The Reynaud phenomenon( Raynaud's disease, Raynaud's syndrome) - Causes, symptoms and treatment. MF.

The phenomenon of Reynaud is a marked reaction of the small blood vessels of the fingertips to the effects of cold or psychoemotional shock.

At the heart of the disease is a violation of the nervous regulation of vascular tone, resulting in a persistent narrowing of small vessels in response to external stimuli. The disease is most common in young people. Women are sick many times more often than men.

Causes of Reynaud's phenomenon

The Reino primary phenomenon is identified, or Reynaud's disease, which occurs on its own and occurs in 90% of cases( its causes are not known for certain, the inherent features of vascular responses to various external factors are considered to be an important predisposing factor)Reynaud, or Reynaud's syndrome , which is a complication of systemic diseases such as systemic scleroderma, systemic lupus erythematosus. In addition, Raynaud's syndrome develops in the defeat of the cervical spine, peripheral nervous system, endocrine system( hyperthyroidism, diencephalic disorders), finger arteritis, arteriovenous aneurysms, additional cervical ribs, and cryoglobulinemia.

Symptoms of Raynaud's disease and syndrome

Three stages are identified during the course of the disease:

• Angiospastic .For this stage, the paroxysmal narrowing of the vessels is characteristic, accompanied by marked clinical symptoms, followed by a period of complete well-being. In case of illness or Raynaud's syndrome, the vessels of the fingers are usually affected at the onset of the disease. A characteristic symptom of the disease at the time of the attack is a consistent change in the color of the skin under the influence of cold or emotional stress. At the beginning of the attack, the skin becomes pale, cold to the touch, after a while due to eating disorders, it becomes bluish.

Blurred fingers of the hand under the phenomenon of Raynaud

The attack lasts a few minutes. Then the blood flow is restored, puffiness and warming of the skin are observed. In this case, patients can complain about more or less severe pain in this area. After a while, the skin acquires a normal color, which is preserved until the next attack. After the end of the attack, many patients have a feeling of chilliness, tingling, and numbness of the fingertips, which after a while pass. In the early stages of the disease, external manifestations are recorded only on one or more fingers of the hand, further the area of ​​the lesion extends to all fingers of the hand, feet, as well as the tips of the nose, ears, and lips.

Very often, with Raynaud's disease, the disease stops at this stage, while Reynaud's syndrome usually has more dramatic consequences.

• Angioparatic stage .At this stage, seizures become more prolonged, numbness and blueing of the fingers can last several hours.

Cyanosis of the terminal phalanges of the fingers of the hand

During this time, patients complain of significant pain at the fingertips. Because of the violation of the blood flow there is swelling of the fingers. Persistent vasoconstriction leads to a disruption in the supply of tissues, which is manifested in the formation of small vesicles, in the place of which small scars form in the aftermath.

The first and second stage in Raynaud's syndrome lasts an average of 3-5 years.

• Tropharopathytic stage .The final stage of the disease is characterized by deep disturbances in the supply of surrounding tissues. At the fingertips there are long-lasting non-healing ulcers, foci of necrosis of tissues, with the infection joining gangrene develops.

Ulcer of the terminal phalanx of the 2nd finger of the hand with Raynaud's syndrome

Necrosis of the terminal phalanges of the fingers of the hand with Raynaud's syndrome

Quite often all three stages of the Raynaud phenomenon can be found in one person, including the neighboring fingers of one hand.

Symptoms similar to the symptoms of Raynaud's disease are also observed in diseases of endocrine glands, nervous system, weakening of immunity, as well as chronic poisoning with salts of lead and mercury, and prolonged exposure to vibration. In these cases, vascular disorders can be one of the first and most significant symptoms, so do not do self-diagnosis, see a doctor if you have the above symptoms.

Diagnosis and Diagnosis of Reynaud

In the diagnostic plan, it is very important to distinguish between Raynaud's syndrome and Raynaud's disease. For Raynaud's disease, the following diagnostic criteria are identified:

• symmetric finger lesion;
• absence of other vascular disease;
• absence of persistent disruption of nutrition of surrounding tissues( necrosis, ulcers, gangrene);
• no damage to the capillaries of the nail bed;
• lack of laboratory indicators specific for systemic diseases( antinuclear antibodies accelerated by ESR).

Diagnosis of Raynaud's disease or syndrome is significant when three-phase( pallor-cyanotic-redness) changes in the skin color of the last phalanx of the fingers during seizures. In other cases, the diagnosis is presumptive. In the presence of certain connective tissue diseases( systemic scleroderma, systemic lupus erythematosus), the diagnosis of Raynaud's syndrome becomes most probable.

Capillaroscopy is used to determine the condition of capillaries of the nail bed.

Picture of normal capillaries of the nail bed, obtained with capillaroscopy. Magnification 175 times

With the help of a microscope, the doctor evaluates the capillaries of the skin fold of the nail bed. The method is painless, no additional preparation for the study is required.

To simulate an attack and to detect skin color changes, a cold sample is performed. The patient's hand is immersed in water with a temperature of 10 ° C for 2-3 minutes and observes the skin condition in the dynamics.

Treating Raynaud's Disease

Today, if not completely cured, then significantly slow the progression of Raynaud's disease. Treatment of the disease is carried out by a rheumatologist. General recommendations are mainly aimed at lifestyle changes and include the following provisions:

• Avoid prolonged exposure to cold places. It is recommended to wear clothing that conserves heat( mittens, hat, warm underwear).
• The refusal to smoke, the use of caffeine-containing beverages is an indispensable component of successful treatment.
• It is necessary to avoid psychoemotional stresses, as well as to refrain from taking medications that have a stimulating effect on the nervous system( sympathomimetics, clonidine and others).
• Avoid exposure to vibration( grinder, blender, etc.);refrigerator, washing machine put on a rubber mat to soften the vibration.

First aid for an attack of

In case of an attack, it is recommended to take measures to warm the brush: put your hands in warm water, clamp in the underarm area, rub the fingertips, perform circular motions in the joints of the hand. Usually, these measures can restore the tone of the vessels.

Drug treatment for Raynaud's disease and syndrome

For the treatment of the disease, vasodilator drugs and antiplatelet agents( preventing platelet adhesion and clot formation) are now widely used. Of the vasodilators, the most common are calcium channel blockers( nifedipine, amlodipine).As an antiaggregant, pentoxifylline is used. In the case of infection of ulcers, the appearance of foci of necrosis shows surgical treatment.

With Raynaud's disease, the prognosis is favorable, as a persistent disruption of tissue nutrition is very rare. With Raynaud's syndrome, the nature of the course of the disease and the impact on the patient's quality of life are usually determined by the underlying disease.

Prevention of Raynaud's Disease

The first attacks of the disease may appear after the infection or the effect of provoking factors - fatigue, hypothermia, excessive firing. The development of Raynaud's disease is possible as a result of brain injury or a strong emotional shock. In favor of the neurological nature of the disease, the symmetry of the lesion also speaks: manifestations of the disease almost simultaneously capture the same areas on the right and left. But the physical load on fingers has a certain value - the disease often occurs in secretaries, pianists. It is necessary to avoid the above risk factors even for a healthy person.

Doctor therapist Sirotkina EV