Raynaud's syndrome is a complex of symptoms associated with spasm of peripheral vessels. It can be a separate disease or a sign of another pathology. Most often, painful manifestations are localized in the vessels of the hands. This syndrome is accompanied by blanching and blueness of the skin of the hands, pain and numbness. Such symptoms are caused by a sharp violation of the blood supply. In advanced cases, tissue necrosis occurs. Raynaud's syndrome in women is much more common than in men. Especially susceptible to this disease are young patients aged 20 to 40 years. The pathology was first described in 1862 by the French neuropathologist Maurice Reynaud. In honor of this doctor, this disease is named.
Causes of the Syndrome
Signs of Raynaud's syndrome develop due to vasospasm and impaired peripheral circulation. As already mentioned, fingers often suffer. In more rare cases, blood circulation is disturbed in the area of the feet, tip of the nose or chin.
The following causes of the development of the syndrome can be distinguished:
- autoimmune diseases accompanied by damage to the connective tissue;
- deviations in the work of the endocrine glands;
- vascular disorders and blood clots;
- diseases associated with professional activities;
- side effects of certain medications.
Vascular spasm usually develops after hypothermia or stress. Next, the main causes of the syndrome will be discussed in detail.
Raynaud's syndrome and disease
In medicine, it is customary to subdivide the concepts - syndrome and Raynaud's disease. If a patient has a peripheral vascular spasm as a secondary sign of existing pathologies, then doctors are talking about Raynaud's syndrome. If this symptom complex appears as a separate disease, then it is called Raynaud's disease. The causes of the primary pathology are not fully understood. It is assumed that it arises from a hereditary predisposition.
Autoimmune pathologies
Most often, the syndrome develops in patients with rheumatic autoimmune diseases. Ailments such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma cause damage to the connective tissue. Most patients with such pathologies have Raynaud's syndrome. The walls of the blood vessels consist of connective tissue, and its defeat leads to spastic phenomena.
Under the influence of cold or stress, patients have spasm of blood vessels and circulatory disorders. Most often, pathological manifestations (numbness, blanching of the skin, pain) are noted in the fingers and toes, as well as the nose and chin. This is due to the fact that blood does not enter the small vessels of distant parts of the body. Then cyanosis (cyanosis) is observed. Blood accumulates in the veins, they swell, which causes a bluish tint of the skin.
Endocrine disorders
The occurrence of the syndrome may be associated with a violation of the adrenal gland. In tumors of the brain layer (for example, pheochromocytoma), these glands produce an excessive amount of adrenaline and norepinephrine. Such hormones have a vasoconstrictive effect and can cause spasm of limb arterioles.
The thyroid hormone triiodothyronine also has a similar effect. Therefore, with hyperthyroidism, this syndrome is often noted.
Vascular diseases and circulatory disorders
Disturbance of peripheral circulation is often noted with vasculitis and periarteritis nodosa. Inflammatory and degenerative processes in the vessels lead to their spasm. As a result, the blood supply to the upper limbs is disturbed.
The syndrome is also observed with blood clots. Blockage of blood vessels significantly complicates blood circulation. As a result, the nutrition of tissues in distant parts of the body is disrupted.
A special case of thrombosis is cryoglobulinemia. With this pathology, blockage of blood vessels occurs only under the influence of low temperature. This is due to the formation of special "cold" proteins, which provoke thrombus formation. As soon as a person is in a warm room, blood clots resolve.
Taking medication
Medication with an adrenaline-like effect can also provoke the onset of the syndrome. This primarily concerns drugs for high blood pressure. Adrenoblockers possess this property: Propranolol, Metoprolol. These drugs dilate the coronary vessels, but constrict the peripheral vessels.
Medications for migraine also have a vasoconstrictive effect: Nomigren, Syncapton. With a tendency to spastic phenomena, you should avoid taking such medications. Doctors noticed that the symptoms of Raynaud's syndrome in women suffering from migraine appear more often than in other categories of patients. Experts suggest that this is due to the use of vasoconstrictor drugs for headaches.
Occupational pathologies
This syndrome often develops in workers whose work is associated with exposure to vibration. Mechanical waves irritate the skin and nerve receptors. This provokes an increased production of the hormone norepinephrine, which has a vasoconstrictor effect.
Often people fall ill whose work is associated with increased stress on the hands. The syndrome is often noted among typists and pianists.
ICD classification
In ICD-10, Raynaud's syndrome is encoded in the rubric of the underlying disease, if the cause of its occurrence is known. However, if this symptom complex is an independent disease or its etiology is not identified, then the syndrome is usually distinguished separately.
According to the ICD, Raynaud's syndrome belongs to the class 170-179. Under these codes in the classification are noted diseases of arteries, arterioles and capillaries. Raynaud's syndrome is designated ICD 173 below. Peripheral vascular disease is included in this group. The full Reynaud syndrome code is 173.0. Also, this code refers to gangrene, which is a complication of this pathology.
Symptoms and stages of pathology
Symptoms of Raynaud's syndrome are most often noted on the fingers, less often on the feet, tip of the nose or chin. Pathology manifests itself in the form of seizures, their course can be divided into 3 phases:
- After exposure to cold or stress, the patient has blanching of the skin of the hands or other affected areas. This is due to vasospasm and circulatory disorders. Due to poor oxygen supply to the tissues, a pain syndrome appears. It is accompanied by numbness and a tingling sensation.
- The skin on the affected area acquires a bluish tint. Because of a spasm of small arteries, blood stagnates in the veins. There is a slight swelling of the tissues.
- Arteries expand again, with redness of the skin. Numbness and a tingling sensation gradually disappear, while pain syndrome often resumes.
This is the first stage of Raynaud's syndrome. A photo of the symptoms of pathology can be seen below.
Over time, this ailment can progress. If at the beginning of the disease cramps are temporary, then in the second stage of the disease they become permanent. Affected areas always look blue and swollen.
The third stage of the syndrome is characterized by a sharp violation of the blood supply to the affected areas. Due to malnutrition, ulcers and foci of necrosis form on the skin.
Symptoms and treatment of Raynaud's syndrome depend on the stage of the disease. The stronger the damage to the vessels, the more difficult it is to stop the manifestations of pathology. If medications usually help in the first and second stages, then in advanced cases it is often necessary to resort to surgical intervention.
Possible complications
In the first and second stages of the disease, complications rarely occur. The dangerous effects of the syndrome occur in advanced cases. Usually they appear in the third stage of the disease. Ulcers and necrotic areas on the skin indicate a serious violation of nutrition and blood supply to tissues. Ultimately, this can lead to gangrene and amputation of the fingers or part of the limb. Therefore, it is necessary to consult a doctor with the initial symptoms of Raynaud's syndrome.
Diagnostics
A rheumatologist may suspect this disease according to patient complaints. Blanching of the skin at low temperatures and stress, numbness and pain are characteristic features. A cold test is performed during the inspection. The patient's hands are placed in cool water and watch the reaction of blood vessels.
Usually this syndrome develops against the background of other pathologies. Therefore, laboratory diagnostic methods are used to identify possible rheumatic, endocrine, vascular diseases, as well as circulatory disorders. For this purpose, the following tests are prescribed:
- General blood test. In autoimmune diseases, anemia and a decrease in the number of platelets and leukocytes are noted.
- Analysis for biochemistry. In patients, an increase in the level of enzymes involved in metabolic processes, as well as alpha and gamma globulins, is detected.
- Blood test for rheumatoid factor and immunoglobulins. If spastic phenomena are caused by autoimmune pathologies, then the result of the analysis on the RF and IgE will be positive.
- Blood test for adrenal and thyroid hormones. This study is carried out with suspected endocrine etiology of the syndrome.
In addition, it is necessary to identify pathological changes in small vessels. Assign angiography of peripheral arteries and capillaroscopy of the nail bed (with damage to the fingers). Dopplerography of small vessels at the lesion site is also performed to evaluate blood microcirculation.
Treatment methods
The treatment of Raynaud's syndrome consists in the treatment of the underlying disease, which caused spastic phenomena in small vessels. Very often, achieving remission in chronic rheumatoid or endocrine pathology leads to the disappearance of seizures. At the same time, medications are prescribed to dilate blood vessels and improve blood microcirculation:
- Trental;
- Nifedipine;
- Verapamil;
- "Vazaprostan";
- Diltiazem
- "Phentolamine";
- Nicardipine.
The syndrome is often accompanied by severe pain in the fingers and hands during the attack. To stop unpleasant sensations, non-steroidal anti-inflammatory drugs are prescribed. If the syndrome is caused by rheumatic pathologies, then such drugs become the first-choice drugs for basic therapy. Use the following tools:
- Diclofenac
- Indomethacin;
- Ibuprofen
- "Butadion";
- Reopirin.
It is important to remember that these drugs aggressively affect the gastrointestinal mucosa. Their prolonged use can cause peptic ulcer. Therefore, along with them, drugs are prescribed that protect the stomach: Omeprazole and Cimetidine.
In the acute period of autoimmune diseases, corticosteroids (Prednisolone, Dexamethasone) and cytostatics (Methotrexate) are indicated. The use of such drugs requires caution, their dosage is selected individually.
If the attack is delayed, then an injection of antispasmodics is prescribed: Drotaverinum, Diazepam, Platifillina. At home, you can warm your hands in warm water or rub them with a piece of woolen cloth. This will help relieve pain quickly.
Drug treatment of Raynaud's syndrome is supplemented with physiotherapy sessions. The application of the following procedures is shown:
- extremely high frequency therapy (EHF);
- magnetotherapy;
- reflexology.
If conservative treatment is ineffective, then resort to surgery. To eliminate the periodic spasm of the arteries, a section of the sympathetic nervous system is removed. As a result, pathological signals that cause a reduction in their walls cease to flow into the vessels. Currently, they try to carry out this operation in the least traumatic way using an endoscope. However, even after surgery, a relapse of the pathology after 2-3 years cannot be ruled out.
Forecast
The prognosis of the disease depends on the degree of pathology. In the first and second stages, this disease responds well to treatment. In advanced cases, necrosis and gangrene can develop. Such complications often end with amputation of the limb.
In some cases, there is a self-healing of this syndrome in the first stage with a change in climate or lifestyle. However, one should not hope for such a favorable outcome. This is quite rare. More often, an advanced pathology leads to tissue necrotization and the development of severe complications. Therefore, it is necessary to consult a doctor at the first sign of spastic phenomena in peripheral vessels.
Prevention
How to prevent the development of an attack with spasm of blood vessels? People suffering from rheumatic and autoimmune diseases need to protect their body from hypothermia. At low temperatures, gloves or mittens should be worn. Whenever possible, emotional overload should be avoided.
You need to pay attention to your diet. Strong tea and coffee should be ruled out. Useful foods high in omega-polyunsaturated fatty acids. These include some types of fish (salmon, mackerel, trout, salmon, tuna), walnuts, avocados, olive and sunflower oil.
The patient should stop smoking, as nicotine provokes vasospasm. Avoid taking medications with adrenergic blockers, ephedrine, ergotamine. If you have to use such drugs for high blood pressure or for migraines, then you need to consult a doctor about replacing such drugs with analogues for therapeutic effect. These measures will help prevent an attack.