The complex of symptoms, characteristic of acute circulatory disturbances in limited areas of the body, was called Reynaud's syndrome. The frequency of the syndrome is higher in countries with cold climatic conditions. It ranges between about 2% and 18%.The disease most often affects people of middle age( 40-50 years), especially women( 4 times more often than men).
The manifestations of Raynaud's disease and the symptoms of Reynaud's syndrome are very similar. However, they differ in the cause that caused their occurrence, and sometimes - the localization. A differential diagnosis is of great importance in the choice of treatment methods.
Mechanism of development and clinical course of the
syndrome. Developmental mechanism of
. Organic and functional disorders in the structure of the vascular wall and apparatus innervating the vessels are considered to be initial, as a result of which their nervous regulation changes. This is expressed in attacks of pathological spasms( constrictions) of blood
A significant decrease in the flow of blood into the tissue disrupts their trophism( nutrition), which is manifested in numbness and a three-phase skin reaction: blanching followed by cyanosis( blue-violet skin and nails) due to lack of blood and oxygen, bright reddening after the end of the "attack""As a result of the tide of blood. There may be a reticular vascular pattern. In subsequent attacks, there may be blisters with liquid light or bloody contents and necrosis( necrosis) of the tissues.
Reynaud syndrome, the causes of which have not been completely studied yet, are usually found when:
- Autoimmune diseases with diffuse connective tissue damage: system scleroderma and systemic lupus erythematosus, rheumatism and rheumatoid polyarthritis, dermatomyositis, Sjogren's syndrome( autoimmune lesion of external glandssecretion - sebaceous, salivary, sweat), nodular periarteritis.
- Vascular diseases: obliterating atherosclerosis of the lower extremities, nonspecific aortoarteritis( Takayasu's disease), and others.
- Diseases accompanied by increased blood viscosity: cryoglobulinemia( the presence of cold proteins in the blood that precipitate under the influence of low temperature), true polycythemia( absolute increase in the blood mass of erythrocytes), lymphatic tissue damage accompanied by high blood viscosity( Waldenström macroglobulinemia).
- Carpal tunnel syndrome and anterior staircase( rarely).
- Osteochondrosis of cervical and upper thoracic parts.
Unlike the syndrome, Raynaud's disease is a manifestation of diseases affecting the central nervous system at the level of the cerebral cortex, hypothalamic region, trunk, spinal cord. This leads to a disturbance in the centers of formation of pulses to the vessels.
Contributing factors and symptoms of
The development and provocation of the disease is facilitated by:
- a long-term effect of low temperature;
- emotional stress and overwork;
- endocrine disorders( pheochromocytoma, hypothyroidism) and Down's syndrome;
- side effect of clonidine, beta-blocking, antitumor and some other drugs of peripheral action during long-term admission;
- vibration disease.
The clinical course of the Reynaud syndrome, the symptoms of which are distributed in stages, proceeds as a progressive process:
- Stage I - angiospastic
- the occurrence of rare short-term, several minutes, attacks of numbness of the skin, expressed blanching and a decrease in temperature in the affected areas followed bypain lomyaschego nature. At this stage, it is possible to establish a provoking factor - cold( washing hands, face or body with cold water), stress, smoking. At the end of the attack, no noticeable changes in these areas are noted.
- II stage - angioparalytic
- characterized by frequent seizures that occur for no apparent reason and last for an hour or more. At the end of the attack, the phase of cyanosis develops - a blue-violet staining appears with consequent hyperemia( redness) and a slight swelling of the affected area.
- III stage - atrophoparalytic
- initially visible dystrophic changes in the skin, nails( with the defeat of the fingers), small scars after small surface bubbles. After a long attack on the background of puffiness and cyanosis of the tissues, bubbles appear with serous-bloody contents. After their opening, the necrotic tissue( sometimes up to the bone) is exposed and a normally surface, long-lasting non-healing ulcer is formed. Her scarring can take a long time. When joining a secondary infection develops a gangrenous process. In cases of severe course, bone resorption occurs followed by deformation of the fingers.
The duration of stages I and II is 3 to 5 years. If the process occurs on the hands or feet, it is often possible to see the symptomatology of all three stages simultaneously.
With Reynaud syndrome, the diagnosis is based mainly on patient complaints and objective data, as well as on additional research methods. This takes into account inadequate sensitivity to the cold factor( in the first place) and changes in the color of the affected areas. It is the whitening of the skin that is characteristic and occurs in 78% of people with this syndrome. It is recommended( the British group of doctors for the study of systemic scleroderma) to determine the reliability of Raynaud's syndrome depending on the response to cold according to the following symptoms:
- Raynaud's syndrome is absent - skin color does not change;
- probability of having a syndrome - a discoloration of the skin is single-phase and is accompanied by numbness or paresthesia( sensitivity disorder);
- reliable - skin color change occurs in two phases;In addition, attacks are repeated.
The reliability and degree of vascular lesions are also determined using instrumental methods: capillaroscopy of the vessels of the nail bed, color Doppler scan, thermography of the affected area( the rate of recovery of the initial skin temperature after cooling).
Differential diagnosis of the syndrome and Raynaud's disease:
|age||over 30 years||at any age|
|signs of connective tissue diseases( . Scleroderma, lupus erythematosus, etc.)||characteristic||no|
|symmetrical lesions||uncharacteristic||is characterized by|
|ulceration, tissue necrosis, gangrene||yes||no|
|ESR( sedimentation rate of erythrocytes)||high||OK|
|enzyme-linked immunosorbent assayin the blood of antinuclear antibodies||positive||negative|
|capillaroscopy( vascular study) - the most informative study of||deformation of capillary loops, their reduction( desolation)||no change|
|possibility of vascular crises in internal organs( lungs, kidneys)||yes||no|
|plethysmography( pressure measurement in the finger artery) after local cooling||pressure reduced by 70% or more||not altered or reduced insignificantlyabout|
|assessment of blood flow velocity by scanning with laser Doppler||very reduced||not reduced|
The final diagnosis of Raynaud's disease can only be established as a result of a thorough examination. If there are no other diseases that caused the onset of the symptom complex, the diagnosis is "Raynaud's Disease".
In the case of Reynaud's syndrome, disability is given mainly in connection with the main disease( rheumatism, scleroderma, etc.).But sometimes, if the patient can not perform work related to his profession, then disability is also possible in connection with Raynaud's syndrome II or III stage.
Individuals with the III stage of the Reynaud syndrome are not suitable for military service, they are not suitable for the II stage, they are limited for the first stage, they are subject to conscription.
Emergency assistance in case of an attack consists in:
- Elimination of the factor that triggered the attack
- Warming the affected area - massaging with wool tissue, taking hot drink
- Taking or injecting vasodilators and analgesics, spasmolytic drugs( drotaverin, no-spa, platyphylline).
In Reynaud syndrome, treatment is long-term. First of all, it is aimed at treating the underlying disease, which caused the onset of the symptom complex.
Smoking should be avoided and the impact of provoking factors should be avoided at work and in domestic conditions, such as contact with cold air and cold water, vibration, long work on a computer keyboard and heavy metal products, contact with various chemical substances, and psychological loads.
- vasodilator( antagonists and calcium channel blockers) - nifedipine( Corinfar, Cordipine, Cordaflex, Kalzigrad, Nifedipine, Nifecard, Osmo-adalat, Phenigidine), Nicardipine, verapamil( Isoptin, Finoptin, Verogalide)
- ACE inhibitors -Captopril, Kapoten
- serotonin receptor blockers - ketanserin
- prostaglandins - Vasaprostan, Wap, Kaverdzhekt, Alprostan
- improving the physicochemical properties of blood and microcirculation - Agapurin, Trental, Dipiridamol, Pentoxifylline, Vasont
Pharmacotherapy necessarily combined with physical therapy and non-traditional treatments. Physiotherapy - UHF, mud therapy, hyperbaric oxygenation, galvanic baths, exercise therapy, reflexotherapy. With ineffective medication and physiotherapy, surgical intervention is possible - sympathectomy. One of the modern methods of treating Reynaud's syndrome is therapy with the help of stem cells, which contribute to the normalization of peripheral blood flow.