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Raynaud's Disease

Raynaud's disease is characterized by blood vessel spasms in the fingers, toes, ears or nose, usually brought on by exposure to cold. Raynaud's phenomenon and Raynaud's disease, a similar disorder, may be associated with autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus and scleroderma.

Information about Raynaud's Disease]

Raynaud's disease can be associated with diseases of the arteries such as Buerger's disease and atherosclerosis, rheumatoid arthritis, scleroderma and systemic lupus erythematosus. It can also follow repeated trauma, particularly vibrations such as those caused by typing or playing the piano. An overdose of ergot compounds or methysergide may also be a cause of Raynaud's phenomenon.

Strong emotion or exposure to the cold causes the fingers, toes, ears or nose to become white, due to a lack of blood flow in the area. They then turn blue, which is a result of tiny blood vessels dilating to allow more blood to remain in the tissues. When the flow of blood returns, the area becomes red and then later returns to normal color. There may be associated tingling, swelling, and painful throbbing. The attacks may last from minutes to hours.

If the condition progresses, blood flow to the area could become permanently decreased causing the fingers to become thin and tapered, with smooth, shiny skin and slow growing nails. If an artery becomes blocked completely, gangrene or ulceration of the skin may occur.

The risk factors include associated diseases and smoking. Women are affected more often than men.

Causes of Raynaud's Disease

Both primary and secondary types of Raynaud's symptoms are believed to be due to over-reactive arterioles (small arteries). While cold normally causes the muscle which makes up the walls of arteries to contract (squeeze down to become smaller), in Raynaud's disease the degree is extreme. Blood flow to the area is thus severely restricted. Some attacks may also be brought on or worsened by anxiety or emotional distress.

Classically, there are three distinct phases to an episode of Raynaud's symptoms. When first exposed to cold, the arteries respond by contracting intensely. The digits (fingers or toes) in question (or in rare instances, the tip of the nose or tongue) become pale and white as they are deprived of blood flow and, thus, oxygen. In response, the veins and capillaries dilate (expand). Because these vessels carry deoxygenated blood, the digit turns a bluish shade. The digit often feels cold, numb, and tingly. After the digit begins to warm up again, the arteries dilate. Blood flow increases significantly, and the digits turn a bright red. During this phase, the patient often describes the digits as feeling warm, and throbbing painfully.

Raynaud's disease may initially only affect the tips of the fingers or toes. When the disease progresses, it may eventually affect the entire finger or toe. Ultimately, all the fingers or toes may be affected. About 10% of the time, a complication called sclerodactyly may occur. In sclerodactyly, the skin over the affected digits becomes tight, white, thick, smooth, and shiny.

When the most serious complications of Raynaud's disease or phenomenon occur, the affected digits develop deep sores (ulcers) in the skin. The tissue may even die (gangrene), requiring amputation. This complication only occurs about 1% of the time in primary Raynaud's disease.

Symptoms of Raynaud's Disease

  • toes or fingers that change color when exposed to the cold
  • toes or fingers that change color upon pressure
  • pain in the fingers or toes when exposed to the cold
  • tingling or pain on warming

Additional symptoms that may be associated with this disease:

  • skin redness or inflammation
  • bluish skin
  • paleness

Diagnosis of Raynaud's Disease

While the patient's symptoms will be the first clue pointing to Raynaud's disease, a number of tests may also be performed to confirm the diagnosis. Special blood tests called the antinuclear antibody test (ABA) and the erythrocyte sedimentation rate (ESR) are often abnormal when an individual has a connective tissue disease.

When a person has connective tissue disease, his or her capillaries are usually abnormal. A test called a nailfold capillary study can demonstrate such abnormalities. In this test, a drop of oil is placed on the skin at the base of the fingernail. This allows the capillaries in that area to be viewed more easily with a microscope.

A cold stimulation test may also be performed. In this test, specialized thermometers are taped to each of the digits that have experienced episodes of Raynaud's disease. The at-rest temperature of these digits is recorded. The hand or foot is then placed completely into a container of ice water for 20 seconds. After removing the hand or foot from this water, the temperature of the digits is recorded immediately. The temperature of the digits is recorded every five minutes until they reach the same temperature they were before being put into the ice water. A normal result occurs when this pre-test temperature is reached in 15 minutes or less. If it takes more than 20 minutes, the test is considered suspicious for Raynaud's disease or phenomenon.

Treatment of Raynaud's Disease

The first type of treatment for Raynaud's symptoms is simple avoidance. Patients need to stay warm, and keep hands and feet well covered in cold weather. Patients who smoke cigarettes should stop, because nicotine will worsen the problem. Most people (especially those with primary Raynaud's) are able to deal with the disease by taking these basic measures.

People with more severe cases of Raynaud's disease may need to be treated with medications to attempt to keep the arterioles relaxed and dilated. Some medications which are more commonly used to treat high blood pressure (calcium-channel blockers, reserpine), are often effective for Raynaud's symptoms. Nitroglycerine paste can be used on the affected digits, and seems to be helpful in healing skin ulcers.

When a patient has secondary Raynaud's phenomenon, treatment of the coexisting condition may help control the Raynaud's as well. In the case of connective tissue disorders, this often involves treatment with corticosteroid medications.

Alternative treatment of Raynaud's Disease

Because episodes of Raynaud's disease have also been associated with stress and emotional upset, the disease may be improved by helping a patient learn to manage stress. Regular exercise is known to decrease stress and lower anxiety. Hypnosis, relaxation techniques, and visualization are also useful methods to help a patient gain control of his or her emotional responses. Biofeedback training is a technique during which a patient is given continuous information on the temperature of his or her digits, and then taught to voluntarily control this temperature.

Some alternative practitioners believe that certain dietary supplements and herbs may be helpful in decreasing the vessel spasm of Raynaud's disease. Suggested supplements include vitamin E (found in fruits, vegetables, seeds, and nuts), magnesium (found in seeds, nuts, fish, beans, and dark green vegetables), and fish oils. Several types of herbs have been suggested, including peony (Paeonia lactiflora) and dong quai (Angelica sinensis). The circulatory herbs cayenne (Capsicum frutescens), ginger (Zingiber officinale), and prickly ash (Zanthoxylum americanum) can help enhance circulation to the extremities.

Prognosis of Raynaud's Disease

The prognosis for most people with Raynaud's disease is very good. In general, primary Raynaud's disease has the best prognosis, with a relatively small chance for serious complications (1%). In fact, about 50% of all patients do well by taking simple precautions, and never even require medications. The prognosis for people with secondary Raynaud's disease (or phenomenon) is less predictable. This prognosis depends greatly on the severity of the patient's other associated condition (e.g. scleroderma or lupus).

For more information visit Raynaud's Foundation

 
 
 
 
 
 
   

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08/05/2010

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