Raynaud's disease - refers to vasospastic diseases, is an angiotrofonevroz with a primary lesion of the small terminal arteries and arterioles . The disease affects the upper limbs, as a rule, symmetrically and bilaterally. It occurs in 3-5% of the population, in women 5 times more often than in men [1] .
It was first described in 1862 by the French physician AG Maurice Raynaud (1834–1881) [2] .
Raynaud's Disease | |
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Characteristic appearance of fingers in Raynaud's disease (Raynaud's phenomenon) | |
ICD-10 | I 73.0 |
ICD-9 | 443.0 |
OMIM | 179600 |
DiseasesDB | 11186 |
MedlinePlus | 000412 |
eMedicine | med / 1993 |
Content
Etiology
Presumably, the basis is genetic predisposition [1] . Risk factors trigger the onset of the disease. These include:
- frequent and prolonged episodes of hypothermia of the upper limbs,
- chronic finger injury
- endocrine disorders (thyroid, sex glands),
- severe emotional stress.
- occupational factors (vibration)
- rheumatic diseases (systemic scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, periarteritis nodosa, etc.)
More often women are ill at the age of 20 - 40 years, quite often the disease is combined with migraine. An increased incidence of typists and pianists was noted. In the pathogenesis of an attack of ischemia, an increase in the tone of the sympathetic nervous system plays a role.
Symptoms
There are 3 main stages of the disease:
- angiospastic (short-term spasms of the vessels of the terminal phalanges of 2-5 fingers or 1-3 toes of the foot; the spasm is quickly replaced by expansion of the vessels with redness of the skin, warming the fingers);
- angioparalitichesky (a brush and fingers get cyanotic coloring, puffiness and pastosnost of fingers);
- tropho-paralitic (tendency to the development of felon and ulcers, foci of superficial necrosis of the soft tissues of the terminal phalanges, after rejection - nonhealing ulcers).
The differential diagnosis is carried out with obliterating endarteritis and circulatory disorders in the limb, caused by compression of the subclavian artery; Other vasospastic pathologies are also considered as diseases for differential diagnosis.
Diagnostics
For patients with this syndrome, a specific violation of microcirculation is characteristic, manifested in the form of coldness of the fingers and a reaction to cold in the form of pain and blanching. Sometimes, according to certain drawings of the capillaries of the blood vessels that are adjacent to the nail plates, Raynaud's phenomenon can be identified. However, it should be noted that there is no unambiguous clinical symptom indicating the presence of this syndrome. The doctor may also conduct certain studies of the patient's limbs to eliminate the contraction of blood vessels that mimics Raynaud's phenomenon, such as, for example, the ladder muscle syndrome .
Usually, people with Raynaud's phenomenon, which is regarded as one of the manifestations of rheumatic diseases, have an increased erythrocyte sedimentation rate , an increased level of antinuclear antibodies is noted. . This combination of symptoms may be the debut of systemic scleroderma and other connective tissue diseases. .
Disease Treatment
Methods of treatment of Raynaud's disease can be divided into two groups - conservative and surgical.
Conservative methods include the use of vasodilating drugs (for example, Phentolamine). Drug therapy for Raynaud's disease continues throughout the life of the patient. It should be noted that with long-term use of these drugs inevitably develop complications.
Surgical treatment is sympathectomy . The essence of the treatment lies in the “turning off” of the nerve fibers through which the pathological impulses go, causing the blood vessels to spasm. There are several types of sympathectomy. The least traumatic is endoscopic sympathectomy.
Prevention
Disease prevention is to keep the limbs always warm. To do this, you must wear multi-layered clothing, especially to protect the hands and feet. Mittens are more practical than gloves, as in them fingers warm each other. Currently there are on sale special gloves and socks with electric heating and hand warmers. Some manage to prevent attacks of Raynaud’s disease by making quick circular moves with their hands: under the action of centrifugal force, blood is pumped into the limbs. Warm water helps to keep warm, but you need to make sure that it is not too hot. People suffering from Raynaud’s disease are strictly forbidden to smoke.
Raynaud's disease can be prevented if provoking factors are avoided and treatment is started at the first signs. But in severe cases, surgery may be required. Raynaud's disease is an early symptom of other diseases, such as systemic sclerosis, characterized by thickening of the skin. However, Raynaud's disease should not be considered a common sign of its onset.
Notes
- ↑ 1 2 MedGid.org .
- ↑ AGM Raynaud: De l'asphyxie locale et de la gangrène symétrique des extrémités. Doctoral thesis, published February 25, 1862. Paris, Rignoux. L. Leclerc, Libraire-Éditeur. Also, Paris, Rignoux, 1867: 15-20.
Links
- Raynaud's disease and Raynaud's syndrome . MedGid.org. The appeal date is April 27, 2013. Archived April 28, 2013.
- Raynaud's Disease