Raynaud’s syndrome refers to paroxysmal spasms of the arteries in the extremities. It often develops under the influence of factors such as cold stimuli or emotional stress, and is characterized by intermittent pale, cyanotic and flushed changes in the skin color of the extremities. It is usually more severe in the upper extremities and occasionally in the lower extremities. Raynaud’s syndrome is not uncommon in clinical practice. The age of onset is mostly between 20 and 30 years old, rarely more than 40 years old. Most of them are seen in cold areas. It occurs in the cold season. The etiology of Raynaud’s syndrome is still not completely clear. Cold stimulation, emotional hormones or mental stress are the main triggering factors. Other triggers such as infection and fatigue. Since the condition often worsens during menstruation and decreases during pregnancy, it is thought that the syndrome may be related to gonadal function. Symptoms Patients often have a sudden change in finger skin color to pale and then purple after being cold or emotionally agitated. The attack often starts at the fingertips and later extends to the entire finger and even the palm. It is accompanied by localized coldness, numbness, pins and needles sensation and loss of sensation. After a few minutes, the skin gradually turns flushed, warms up, and feels burn-like swelling before the skin finally returns to normal color. The attack can often be relieved after warming the limbs with hot drinks or alcohol. Generally, after the release of cold stimulation, the skin color from the pale, cyanotic, flushed stage to return to normal time of up to 15 to 30 minutes. In a small number of patients, cyanosis occurs at the beginning without the pale phase, or the pale phase turns to flush without cyanosis. The radial artery pulsation does not diminish during the attack. There are no other symptoms in the interictal period except slightly cold skin temperature and slightly pale skin color of the fingers. The onset is usually seen in the fingers, but also in the toes and occasionally in the ears and nose. Another important feature of Raynaud’s syndrome is the symmetry of the onset of symptoms. For example, the little finger and ring finger are often the first to be affected, followed by the index and middle fingers. The thumb is rarely affected because of its rich blood supply. The degree and extent of skin color changes in both fingers are also the same. In a small number of patients, the initial onset is unilateral, and later it changes to both sides. The course of the disease is generally slow, but in a few patients it progresses faster, with frequent attacks, severe symptoms, swelling of the fingers (toes), each attack lasting more than one hour, and can be triggered by a slight decrease in ambient temperature and slight emotional excitement. In severe cases, the symptoms do not disappear even in the warm season, and nutritional changes appear at the ends of the fingers (toes), such as deformed and brittle nails, atrophy of the batch pad, thinning of the skin, disappearance of wrinkles, and ulceration or gangrene of the nail and finger tips. However, the radial artery is never weakened. Tests (a) Laboratory tests Antinuclear antibodies suggestive of systemic connective tissue disease, rheumatoid factor immunoglobulin electrophoresis, complement values, anti-natural DNA antibodies, condensation globulin, and the Coombs’ (Combs) test should be performed as routine tests. (b) Special tests Cold excitation test: After the finger is cooled by cold, the time required for the finger circulation to return to normal is traced by photoelectric volumetric tracer (PPG) as a simple, reliable and non-invasive test to estimate the circulation of the finger end. During the test, the patient should sit quietly in the room (room temperature 26±2℃) for 30 minutes. After tracing the finger-end circulation waveform with the PPG, both hands should be immersed in ice water for 1 minute and dried immediately, and then the finger-end circulation should be traced every minute for a total of 5 minutes. In patients with Raynaud’s syndrome, it takes significantly longer (more than 5 minutes) to return to normal circulation. In normal people, the arterial wave at the end of the finger is bi-directional, i.e., it has a main peak wave and a heavy wave. In patients with Raynaud’s syndrome, the arterial wave is unidirectional, with a low, blunt, flat peak, or even absent. This test can also be used to assess the effectiveness of treatment. If the patient’s symptoms improve after medication, the finger-end circulation recovery time will be shortened. Finger humidity recovery time measurement After the finger has been cooled down by cold, the thermistor probe is used to determine the time required to return to normal temperature, which is used to estimate the blood flow in the finger and provides objective evidence for the diagnosis of Raynaud’s syndrome. 95% of normal people have their finger temperature returned to baseline within 15 minutes, while the majority of patients with Raynaud’s syndrome have their finger temperature returned to normal in more than 20 minutes, and this test can also be used to The test can also be used to estimate the effect of treatment. Finger arteriogram If necessary, an upper extremity arteriogram is performed to understand the condition of the finger arteries and to help determine the diagnosis of Raynaud’s syndrome. It can also show if there are organic lesions in the arteries. Arteriography is not only an invasive test, but also complex, and therefore should not be used as a routine test. In special tests, upper extremity nerve conduction velocity is measured to detect the possible presence of carpal tunnel syndrome. X-ray plain films of the hand are helpful in detecting rheumatoid arthritis and calcinosis of the fingers. Treatment The most important aspect of the treatment of Raynaud’s syndrome is the treatment of the primary cause. The symptomatic treatment of the disease is divided into pharmacotherapy, biofeedback and surgery, which are chosen according to the patient’s specific situation. Pharmacotherapy The following drugs are used clinically: 1. Priscol: also known as Toltrazurin, 25-50 mg orally each time, 4-6 times a day, after meals. For severe local pain and ulcer formation, the dose can be increased to 50-100mg per dose. 25-50mg per dose for intramuscular, intravenous or intra-arterial injection, 2-4 times daily. In some patients, it can cause side effects such as hot flashes, fainting, dizziness, headache, nausea, vomiting and chicken skin. 2, reserpine (reserpine): because of its catecholamine and serotonin removal effect. It is a drug with a long history and good efficacy in the treatment of Raynaud’s syndrome. The oral dose varies greatly, and Kontos reported that 1mg/d orally for a period of 1 to 3 years can reduce the number of symptom attacks and reduce the degree of symptoms. 3, nifedipine (nifedipine): nifedipine is a calcium channel blocker, it reduces the calcium storage capacity or calcium binding capacity of the calcium ion storage site on the myocyte membrane, so that the formation of action potential and smooth muscle contraction is blocked, thereby causing vasodilation. Clinical studies have shown that it can significantly improve the clinical symptoms of moderate and severe Raynaud’s syndrome. 4, guanethidine (quanet-hidine): similar to the effect of reserpine, oral 5-10mg per dose, 3 times a day. It can also be combined with phenoxybenzamine (phonoxy-benzamine) at a daily dose of 10-30mg. about 80% of patients are effective. 5.Methyldopa (methyl dopa): The daily dose is 1~2g, most patients can receive the effect of preventing Raynaud’s syndrome attack. Blood pressure should be taken into account when using the drug. Recently, some experts have reported that the following drugs are also effective in the treatment of Raynaud’s syndrome. Prostaglandins: Prostaglandin E1 (PGE1) and prostacyclin (PGI2) both have the effect of vasodilatation and inhibition of platelet aggregation. It has satisfactory efficacy in Raynaud’s syndrome with infected gangrenous fingers. Intravenous infusion of PGE 110ng/min for 72 hours. Infusion of PGI1 (7.5ng/kg/min for 5 hours) was given once a week for 3 times. The treatment effect usually lasts for 6 weeks. Stanozol: It is an anabolic steroid hormone with fibrinolytic enzyme activation and has been reported to dissolve fibrin deposited in finger arteries as well as reduce plasma viscosity. It was administered orally 5 mg twice daily for 3 months. In addition, topical application of 205 nitroglycerin ointment, 4-6 times daily, can significantly reduce the number of Raynaud’s sign episodes and significantly reduce numbness and pain by clinical use. Traditional Chinese medicine and acupuncture have some value in the treatment of this disease. Surgical treatment The vast majority (80-90%) of patients with Raynaud’s syndrome can have their symptoms relieved or stop progressing after medical treatment, and only a few patients can be considered for sympathectomy if the drug treatment is ineffective in sufficient doses and courses, the condition worsens, the symptoms seriously affect work and biology, or the skin at the fingertips has nutritional changes, but the vasodilatory response should be measured before surgery, and if the vasodilatory If the vasodilation index is not sufficient, sympathectomy will not have the desired effect. It has been reported that only 40-60% of the patients have improved their symptoms after surgery, but the symptoms do not last long and often recur 2 years after surgery; the efficacy of sympathectomy in patients with arterial occlusive lesions is positive; the efficacy of sympathectomy in patients with connective tissue disease is poor.