DO YOU HAVE RAYNAUDS DISEASE?
BACKGROUND:
It is named for Maurice Raynaud (1834 - 1881),a French physician who first described it in 1862
WHAT IS RAYNAUDS DISEASE?:
It is a vascular disorder[1] that affects blood flow to the extremities (the fingers, toes, nose and ears) when exposed to cold temperatures or in response to psychological stress.
WHAT IS THE FREQUENCY AND COMMON AGE GROUP?:
Raynaud's disease affects 5-10% of young women in temperate climates. The condition is often familial and usually appears between the ages of 15 and 30 years.
WHAT ARE THE USUAL SYMPTOMS?
The symptoms include several cyclic color changes:
- On exposure to cold temperatures, the blood supply to the fingers or toes, and in some cases the nose or earlobes, is markedly reduced; the skin turns pale or white (called pallor), and becomes cold and numb.
- When the oxygen supply is depleted, the skin colour turns blue (called cyanosis).
- These events are episodic, and when the episode subsides or the area is warmed, the blood flow returns and the skin colour first turns red (rubor), and then back to normal, often accompanied by swelling and tingling.
All three colour changes are observed in classic Raynaud's disease. However, not all patients see all of the aforementioned colour changes in all episodes, especially in milder cases of the condition. Symptoms are thought to be due to reactive hyperemias of the areas deprived of blood flow.
WHAT IS PRIMARY RAYNAUDS PHENOMENON?
This is also called Raynaud's disease.It does not progress to ulceration or infarction and significant pain is unusual. No investigation is necessary and the patient should be reassured and advised to avoid exposure to cold, in the first instance. Treatment with a long-acting preparation of nifedipine may also be helpful. The underlying cause is unclear. Sympathectomy is not indicated.
WHAT IS SECONDARY RAYNAUDS DISEASE?
This is also known as Raynaud's syndrome and tends to occur in older people in association with connective tissue disease (most commonly systemic sclerosis or the CREST syndrome, vibration-induced injury (from the use of power tools) and thoracic outlet obstruction (e.g. cervical rib). In contrast to primary disease the condition is associated with fixed obstruction of the digital arteries; fingertip ulceration and necrosis are often present and pain is usual. The fingers must be protected from cold and trauma, infection requires treatment with antibiotics, and surgery should be avoided if possible. Vasoactive drugs have no clear benefit. Sympathectomy helps for a year or two. Prostacyclin infusions are sometimes beneficial.
HOW CAN YOU PREVENT?
Patients with Raynaud's disease should keep their extremities warm by wearing gloves and socks. Patients are advised to avoid stressful situations, touching of cold objects, and artificially cold environments, such as refrigerated or highly air conditioned spaces. Patients are also advised to avoid medications and foods that can constrict blood vessels, such as decongestants and caffeinated beverages, as well as smoking.
WHAT IS THE TREATMENT?
The severity of the disease runs from mild to severe. In people with mild cases, it may be just an annoyance. HeatBands and hand warmers may be used on the wrists to warm the blood flowing to the hands. More serious cases can require medical intervention due to the risks of gangrene and possible digital amputation.
A more recent treatment for severe Raynaud's is the use of Botox. The 2009 article [2] studied 19 patients ranging in age from 15 to 72 years with severe Raynaud's phenomenon of which 16 patients (84%) reported pain reduction at rest. 13 patients reported immediate pain relief, 3 more had gradual pain reduction over 1-2 months. All 13 patients with chronic finger ulcers healed within 60 days. Only 21% of the patients required repeated injections.
A 2007 article [3] describes similar improvement in a series of 11 patients. All patients had significant relief of pain.
Treatment for Raynaud's disease may include prescription medicines that dilate blood vessels, such as calcium channel blockers (nifedipine) or diltiazem. Fluoxetine, a selective serotonin reuptake inhibitor, and other antidepressant medications may reduce the frequency and severity of episodes.
Milder cases of Raynaud's can often be addressed by biofeedback[4] or other techniques to help control involuntary body functions like skin temperature. In severe cases, a sympathectomy procedure can be performed. Here, the nerves that signal the blood vessels of the fingertips to constrict are surgically cut. Microvascular surgery of the affected areas is another possible therapy.
REFERENCES
1.^ Raynaud disease at Dorland's Medical Dictionary
2. ^
3.^ Kumar, Vinay; Nelso Fausto, Abul Abbas (2004). Robbins & Cotran Pathologic Basis of Desease. Saunders. pp. 542. ISBN 0721601871.
4.^ Berlin, Al, Pehr K (2004). J Am Acad Dermatol 50 (3): 456–60. PMID 14988692.
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