Raynaud’s syndrome is a vasospastic disease characterized by paroxysmal disorder of arterial circulation in the vessels of the extremities (feet and hands) under the influence of cold or emotional excitement. Disease develops against the background of collagenoses, rheumatoid arthritis, vasculitis, endocrine, neurological pathology, blood diseases, occupational diseases. Clinically, pathology is manifested by seizures, including successive paleness, cyanosis and hyperemia of the fingers or toes, chin, tip of the nose. This syndrome leads to gradual trophic changes in tissues. Conservative measures include taking vasodilators, surgical treatment consists in sympathectomy.
ICD 10
I73.0 Raynaud’s syndrome
Meaning
Raynaud’s syndrome is a secondary condition developing against the background of a number of diseases: diffuse connective tissue pathology (scleroderma, systemic lupus erythematosus), systemic vasculitis, rheumatoid arthritis, diseases of sympathetic ganglia, endocrine and hematological disorders, diencephalic disorders, compression of neurovascular bundles. In addition, Raynaud’s syndrome can be triggered by exposure to occupational hazards (cooling, vibration).
In the pathogenesis of this disease, the leading role is assigned to endogenous vasoconstrictors – catecholamines, endothelin, thromboxane A2. There are three consecutive phases in the development of Raynaud’s syndrome: ischemic, cyanotic and hyperemic. The phase of ischemia develops due to spasm of peripheral arterioles and complete emptying of capillaries; it is manifested by local pallor of the skin. In the second phase, due to blood retention in the venules and arteriovenular anastomoses, paleness of the skin is replaced by cyanosis (cyanosis). In the last phase – reactive hyperemic, redness of the skin is noted.
In the absence of etiofactors characteristic of Raynaud’s syndrome, the presence of Raynaud’s disease is assumed. The role of heredity, endocrine dysfunctions, mental trauma, chronic nicotine and alcohol intoxication has been established in the occurrence of Raynaud’s disease. Raynaud’s disease is more common among women 20-40 years old suffering from migraine.
Symptoms
The symptoms of Raynaud’s syndrome are caused by paroxysmal vasospasm and resulting tissue damage. In typical cases, disease affects the IV and II fingers of the feet and hands, sometimes the chin, ears and nose. Ischemic attacks are short-lived at first, rare; they occur under the influence of cold agents, due to excitement, smoking, etc. Suddenly, paresthesia develops, cold fingers, the skin becomes alabaster-white. Numbness is replaced by burning, aching pain, a feeling of bursting. The attack ends with a sharp hyperemia of the skin and a feeling of heat.
The progression of Raynaud’s syndrome leads to an extension of the time of seizures to 1 hour, their frequency, spontaneous occurrence without visible provocation. After the height of the paroxysm, the cyanotic phase occurs, there is a slight swelling of the tissues. In the intervals between attacks, the feet and hands remain cold, cyanotic, moist. Paroxysms of ischemia in Raynaud’s syndrome are characterized by a symmetrical and consistent development of manifestations: first on the fingers of the hands, then on the feet. The consequences of tissue ischemia in the case of a long and severe course of Raynaud’s syndrome can be trophic changes in the form of poorly healing trophic ulcers, areas of necrosis, dystrophic lesions of the nail plates, osteolysis and deformation of the phalanges, gangrene.
Diagnostics
A patient with is referred for consultation by a rheumatologist and a vascular surgeon. In Raynaud’s syndrome, angiography of the peripheral vascular bed allows to identify changes in the distal sections of the arteries, in which areas of uneven stenosis and total vascular obstruction, the absence of capillary networks and collaterals are determined. Capillaroscopy of the nail bed and the anterior surface of the eye reveals morphological changes in the microvascular pattern, indicating a violation of perfusion.
Laser Doppler flowmetry, used to assess peripheral microcirculation, reveals defects in metabolic and myogenic regulation of blood circulation, a decrease in veno-arterial reactions and sympathetic activity. In the period between attacks with Raynaud’s syndrome, a cold test can provoke vasospasm and assess the state of blood flow.
Treatment
The first principle therapy is the exclusion of provoking moments – smoking, cooling, vibration and other household and industrial factors. The primary disease that caused the development of Raynaud’s syndrome is being identified and treated. Among vasodilators in Raynaud’s syndrome, the appointment of calcium antagonists – nifedipine, alprostadil, selective calcium channel blockers – verapamil, nicardipine diltiazem is effective. If necessary, ACE inhibitors (captopril), selective blockers of HS2-serotonin receptors (ketanserin) are used.
In Raynaud’s syndrome, antiplatelet drugs are prescribed – dipyridamole, pentoxifylline, low molecular weight dextrans (rheopolyglucine). The progression and resistance of Raynaud’s syndrome to drug therapy serves as an indication for surgical sympathectomy or gangliectomy. When an ischemic attack develops, urgent measures are warming the limb in warm water, massaging with a woolen cloth, offering the patient a hot drink. With a prolonged attack, injectable forms of antispasmodics (drotaverine, platyphillin), diazepam, blockade are prescribed.
In Raynaud’s syndrome, non-drug methods are used – psychotherapy, reflexology, physiotherapy, hyperbaric oxygenation. In Raynaud’s syndrome caused by systemic collagenoses, extracorporeal hemocorrection sessions are indicated. A new word in the treatment of Raynaud’s syndrome is stem cell therapy aimed at normalizing peripheral blood flow. Stem cells promote the discovery of new collaterals in the vascular bed, stimulate the regeneration of damaged nerve cells, which eventually leads to the cessation of vasoconstriction paroxysms.
Prognosis and prevention
The prognosis depends on the progression of the underlying pathology. The course of the syndrome is relatively favorable, ischemic attacks can spontaneously stop after a change in habits, climate, profession, sanatorium treatment, etc
. The absence of primary preventive measures allows us to speak only about the secondary prevention of Raynaud’s syndrome, i.e. the exclusion of triggering factors leading to vasospasm – hypothermia, vibration, smoking, psychoemotional stress.
