Raynaud ‘s syndrome is accompanied by a consistent change in the color of the fingers (pale blue-red), coldness, numbness, goosebumps and sometimes pains in the hands. In addition to the extremities, similar manifestations may occur in the area of the tip of the nose, chin, earlobes and tongue. The duration of the attack is usually 15-20 minutes.
Raynaud ‘s syndrome is more common in women, the first attack occurs usually up to 30 years. The syndrome is divided into primary – Raynaud’s disease – and secondary, developing on the basis of concomitant diseases.
The main cause of Raynaud’s primary syndrome is a violation of the mechanisms of regulation of vascular tone. Cold and stress – provoking factors of attacks.
The main factor in the development of secondary Raynaud syndrome is structural changes in the blood vessels that have developed due to certain diseases:
- Rheumatic diseases: systemic scleroderma, systemic lupus erythematosus , rheumatoid arthritis , dermatomyositis , Sjogren’s disease , mixed connective tissue disease, periarthritis nodosa, obliterating thromboangigitis et al.
- Vascular diseases: arteriosclerosis obliterans, postthrombotic or thrombotic syndromes.
- Blood diseases: paroxysmal hemoglobinuria, cryoglobulinemia, multiple myeloma, thrombocytosis.
- Infectious diseases: hepatitis B and C.
- Neurogenic Raynaud syndrome : compression of the neurovascular bundle with the development of algodystrophy , carpal tunnel syndrome, CNS disease with plegii .
- Prolonged immobilization, pheochromocytoma, paraneoplastic syndrome, primary pulmonary hypertension.
In addition, the causes of Raynaud’s secondary syndrome can be:
- professionalism features : “vibrating white finger”, chlorovinyl disease, etc.
- long-term medication: ergotamine, serotonin, beta blockers, anticancer drugs ( bleomycin , vinblastine and cisplastin ), etc.
The first place among the causes of the syndrome is rheumatic diseases, especially systemic scleroderma , where Raynaud’s syndrome is an early manifestation of the disease.
In the rays of the development of Raynaud ‘s drug syndrome, after discontinuation of the respective drugs, it usually disappears.
Among the professional factors against which Raynaud’s syndrome may develop , the most frequent are vibration, cooling and contact with PVC. However, other factors, such as work with heavy metals, silicon dust, should be taken into account when collecting a professional history in patients suffering from this disease.
Diagnosis of Raynaud’s syndrome is based on generally accepted and special methods of research, and the diagnosis of Primary Raynaud’s syndrome ( Raynaud’s disease ) is established when the following criteria are present:
- the onset of the disease before 30 years;
- symmetrical nature of the attacks;
- absence of necrosis on the surface of the fingers, ulcers;
- exclusion of the underlying disease at the time of the survey and confirmed in the process of further observation.
Laboratory and instrumental methods of diagnosis help to make the final differential diagnosis of primary and secondary Raynaud syndrome .
- Complete blood count (possible elevated or normal ESR), protein, protein fractions , fibrinogen – change in their proportions.
- Coagulogram , the study of blood properties (viscosity, hematocrit , gluing platelets and red blood cells) – for the diagnosis of blood diseases that can trigger seizures.
- Immunological research: antinuclear factor , rheumatoid factor , circulating immune complexes, immunoglobulins, antibodies to DNA and ribonucleoprotein – all this speaks for the presence of rheumatic diseases, that is, for the secondary nature of the pathology.
- Capillaroscopy: identification and clarification of the nature of vascular lesions.
- Chest X-ray: Identification of the cervical rib.
- Investigation finger blood flow by Doppler ultrasound, laser doppler – flowmetry , angiography, Digital Plethysmography.
In recent years, increased attention to the new modification of biomicroscopic research methods – wide-field capillaroscopy of the nail bed, which has a higher resolution in terms of detailing the structural changes in the nail bed, is used to diagnose Raynaud’s syndrome.
Treatment of the syndrome is a complex task, the solution of which depends on the possibility of eliminating the causal factors and effective influence on the leading mechanisms of the development of vascular disorders.
All patients with Raynaud’s syndrome are advised to eliminate cooling, smoking, and contact with chemical and other factors that provoke vascular spasm in everyday life and at work. Sometimes it is enough to change working conditions (exclude vibration, exposure to vinyl chloride, lead, arsenic, etc.) or place of residence (warmer climate), so that Raynaud syndrome manifestations significantly decrease or disappear.
Among vasodilator drugs, effective agents for the treatment of Raynaud’s syndrome are calcium antagonists.
- nifedipine ( corinfar, cordafen , etc.) is prescribed at 30-60 mg / day.
For the treatment of Raynaud’s syndrome, you can use other calcium blockers:
With progressive Raynaud syndrome , vazaprostan is recommended (prostaglandin El , alprostadil , iloprost ).
The initial effect of vazaprostan can appear after 2-3 intravenous infusions, but a more lasting effect is observed after the end of the course of treatment and is reflected in a decrease in the frequency, duration and intensity of Raynaud’s syndrome attacks , a decrease in chilliness, numbness and pain. The positive effect of vazaprostan is usually maintained for 4-6 months, it is recommended to repeat courses of treatment (2 times a year).
It is recommended to use nitrates (nitroglycerin) of local action (ointments, patches). They dilate blood vessels, acting directly through the skin.
Powerful drugs for vascular dilation are PDE-5 inhibitors ( sildenafil , tadalafil ). These drugs have serious side effects, in particular on the heart (in patients with heart rhythm disturbances and ECG changes). Therefore, it is necessary to adequately assess the possible risks from the use of this class of drugs.
To prevent vasospasm, alpha- blockers (prazosin) can be used . However, it should be used with great caution, since there is a high risk of a sharp drop in blood pressure.
Recently, good indicators have appeared with the use of statins ( atorvastatin ) and an inhibitor of a special enzyme, which is directly responsible for vascular spasm when exposed to cold ( fasudil ).
Ketanserin , a selective blocker of the HS2-serotonin receptors, is also used in the treatment of Raynaud’s syndrome ; appointed by 20-60 mg / day , usually well tolerated, can be recommended for elderly patients.
Of great importance in the treatment are drugs that improve blood properties, reducing viscosity: antiplatelet agents (aspirin 75-100 mg per day), anticoagulants (heparin), dipyridamole 75 mg or more per day; pentoxifylline ( trental , agapurin ) at a dose of 800-1200 mg / day orally and intravenously; low molecular weight dextrans ( reopoligljukin et al.) – intravenous infusion of 200-400 ml, in a course of 10 infusions.
It is necessary to take into account the need for long-term long-term therapy and often complex use of drugs of different groups.
Raynaud syndrome drug therapy is recommended to be combined with the use of other treatment methods (hyperbaric oxygenation, reflexotherapy, psychotherapy, physiotherapy).