Cold hands and feet may be a real disease! What situations should be considered as a sign of disease? The day before yesterday, a 40-year-old woman visited the clinic because her hands were cold and painful for one year, and during the consultation, the patient reflected that the pain was especially obvious when it was cold. Last winter, there was a little pain, but this year, because of the death of her husband, the pain is more obvious, the pain at night can not sleep. In recent days, the temperature across the country has fallen to historic lows, many people will have cold hands and feet, especially women, serious, all year round hands and feet have been cold, the season of cold weather is particularly serious. Cold hands and feet may indicate which rheumatic immune diseases? I. Raynaud’s phenomenon The ends of the hands and feet or the tips of the nose and ears turn white, purple or red when exposed to cold. In other words, these parts are not only cold, but also have color changes. This is called Raynaud’s phenomenon in medical science. Raynaud’s phenomenon can be seen at any age, but it is more common in 20-40 years old, and more common in women. It starts slowly, with occasional mild, short-lived attacks in winter, and can gradually worsen as the disease progresses. The typical Raynaud’s phenomenon is divided into 3 phases, namely the ischemic phase, the hypoxic phase, and the congestive phase. The ischemic phase is the early manifestation, which usually occurs at the ends of fingers and toes, with episodes of pallor, stiffness and coldness, accompanied by sweating, numbness or pain, mostly symmetrical from the finger ends to the palm of the hand, rarely beyond the wrist. The hypoxic phase is the continued ischemia of the affected area, with dilated capillary bruising, cyanosis of the skin into purple, low skin temperature, and pain, but to a lesser extent. The congestive phase is one that generally occurs after warming, but can also occur spontaneously. The vasospasm is released, the arteries are congested, the skin is flushed, skin temperature returns, there may be tingling sensation, swelling and mild throbbing pain. After blood perfusion is normalized, skin color and sensations such as pain return to normal. The course of the attack usually lasts about 10 minutes, and some of them last for more than an hour. It may start with one finger and gradually involve the rest of the fingers. Frequent episodes of Raynaud’s phenomenon may lead to skin nail changes in the terminal phalanges. The nails show slow growth, cracking, and deformation. It is important to note that mere pallor, cyanosis or cyanosis is atypical of Raynaud’s phenomenon. Test for the presence of Raynaud’s phenomenon If you are not sure whether Raynaud’s phenomenon exists, you can conduct a stimulation test, usually with cold water test, immerse the fingers or toes in cold water for 1 minute or clench both hands for 1.5 minutes to appear white to purple to red, or invade the ice water for 20 seconds, observe the recovery time of finger temperature, the normal average recovery time is 5-10 minutes, and Raynaud’s phenomenon often exceeds 20 minutes How does Raynaud’s phenomenon occur? How does Raynaud’s phenomenon occur? Raynaud’s phenomenon is most common in some rheumatic immune diseases, such as systemic lupus erythematosus, dry syndrome, scleroderma, rheumatoid arthritis. Other diseases such as atherosclerosis, thrombotic vasculitis, acute arterial blockage, pulmonary hypertension, spinal cavernous disease, hematologic diseases and smoking, some drugs and lead and arsenic poisoning can also occur. The cause of Raynaud’s phenomenon is the thickening of the intima of the small arteries, the hypertrophy of the middle layer, and the formation of thrombus in the small arteries, which leads to the blockage of the arteries and ischemia, and the vasoconstriction when cold, which leads to the aggravation of ischemia. This pain starts with a burst of paroxysmal pain, and in severe cases, persistent pain. Analgesic treatment alone is often ineffective and the primary disease must be treated. Diseases such as systemic lupus erythematosus or dry syndrome and rheumatoid arthritis can often be relieved with treatment, but Raynaud’s phenomenon caused by scleroderma is generally less effective. Early treatment can relieve pain and delay the onset of gangrene, but once necrosis occurs in the limb, the treatment is often not effective. Therefore, when the hands and feet are cold and turn white, purple and red when cold, please consult the rheumatology department as soon as possible. Reynaud’s phenomenon with no known cause There are also some young women who are in good health but have cold hands and feet when they are cold or emotionally agitated, and in severe cases, the process of turning white to purple and red. In clinical practice, this unexplained Raynaud’s phenomenon is called Raynaud’s disease. Most women with Raynaud’s disease have a good prognosis, but some will progress to some type of rheumatic disease over the years. How to deal with Raynaud’s phenomenon? If there is a disease state, of course, the primary disease is treated. The treatment of Raynaud’s phenomenon starts with the application of peripheral vasodilators, such as calcium antagonists such as nifedipine, ACEI class such as lenopril, and for frequent attacks or severe ischemia, sedative vasodilators such as prostaglandins. Some patients need to apply aspirin to inhibit platelet agglutination, and there are also herbs that activate blood circulation and remove blood stasis such as ginkgo biloba will improve blood circulation, and a new drug commonly used recently is cilostazol, which not only dilates peripheral blood vessels, but also inhibits platelet agglutination. Second, systemic sclerosis If it is not only cold hands and feet, but also hard skin. It starts with swelling of the end joints or fingers, mild diffuse swelling, feeling stuffy when moving, and slowly the skin becomes hard from the end to the proximal end. This hardness does not only appear in the hands and feet, but also in the facial skin, so the face may look stiff but less wrinkled, look younger than people of the same age, the tip of the nose becomes pointed, there are radioactive streaks around the mouth, severe difficulty in opening the mouth, choking sensation when eating, difficulty in swallowing dry food, and frequent acidity, belching, and hiccups. Some patients have a cough and shortness of breath after activity. Some patients have alternating skin hyperpigmentation and depigmentation, also known as the “burnt salt sign”. All these changes may occur in the same patient. This disease is the aforementioned scleroderma, also known as systemic sclerosis. It is a rheumatic immune disease involving multiple organs, and the basic pathological change is fibrosis of the connective tissue. The underlying pathology is fibrosis of the connective tissue. Small arteries in the hands and feet and other parts of the intima thickened, fibrosis, resulting in narrowing the lumen of the blood supply to reduce the temperature of the hands and feet, when the cold vascular further contraction, there will be Raynaud’s phenomenon. Third, there are other reasons Some people not only have cold hands and feet, but also have persistent redness or cyanosis of the fingers or toes, with a lot of sweating, called hand and foot cyanosis. It rarely presents with fingertip atrophy or ulcers. Cold hands and feet may also be related to low activity, low heat production and poor peripheral circulation, when more exercise is a good remedy. There is also a cause of cold hands and feet is smoking, because nicotine is a vasoconstrictor, can cause skin vasoconstriction. Cold hands and feet in the elderly are mostly due to slow blood circulation, increased blood viscosity, combined with a variety of diseases such as diabetes, hypertension, coronary heart disease, atherosclerosis, arterial blood supply is affected is the main reason. In addition to keeping warm, treatment of the primary disease is the basis.