Overview of Raynaud’s disease
Raynaud’s disease is characterized by paroxysmal spasm of the small arteries of the extremities causing local ischemia, typically manifested by the end of the limbs skin pallor, bruising, followed by redness of the skin most of the etiology of the disease is not known, may be related to genetics, sympathetic nervous system dysfunction, vascular sensitivity, and other factors in order to the general treatment, medication-based treatment
Definition
Raynaud’s disease is a localized ischemic phenomenon caused solely by paroxysmal spasm of the small arteries in the extremities.
Incidence
There are no specific statistics on the incidence of Raynaud’s disease in China.
It is more common in women aged 20 to 30 years old, and the ratio of male to female is about 1:5.
Mostly in the cold season, the onset of insidious, can also be sudden.
Causes
Causes
The cause of the disease is not clear, but the following factors may be related to the occurrence of this disease.
Genetic factors
Family and twin studies have shown that genetic factors seem to play an important role in the development of Raynaud’s disease, and half of the patients with Raynaud’s disease have a positive family history of Raynaud’s phenomenon in their first-degree relatives.
Sympathetic Dysfunction
Raynaud’s disease is thought to be a “localized defect” in vascular thermoregulation. Cold stimuli increase the sensitivity of contractile proteins, leading to vasoconstriction.
Vascular sensitization factors
Increased sensitivity of the extremity arteries themselves to cold.
Vascular wall structural factors
Alterations in the organization of the vascular wall can cause normal vasoconstriction or an abnormal response to blood adrenaline.
Predisposing factors
Cold stimulation.
Emotional stress and excitement.
Smoking.
Symptoms
Typical symptoms of Raynaud’s disease are intermittent changes in skin color after exposure to cold and emotional stress. The classic changes are divided into ischemic, hypoxic, and congestive phases, and the specific symptoms are listed below.
Ischemic phase
When the local area is exposed to cold or emotional excitement, the fingers or toes, tip of the nose, outer ear, cheeks and other parts of the body appear pale, become cold, the skin temperature of the extremities decreases, cold sweat and other manifestations, with the finger area being the most common.
It is often accompanied by a sensation of ants, numbness or pain.
Symptoms often last from a few minutes to several hours.
Each attack does not necessarily involve the same fingers or toes.
Ischemic phase
The localized ischemic phase continues with continued sensory deficits, decreased skin temperature, bruising and pain in the extremities.
It often lasts for several hours and then subsides or shifts to a congestive phase.
Congestive phase
Arterial congestion manifested by a rise in skin temperature and flushing of the skin, followed by a return to normal.
Consultation
Department of Medicine
Rheumatology
If the skin at the ends of the limbs becomes pale and blue, followed by redness after a cold stimulus or emotional excitement, prompt medical attention is recommended.
Preparation
Consultation: Registration, Preparation of Documents, Frequently Asked Questions
Tips for seeking medical treatment
Record the development of symptoms, triggers, etc. to give the doctor more reference.
Relax and keep warm to avoid localized exposure to cold.
Preparation List
Symptom list
Especially pay attention to the time of symptom onset, special manifestations, etc.
When do the fingers or toes turn white or purple? Will they return to normal?
How long have these symptoms been present?
Are there any triggers for these symptoms?
Are they accompanied by pain? What is the degree of pain?
Medical History Checklist
Have there been any traumatic injuries to the fingers or toes?
Has anyone in the family suffered from Raynaud’s disease?
Checklist
Test results from the last six months to bring to the doctor’s office
Laboratory tests: routine blood tests, immunologic tests, erythrocyte sedimentation rate test, C-reactive protein test
Medication list
Medication in the last 3 months, bring the box or package with you if available
Calcium channel blockers: nifedipine, verapamil
Vasodilators: nafronamide oxalate, inositol nicotinate
Diagnosis
Diagnosis is based on
Medical history
Relatives who have had the disease.
Clinical manifestations
When localized cold or emotional excitement, bilateral fingers or toes, the tip of the nose, the outer ear, cheeks and other parts of the pale, become cold, limb skin temperature decreased, cold sweat and other manifestations.
Symptoms may be relieved on their own, or after exposure to a warm environment, warm bath, rubbing or waving the affected limbs.
Laboratory Tests
These include routine blood tests, inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), and immunologic tests. In Raynaud’s disease, these indicators should be normal, if there is an abnormality, mostly suggests that it is secondary Raynaud’s phenomenon.
Routine blood tests: These tests detect abnormalities in the white blood cell count, and if elevated, suggest the presence of an infection.
Erythrocyte sedimentation rate: if increased, it supports secondary Raynaud’s disease.
C-reactive protein: if elevated, it supports secondary Raynaud’s phenomenon.
Immunologic tests: e.g., antinuclear antibody profile, rheumatoid factor, complement, etc. These tests help to rule out diseases such as systemic lupus erythematosus, scleroderma, and rheumatoid arthritis.
Nailfold microangioscopy
Nailfold microangioscopy is a unique, non-invasive method of visualizing the structure of the microcirculation.
Normal capillaries are evenly distributed and have a regular “hairpin” appearance. Nailfold microangioscopy is usually normal in Raynaud’s disease.
In secondary Raynaud’s disease associated with scleroderma, early abnormalities are characterized by capillary dilatation and a small amount of hemorrhage; late features include loss of capillaries, extensive areas of ischemia, and abnormal neovascularization.
Other tests
Cold water test: fingers (toes) are immersed in 4℃ cold water for 1 minute, skin color change is considered positive.
Fist clenching test: clench both hands for 90 seconds, then bend the upper limbs at the elbow and flatten the waist to release the hands. Some patients may show color change during seizure.
Diagnostic criteria
Raynaud’s disease is diagnosed when the following criteria are met.
Episodic pallor or cyanosis of the extremities.
Peripheral pulses should be strong and symmetrical.
No signs of fingertip induration, ulceration, or gangrene.
Nailfold capillaries are normal.
Normal laboratory markers for vascular and autoimmune diseases.
No history of connective tissue disease.
Exclude occupational and environmental, drug, and neurologic disorders such as frostbite, cisplatin use, and carpal tunnel syndrome.
Differential Diagnosis
Cyanosis of the extremities
Similarities: both have cyanosis of the skin of the hands and feet.
Differences: changes in skin color in Raynaud’s disease are paroxysmal, involve only the fingers, and the skin is usually dry. In acrocyanosis, the change in skin color is persistent, the entire hand and foot are involved, and the skin is clammy.
Reticular cyanosis
Similarities: Both have cyanosis of the skin of the hands and feet.
Differences: Reticulocyanosis is a rare functional cutaneous vasospasm disorder that occurs in exposed limb areas such as hands, forearms, ankles, and calves, and in severe cases, it may encroach on the entire limb, rarely appearing alone on the hands and feet.
Treatment
Treatment of Raynaud’s disease is aimed at preventing attacks and relieving symptoms.
General treatment
Keep the whole body warm and minimize the exposure of limbs to cold.
Strictly prohibit smoking and avoid drinking alcohol.
Strengthen exercise to improve the body’s ability to withstand the cold.
Physical therapy, such as alternating cold and heat, can be carried out under the guidance of a doctor.
Pay attention to the changes of your condition, once the symptoms worsen or recur, you should go to the hospital in time.
Medication
Patients with Raynaud’s disease can usually control their symptoms after general treatment, and medication is seldom used. If vasospasm attacks seriously affect daily life or work, medication may be prescribed according to the doctor’s recommendation. During drug treatment, the medication should be used strictly according to the doctor’s instructions and should not be changed without authorization or stopped suddenly.
Calcium channel blockers
Can make blood vessels dilate and increase blood flow.
Can choose nifedipine, verapamil and so on.
Nifedipine can have adverse reactions such as facial redness, fever, headache, ankle edema, and tachycardia. The use of nifedipine extended-release agent can reduce the adverse effects, if you can not apply the extended-release agent can be used Yinladipine and amlodipine.
Vasodilators
Nafronyl oxalate: It has mild peripheral vasodilator effect, which can shorten the duration of attack and reduce pain. It is contraindicated in women during pregnancy.
Inositol nicotinate: may shorten the duration and reduce the number of attacks. There may be mild nausea, sweating, itching and other adverse reactions. Tolazoline hydrochloride: has peripheral vasodilatory effect, common adverse reactions such as flushing, cold, abdominal pain, nausea, vomiting.
Prostaglandin.
Has strong vasodilatory and antiplatelet aggregation effects.
Prostacyclin and prostaglandin are available.
Prognosis
Cure
The prognosis for Raynaud’s disease is relatively good, with a small percentage of mild cases resolving spontaneously.
Hazards
Numbness or pain in the limbs often occurs, which may affect normal work and life.
Some patients are prone to serious psychological burden due to recurrent disease.
Daily
Daily Management
Dietary management
Eat more fresh vegetables, fruits, lean meat and other high-protein, high-vitamin easy-to-digest foods.
Avoid spicy and stimulating foods, such as wine, strong tea, coffee, raw garlic, ginger, chili, curry, etc.
Avoid eating raw and cold food.
Life Management
Avoid cold stimulation
Observe weather changes and increase clothing appropriately in cold weather.
Minimize outdoor activities or work in cold weather.
Wear warm hats, masks, gloves and warm socks.
Try to stay out of cold water and avoid touching objects that are cold.
Use warm water to wash hands and feet.
Appropriate Exercise
Depending on your health condition, perform exercises such as walking and playing tai chi.
Exercise should be gradual and not too strenuous.
Prevention of infection
Avoid going to places where people gather.
Keep hands and feet clean.
Smoking cessation
Strictly quit smoking and avoid exposure to second-hand smoke.
Psychological support
Face the disease with a positive and optimistic attitude and build up confidence in overcoming the disease.
Talk to your family, partner and friends about your inner feelings, and avoid emotional stress and fatigue that may trigger vasospasm.
Actively participate in work or activities within your ability to enrich your life.
If severe anxiety, depression, insomnia, etc. occur, it is recommended to go to the hospital in time for formal psychological treatment.
Prevention
If there is a relative suffering from Raynaud’s disease, regular medical checkups should be conducted and timely consultation should be made when discomfort occurs.
Actively treat autoimmune diseases or other systemic diseases.
Eat a balanced diet with a variety of food types.
If possible, live or work in a warmer climate.
Ensure good mood and adequate sleep, and have a regular work schedule.