrome. Pain sensations in this phase are dulled, compared with the first phase. The duration of the second phase ranges from several minutes to several hours. Then comes the third phase - the phase of vasodilation (vasodilation). It is also called reactive hyperemia due to changes in the color of the skin from cyanotic to red.

The third phase occurs after the disappearance of spasm of blood vessels. The blood flow resumes with the same force, the stagnant blood from the veins is pushed out further along the course of the blood stream in fresh portions, the tissues are restored. This is all accompanied by reddening of the skin of the fingers, a sensation of heat, an increase in the skin temperature of this area. Pain sensations and other disorders of the sensitive sphere disappear. After some time, the skin acquires a normal color.

The above three-phase course of an attack of Raynaud's syndrome is classic, but far from always occurring in such a form. In real life, the picture is not always complete. Usually the initial stages of the disease proceed only in the form of an insignificantly expressed first phase, when the vasospasm is not yet so strong. Gradually, as the process progresses, two other stages appear, but their severity can vary individually. The duration of the attack is also subject to significant fluctuations: from 10-15 minutes to several hours. The frequency of seizures varies from several a year to daily. Much depends on the reactivity of the body, the cause of Raynaud's syndrome and the duration of its existence, the presence of concomitant diseases. The lesion area also tends to increase as the disease progresses: after an unnamed and the index fingers are drawn into the hands completely, similar changes are added in the feet, on the face. Interesting (and so far incomprehensible to physicians) is the fact that the thumb of the hand is not involved in the pathological process of Raynaud's syndrome.

The Raynaud's syndrome is not as harmless as it might seem at first glance. Periodically occurring spasm of blood vessels still does not pass without a trace. Functional disorders without timely treatment are replaced by organic ones. What does this mean? This means the following: a disturbance of blood flow sooner or later leads to the development of trophic disorders. Trophic changes no longer have a paroxysmal character, they are permanent, which considerably overshadow the patient's life. Fingers swell, the skin crackles, there are long-lasting non-healing sores, often there are panarits. In severe cases, necrosis (death) of surface tissues with their rejection is possible, and gangrene develops (and then the surgeon can not do without!). Of course, the stage of trophic disturbances is the result of a far-reaching process, which, to date, is rare.

In the clinical course of the syndrome and Raynaud's disease there are some differences. Most often, Raynaud's disease occurs at a young age, proceeds with a symmetrical lesion of the extremities, trophic changes develop quite rarely. Raynaud's syndrome can be accompanied by a significant asymmetry in the lesion (for example, one finger on the left hand and the entire hand right), progresses faster (which is due to the presence of the primary source of clinical manifestations, the main disease).

In addition to changes in peripheral tissues, patients with Raynaud's syndrome can make complaints about fluctuations in the arterial pressure, pain in the region of the heart and abdomen, pain in the spine, sleep disorders, migraine headaches.

Diagnostics

The characteristic clinical picture of Raynaud's syndrome usually does not cause difficulties in the diagnostic plan. However, to confirm the presence of this disease, one of the following examination methods is necessary: ​​capillaroscopy, rheovasography, ultrasonic dopplerography. These instrumental methods allow us to confirm the vasospasm. Spasm of blood vessels can be caused by a cold test (immersion of fingers in cold water for several minutes). Recently, such a diagnostic method as the wide-field capillaroscopy of the nail bed has come to the forefront, as this study allows a detailed study of the microvascular bed. In addition to instrumental diagnostic methods, a general blood test, a coagulogram (determination of the parameters of the blood coagulation system), and immunological parameters of the blood are examined. The majority of m events are conducted with the aim of establishing the causal factor: it is necessary to find out whether this syndrome or Raynaud's disease. And if this is Raynaud's syndrome, then, first of all, it is necessary to treat the underlying disease that has become a source of clinical manifestations.

Treatment

Getting rid of Raynaud's syndrome begins with the treatment of the underlying disease. Without such therapy, all ways of influencing Raynaud's syndrome will be powerless. If the cause is not found yet, then symptomatic treatment is performed.

Patients with Raynaud's syndrome should stop smoking, drinking alcohol, avoid exposure to professional harmfulness (vibration, heavy metals and the like), less supercooled and less nervous. Sometimes people even need to change their place of residence: move to a zone with a warmer climate. In the initial stages of the disease, only these preventive measures can be said to be sufficient for the disappearance of the symptoms of the disease. Otherwise, resort to medical therapy.

From drugs for the treatment of Raynaud's syndrome use:

• calcium antagonists (Nifedipine, Verapamil, Diltiazem, Corinfar), which prevent the occurrence of vasospasm, reducing the accumulation of calcium in the vessel wall;
• antiplatelet agents and vasodilators (Pentoxifylline, Dipiridamol, Vazaprostan, Reopoligyukin, Xanthinol nicotinate, Fentolamine and others), which prevent blood clots and improve microcirculation in tissues;
• antispasmodics and analgesics, non-steroidal anti-inflammatory drugs (No-shpa, Platifillin, Diclofenac, Ibuprofen, Meloxicam and others) that relieve pain and inflammation. Nonsteroidal anti-inflammatory drugs become the basis for the treatment of Raynaud's syndrome in connective tissue diseases, in such cases they are prescribed for long-term use;
• inhibitors of the angiotensin-converting enzyme (Captopril, Enalapril and others);
• selective blockers of HS2-serotonin receptors (Ketanserin).

The effectiveness of the use of medicines increases with the simultaneous use of physiotherapy methods. It can be electrophoresis with various medicinal products (with nicotinic acid, Euphyllinum, Papaverin and others), mud applications, applications with dimexid, magnetotherapy, carbon dioxide, radon and sulphide baths, laser therapy, transcranial electrostimulation. Many patients are helped by acupuncture, hyperbaric oxygenation. Massage of the affected limbs is indicated. In some cases, resort to psychotherapy.

There is also surgical treatment of Raynaud's syndrome, which is shown in case of disease resistance to complex medical and physiotherapeutic treatment. The essence of the procedure is the denervation of vessels that feed the affected areas. Such an intervention is called sympathectomy. In this case, with the help of a scalpel, the nerve fibers are cut through which an impulse takes place that causes a vasospasm. The expediency of this method of treatment is considered only in severe cases of Raynaud's syndrome. It is worth noting that among doctors there is another point of view on this method of treatment. The fact is that in a number of cases, several months after surgical treatment, the symptoms of the disease return again, and therefore this method of treatment is not considered effective. And, of course, without the help of a surgeon can not do when trophic disorders lead to gangrene.

One of the new and modern methods of treating Raynaud's syndrome is the treatment with stem cells. The time will show the safety and long-term results of such a technique.

At the time of an attack with Raynaud's syndrome, the patient as a first aid measure can recommend drinking a hot drink (for example, weak tea), warm the affected limb in warm water (a bath), rub the skin with a soft cloth (like a flannel). All this will promote the expansion of blood vessels and the restoration of blood flow in the affected area, and therefore, the cessation of the attack.

Raynaud's syndrome is not life threatening. In some cases, the disease suddenly goes into the stage of remission spontaneously. It is important to determine the cause of this pathology, since the underlying disease can be more severe and, without treatment, lead to irreversible effects on the body.

Thus, summing up the above, we can say that Reynaud's syndrome is a multifaceted problem of modern medicine. All the causes and mechanisms of pathological changes in the body with this disease have not yet been fully understood, but one thing is certain: this ailment is not terrible if we fight it. Complex treatment in most cases causes the disease to recede. Be attentive to yourself, at the first suspicion of Raynaud's syndrome, contact qualified specialists to take the necessary measures in time.

European clinic Sienna-Med, lecture of a specialist on the topic "Clinic, diagnosis and treatment of Raynaud's syndrome":