Raynaud’s phenomenon is a paroxysmal anemia of the toes, which is characterized by “pale distal toes, followed by cyanosis, reddening, and long with pain, lasting from a few minutes to several hours, mostly in the upper extremities, but also in the lower extremities in 40% of patients.
This phenomenon was first discovered in 1862, and in 1932 Allen and Brown established the diagnostic criteria as follows.
① Episodes in response to cold or mental stress.
② symmetrical involvement of both hands.
③ Normal pulse.
④ no or only superficial fingertip pain.
⑤ absence of corresponding other underlying disease.
⑥ Symptoms for at least 2 years without any other etiology.
However, some patients with primary Raynaud’s phenomenon can progress to systemic disease after several years. Raynaud’s phenomenon is a common symptom in women > men, with onset mostly in the 20s and 40s.
Etiology
(i) Primary: It is aggravated by cold or stress. The cause of ischemia is unknown, and the current consideration is that the cause of ischemia may be increased vasodilatory nerve activity and increased tone at the fingertips. Raynaud’s phenomenon occurs due to increased sympathetic nerve activity. The pallor is caused by spasm of small skin arteries. Cyanosis is caused by capillary filling. The vasospasm is lifted and then refilled with blood
(II) Secondary: Raynaud’s phenomenon is accompanied by certain systemic diseases or with neurological and vascular abnormalities
1, rheumatic diseases: 80% – 90% of systemic sclerosis appears Raynaud’s phenomenon, 30% of Raynaud’s phenomenon patients eventually occur systemic sclerosis. Systemic sclerosis is also accompanied by finger and toe sclerosis, broken finger and toe ends, skin and subcutaneous tissue calcification, histological examination can be seen in the endothelium of finger end arteries, thrombosis. 10% – 35% of SLE can appear Raynaud’s phenomenon
2, traumatic vasculitis: repeated local trauma prone to Raynaud’s phenomenon. The mechanism is the chronic stimulation of the annular vesicles caused by sympathetic reflexes and spasm of the small arteries between the fingers.
3, peripheral vascular disease; atherosclerosis or arterial embolism. Spasm or thrombosis of the ulnar artery and thrombosis of the interphalangeal artery predispose to Raynaud’s phenomenon.
4, nerve compression: thoracic hypothoracic nerve syndrome or carpal tunnel syndrome can appear first Raynaud’s phenomenon.
5, drugs and chemical factors: ergometrine has a direct vasoconstrictive effect. Ergot alkaloids can make the endothelial muscle fibrosis, polyvinyl chloride or Quin preparation can easily induce Raynaud’s phenomenon. Recently, it is found that β-receptor inhibitors also have the role of inducing Raynaud’s phenomenon.
6, hematological abnormalities: cold globulinemia, cold agglutinin disease. Erythrocytosis or macroglobulinemia can occur Raynaud’s phenomenon.
7.Other: such as tumor or hepatitis caused by the deposition of immune complexes.
Diagnosis
1. History: History of the typical triad of pallor, cyanosis and redness of the fingertips caused by exposure to cold or mental stress. Differentiation between primary and secondary: history of the latter systemic diseases, connective tissue diseases, tumors, vascular or anatomical abnormalities, occupational factors and medication use, etc.
2.Physical examination: Raynaud’s phenomenon is not easily detected on physical examination, but invasion occurs in 15 degrees of water
3.Other.
① Laboratory tests: such as blood sedimentation and white blood cell count, ANA, RF . The abnormalities in the above indicators should be further investigated by anti-dsDNA. Recently, it is found that β thromboprotein, an indicator of platelet sex, is used to distinguish primary Raynaud’s phenomenon or Raynaud’s phenomenon caused by scleroderma. In the former, β-thromboprotein levels are normal, while in the latter, they are elevated.
②Vascular Doppler examination.
③Differential diagnosis: Raynaud’s phenomenon is a paroxysmal attack should be differentiated from persistent vasospastic ischemia.
Treatment
1.Keep warm, quit smoking, avoid trauma.
2.Calcium antagonists refer to the main drugs for the treatment of Raynaud’s phenomenon.
3.α-blockers: prazosin 0.5 mg tid each time . It can be gradually increased to 1-2 mg per dose. When taking may appear headache, nausea, so it is appropriate to start from a small dose.
4, nitroglycerin patch: can be applied to the affected fingers or in the radial and ulnar side of the hand to dilate the blood vessels of the fingers.
5, sympathectomy: the long-term effect is not certain, lumbar sympathectomy on the lower extremity vasospasm effect is better.
6, prostacyclin: to dilate blood vessels to inhibit platelet aggregation. It is mainly used for those with severe finger end rupture.
7.Exercise.
8, behavioral therapy: spasticity seizures can be temporarily controlled by biofeedback.