Raynaud's syndrome is a complex of symptoms associated with spasm of peripheral vessels. It can be a separate disease or a sign of another pathology. Most often, painful manifestations are localized in the vessels of the hands. This syndrome is accompanied by blanching and blueness of the skin of the hands, pain and numbness. Such symptoms are caused by a sharp violation of the blood supply. In advanced cases, tissue necrosis occurs. Raynaud's syndrome is much more common in women than in men. Particularly susceptible to this disease are young patients aged 20 to 40 years. The pathology was first described in 1862 by the French neurologist Maurice Raynaud. This disease is named after this doctor.
Causes of the syndrome
Signs of Raynaud's syndrome develop due to vasospasm and impaired peripheral circulation. As already mentioned, the fingers are most often affected. In more rare casesblood circulation is disturbed in the area of the feet, the tip of the nose or the chin.
The following causes of the development of the syndrome can be distinguished:
- autoimmune diseases accompanied by connective tissue damage;
- deviations in the functioning of the endocrine glands;
- vascular disorders and blood clots;
- work related diseases;
- side effects of certain medications.
Vaspasm usually develops after hypothermia or stress. Next, the main causes of the syndrome will be discussed in detail.
Syndrome and Raynaud's disease
In medicine, it is customary to subdivide the concepts - Raynaud's syndrome and disease. If a patient has a spasm of peripheral vessels as a secondary sign of existing pathologies, then doctors talk about Raynaud's syndrome. If this symptom complex appears as a separate disease, then it is called Raynaud's disease. The causes of primary pathology are not fully understood. It is assumed that it occurs due to hereditary predisposition.
Autoimmune pathologies
Most often, the syndrome develops in patients with rheumatic autoimmune diseases. Diseases such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma cause connective tissue damage. Most patients with such pathologies have Raynaud's syndrome. The walls of blood vessels are made up of connective tissue, and its damage leads to spastic phenomena.
Under the influence of cold or stress in patientsthere is a spasm of blood vessels and circulatory disorders. Most often, pathological manifestations (numbness, blanching of the skin, pain) are noted in the area of the fingers and toes, as well as the nose and chin. This is due to the fact that the blood does not flow well into the small vessels of distant parts of the body. Then cyanosis (cyanosis) is observed. Blood accumulates in the veins, they swell, which causes a bluish tint to the skin.
Endocrine disorders
The occurrence of the syndrome may be associated with impaired activity of the adrenal glands. In tumors of the medulla (eg, pheochromocytoma), these glands produce excessive amounts of epinephrine and norepinephrine. Such hormones have a vasoconstrictive effect and can cause spasm of the arterioles of the extremities.
The thyroid hormone triiodothyronine has a similar effect. Therefore, this syndrome is often noted with hyperthyroidism.
Vascular diseases and circulatory disorders
Impaired peripheral circulation is often noted in vasculitis and periarteritis nodosa. Inflammatory and degenerative processes in the vessels lead to their spasm. As a result, the blood supply to the upper limbs is disrupted.
The syndrome is also observed with blood clots. Blockage of blood vessels significantly impedes blood circulation. As a result, the nutrition of tissues in remote areas of the body is disrupted.
A special case of thrombosis is cryoglobulinemia. With this pathology, blockage of blood vessels occurs only under the influence of low temperature. This is due to the formation of special"cold" proteins that provoke thrombosis. As soon as a person is in a warm room, blood clots dissolve.
Medication
Medications with adrenaline-like action can also provoke the occurrence of the syndrome. First of all, this applies to drugs for high blood pressure. Adrenoblockers have this property: Propranolol, Metoprolol. These medicines dilate the coronary vessels but constrict the peripheral ones.
Medications for migraine also have a vasoconstrictive effect: Nomigren, Syncapton. With a tendency to spastic phenomena, you should avoid taking such medications. Doctors have noticed that the symptoms of Raynaud's syndrome in women with migraine appear more often than in other categories of patients. Experts suggest that this is due to the use of vasoconstrictor drugs for headaches.
Occupational pathology
This syndrome often develops in workers whose work activity is associated with exposure to vibration. Mechanical waves irritate the receptors of the skin and nerves. This provokes increased production of the hormone norepinephrine, which has a vasoconstrictive effect.
Often people get sick, whose work is associated with increased stress on the brush. The syndrome is often noted in secretaries-typists and pianists.
ICD classification
In ICD-10, Raynaud's syndrome is coded under the heading of the underlying disease if the cause of its occurrence is known. However, if this symptom complex isan independent disease or its etiology has not been identified, then the syndrome is usually distinguished separately.
According to the ICD, Raynaud's syndrome belongs to class 170-179. Under these codes in the classification, diseases of the arteries, arterioles and capillaries are noted. Further, Raynaud's syndrome is designated by the ICD code 173. This group includes peripheral vascular diseases. The full code for Raynaud's syndrome is 173.0. This code also denotes gangrene, which is a complication of this pathology.
Symptoms and stages of pathology
Symptoms of Raynaud's syndrome are most often noted on the fingers, less often on the legs, tip of the nose or chin. Pathology manifests itself in the form of seizures, their course can be divided into 3 phases:
- After going out into the cold or stress, the patient has blanching of the skin of the hands or other affected areas. This is due to vasospasm and circulatory disorders. Due to poor supply of tissues with oxygen, pain occurs. It is accompanied by numbness and a tingling sensation.
- The skin on the affected area becomes bluish. Due to spasm of small arteries, blood stagnates in the veins. There is a slight swelling of the tissues.
- The arteries dilate again, and reddening of the skin is observed. The numbness and tingling sensation will gradually disappear, with frequent recurrence of pain.
This is the first stage of Raynaud's syndrome. Photos of the symptoms of the pathology can be seen below.
Over time, this disease can progress. If at the beginning of the disease spasms are temporarycharacter, then in the second stage of the disease they become permanent. The affected areas always look blue and swollen.
The third stage of the syndrome is characterized by a sharp violation of the blood supply to the affected areas. Due to malnutrition, ulcers and foci of necrosis form on the skin.
Symptoms and treatment of Raynaud's syndrome depend on the stage of the disease. The stronger the damage to the vessels, the more difficult it is to stop the manifestations of the pathology. If medications usually help in the first and second stages, then in advanced cases it is often necessary to resort to surgical intervention.
Possible Complications
Complications are rare in the first and second stages of the disease. Dangerous consequences of the syndrome occur in advanced cases. They usually appear in the third stage of the disease. Ulcers and necrotic areas on the skin indicate a serious malnutrition and blood supply to tissues. This can eventually lead to gangrene and amputation of fingers or part of a limb. Therefore, it is necessary to consult a doctor at the initial symptoms of Raynaud's syndrome.
Diagnosis
A rheumatologist may suspect this disease based on the patient's complaints. Skin blanching at low temperatures and stress, numbness and pain are characteristic signs. During the inspection, a cold test is performed. The patient's hands are placed in cool water and the reaction of the vessels is observed.
Usually this syndrome develops against the background of other pathologies. Therefore, laboratory diagnostic methods are used to identify possiblerheumatic, endocrine, vascular diseases, as well as circulatory disorders. For this purpose, the following tests are prescribed:
- General blood test. In autoimmune diseases, anemia and a decrease in the number of platelets and leukocytes are noted.
- Analysis for biochemistry. Patients show an increase in the level of enzymes involved in metabolic processes, as well as alpha and gamma globulins.
- Blood test for rheumatoid factor and immunoglobulins. If spastic phenomena are caused by autoimmune pathologies, then the result of the analysis for RF and IgE will be positive.
- A blood test for adrenal and thyroid hormones. This study is performed when an endocrine etiology of the syndrome is suspected.
In addition, it is necessary to identify pathological changes in small vessels. Assign angiography of the peripheral arteries and capillaroscopy of the nail bed (in case of damage to the fingers). Dopplerography of small vessels is also carried out at the site of the lesion to assess blood microcirculation.
Treatment methods
Treatment of Raynaud's syndrome consists in the treatment of the underlying disease, which caused spastic phenomena in small vessels. Very often, the achievement of remission in chronic rheumatoid or endocrine pathology leads to the disappearance of seizures. At the same time, medications are prescribed to dilate blood vessels and improve blood microcirculation:
- "Trental";
- "Nifedipine";
- "Verapamil";
- "Vazaprostan";
- "Diltiazem";
- "Fentolamine";
- "Nicardipine".
The syndrome is often accompanied by severe pain in the fingers and hands during an attack. To stop discomfort, prescribe non-steroidal anti-inflammatory drugs. If the syndrome is caused by rheumatic pathologies, then such drugs become the first choice medicines for the main therapy. The following means are used:
- "Diclofenac";
- "Indomethacin";
- "Ibuprofen";
- "Butadion";
- "Reopirin".
It is important to remember that these drugs act aggressively on the gastrointestinal mucosa. Their prolonged use can cause peptic ulcer. Therefore, along with them, they are prescribed drugs that protect the stomach: Omeprazole and Cimetidine.
In the acute period of autoimmune diseases, corticosteroids ("Prednisolone", "Dexamethasone") and cytostatics ("Methotrexate") are indicated. The use of such drugs requires caution, their dosage is selected individually.
If the attack is delayed, then injections of antispasmodics are prescribed: Drotaverine, Diazepam, Platiphyllin. At home, you can warm your hands in warm water or rub them with a piece of woolen cloth. This will help relieve pain quickly.
Drug treatment of Raynaud's syndrome is supplemented with physiotherapy sessions. shownapplying the following procedures:
- Extremely High Frequency Therapy (EHF);
- magnetic therapy;
- reflexology.
If conservative treatment is ineffective, then resort to surgery. To eliminate the periodic spasm of the arteries, a section of the sympathetic nervous system is removed. As a result, pathological signals cease to enter the vessels, which cause the contraction of their walls. Currently, they try to carry out this operation in the least traumatic way using an endoscope. However, even after surgery, a recurrence of the pathology after 2-3 years cannot be ruled out.
Forecast
Prognosis of the disease depends on the degree of pathology. In the first and second stages, this disease responds well to treatment. In advanced cases, necrosis and gangrene may develop. Such complications often end in limb amputation.
In some cases, self-healing of this syndrome in the first stage is noted with a change in climate or lifestyle. However, one should not hope for such a favorable outcome. This is seen quite rarely. Much more often, neglected pathology leads to tissue necrosis and the development of severe complications. Therefore, it is necessary to consult a doctor at the first signs of spastic phenomena in peripheral vessels.
Prevention
How to prevent the development of an attack with vasospasm? People suffering from rheumatic and autoimmune diseases need to protect their body from hypothermia. At low temperatures, gloves or mittens should be worn. AlsoEmotional overload should be avoided whenever possible.
You need to pay attention to your diet. Drinking strong tea and coffee should be avoided. Useful foods high in omega-polyunsaturated fatty acids. These include certain types of fish (salmon, mackerel, trout, salmon, tuna), walnuts, avocados, olive oil and sunflower oil.
The patient should stop smoking, as nicotine provokes vasospasm. It is necessary to avoid taking drugs with adrenergic blockers, ephedrine, ergotamine. If you have to use such drugs for high blood pressure or migraine, then you should consult your doctor about replacing such drugs with analogues for therapeutic action. These measures will help prevent an attack.
