Raynaud's disease: causes, symptoms and treatment, prognosis. Raynaud's disease - everything you need to know about the pathology. Why is Raynaud's disease dangerous? What are its consequences?

There is some confusion - there is Raynaud's disease and Raynaud's syndrome. They proceed in the same way, but many patients do not understand and ask for clarification of the difference between them.

We can say in general: if you see the name of the syndrome and the same name of the disease, then this means the following:

• A disease is called if no reasons for the development of this syndrome have been found (idiopathic condition), or they are hidden (cryptogenic etiology). There is practically no difference between this for the patient;
• The same condition for which we have found a cause can be called a syndrome. By eliminating the cause, the syndrome itself resolves.

Thus, Raynaud's syndrome is a secondary condition that develops in many rheumatic conditions, blood diseases, compression of nerve and vascular bundles, and endocrine pathology.

More than 90% of patients suffer from this syndrome, and approximately every 12 cases of this suffering remain for Raynaud's disease.

Raynaud's disease is almost always a disease of women. Out of every ten cases, only 1-2 patients are men. Therefore, if Raynaud's disease begins in men, it is almost always a secondary manifestation, and the cause must be looked for. Likewise, Raynaud's disease often begins in young adulthood, but not in adulthood.

Its symptoms were first described by the French physician Maurice Raynaud in the mid-19th century. What is Raynaud's disease and syndrome?

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What it is?

Raynaud's disease photo of hands (symptoms)

Raynaud's disease is a disease that is based on a sharp vascular spasm that affects small arterial vessels whose walls contain smooth muscle. This condition is associated with a violation of vascular tone, and it belongs to angiotrophoneurosis.

• Usually the lesion is symmetrical, and most often occurs in the vessels of the fingers, but can also occur in other places.

In addition to the hands, the color of the skin on the feet systematically changes, and less often on the nose, lips and ears. This pronounced pallor is associated with a lack of blood flow, sometimes it appears with emotional excitement, or even with the slightest cooling of the body - for example, if the patient is under air conditioning, or puts his hands in cold water, or touches a portion of ice cream.

After the affected parts of the body are warmed, they remain cold for some time.

Raynaud's syndrome photo symptoms

What reasons lead to the development of this disease? If we talk about Raynaud's syndrome, the reasons that lead to it, in addition to hypothermia and stress, are the following:

• Permanent chronic injuries (most often involving fingers);
• Endocrine diseases (most often of the thyroid gland);
• Vasculitis, or diseases that occur with inflammation of the vascular wall;
• Occupational diseases (vibration disease). Typists and pianists often get sick;
• Various connective tissue diseases (scleroderma, dermatomyositis,).

The fact that Raynaud's disease and syndrome is based on a generalized rather than local vascular disorder is a frequent combination of symptoms with migraine. With a migraine, characteristic throbbing and aching pain occurs in one side of the head.

Signs by stages of development

Since Raynaud's disease is long-term and chronic, several stages can be distinguished in its course:

1. Stage of vasospasm. This is a short paroxysm of blood vessels, usually occurring on the terminal phalanges of the fingers. It passes quickly, giving way to pronounced redness and a feeling of heat in the fingers, sometimes aching with pain occurs;
2. The stage of vascular paralysis (the spasm becomes chronic), the skin acquires a bluish tint, persistent swelling and pastiness develop (this is especially noticeable on the fingers). This stage occurs 6-8 months after the first symptoms of vascular disorders appear;
3. Trophoparalytic stage. It is characterized by trophic disorders: non-healing ulcers and wounds occur, and superficial necrosis (necrosis) is formed, noticeable on the phalanges. The patient does not tolerate any cooling or exposure to low temperatures at all.

As a result, articular syndrome occurs (in the hands), stiffness appears, constant bluishness of the skin, and frequent pain occurs.

As a result, a harmless vascular spasm can lead to disability after a few years. How does this vascular lesion begin and how does it progress?

Symptoms of Raynaud's disease, photo

color change (photo)

Let us list the classic signs of angiotrophoneurosis. These symptoms of Raynaud's disease are most common in women:

• There is an initial change in skin color, which first changes from its normal color to pale, and then to bluish, and finally to red. In other words, first the blood flow is limited, then venous stasis occurs, that is, the outflow is disrupted. And redness is associated with the restoration of blood flow in an increased volume;
• When pallor occurs, chilliness, a feeling of coldness, as well as numbness or a crawling sensation appear. Sometimes there is a feeling of pain;
• When blood supply is restored, most often, aching, swelling of the skin occurs and a feeling of heat occurs, similar to that which appears during inflammation;
• With a long course, an increase in trophic disorders occurs, and deformation of the joints of the fingers occurs.

Why do such signs occur?

When the nervous autonomic (sympathetic, mainly) influences on the vessels are disrupted, they cease to “actively participate” in blood circulation. They become passive “pipes” for carrying blood. In this case, the blood tries to get into those vessels that:

• larger diameter;
• fewer branches;
• short length;
• gentle origin of the adductor (maternal) trunk.

As a result, when active regulation of blood flow ceases, its volume drops, since a significant part of the vascular bed is simply empty.

The blood flow is shunted, that is, it is dumped “by the cash register,” which causes oxygen starvation of the tissues. As a result, a large mass of blood rushes past the tissues, like a high-speed electric train without stopping past a poor village.

Diagnostics and list of tests

Diagnosis of Raynaud's disease involves a very important step: routine questioning and examination of the patient, as well as provocative tests with cooling. When a doctor sees with his own eyes an episode of ischemia of the capillaries of the hands, this allows him to make an accurate diagnosis.

Auxiliary diagnostic methods are:

• Ultrasound of vessels of the extremities;
• Computed contrast angiography of the extremities, with a particularly close assessment of the distal capillary network in the fingers. Attention is drawn to the development of the anastomotic network;
• Carrying out capillaroscopy of the nail bed to look for microcirculation disorders;
• Carrying out Doppler laser flowmetry with accompanying functional tests.

What is laser flowmetry? In this completely painless research method, tissues are probed with a laser beam. The beam hits stationary tissue and moving blood. After being reflected, it comes back.

Based on the frequency shift in the radiation returned to the receiver, a special curve is built that obeys many rules. Based on the analysis of this curve, a conclusion is drawn about the presence and nature of disorders of peripheral capillary hemodynamics.

Differential diagnosis is of great importance, that is, searching for the cause of Raynaud's syndrome (for example, when its symptoms occur atypically in men over 40 years of age). Here you can conduct the most large-scale studies, with the involvement of various specialists - from oncologist to endocrinologist.

Treatment of Raynaud's disease, drugs

The goal of treating the disease is to prevent attacks. Therefore, treatment of Raynaud's disease begins not with the prescription of drugs, but with the elimination of risk factors that provoke vascular spasm. And the most important thing here is to protect the patient from hypothermia, both local and general.

• Here are some useful tips.

Protecting yourself from the cold

In order to completely rid yourself of attacks of angiotrophoneurosis in some cases, you need to follow the following recommendations:

• do not forget about warm clothes in spring and autumn;
• do not choose tight shoes, they should be loose;
• at the same time, loose shoes should have a warm toe and a thick insole;
• give preference to mittens; gloves are colder;
• don’t be lazy to always carry a backpack with a warm sweater if you may find yourself in an air-conditioned room;
• try not to fall asleep with windows open, especially in winter. If your feet and hands are cold before going to bed, wear mittens and socks, and buy terry, warm or flannel bedding;
• when visiting a dacha, heat the room well before going to bed, and if this is not possible, purchase an electric blanket;
• try to completely avoid contact of your body with cold water, and do not hesitate to ask someone for help;
• wash dishes, vegetables and fruits only in warm water;
• Use oven mitts and gloves when working with frozen meat and when taking out cold foods.

If you have a long-term illness, you need to prevent trophic disorders. You need to protect your skin.

Let's protect the skin from trophic disorders

First of all, you need to avoid traumatic factors, for example, strumming the guitar, or picking berries on thorny bushes. The following recommendations may help you:

• examine the skin of your hands and feet every day before going to bed and lubricate it with a nourishing cream;
• use mild soap;
• protect your hands with rubber gloves when washing dishes or using cleaning products;
• try to wear socks and mittens made from natural materials.

Additional, but very important measures include quitting smoking, reducing alcohol consumption, and avoiding stressful situations that cause a pronounced release of adrenaline and the appearance of vascular spasm.

In some cases (for example, when taking beta blockers), symptoms of Raynaud's disease may appear even without any cooling, since these drugs sometimes have a vasoconstrictor (vasoconstrictor) effect.

About taking medications

Treatment of Raynaud's disease with drugs is always complex. In some cases, it is necessary to use completely unexpected drugs, since the beginning of the pathological cascade may be in the central nervous system.

Thus, antidepressants (SSRIs) and tranquilizers can be used, which reliably reduce the frequency of attacks of the disease.

Courses of medications to improve microcirculation (Pentoxifylline, Trental) are indicated. Calcium blockers (Nifedipine) are used.

Physiotherapy is an important component of treatment. Sessions of hyperbaric oxygenation (HBO) are used, sessions of electrophoresis, ozokerite therapy, and massage are performed. Acupuncture sessions have a good therapeutic effect.

In case of resistant course and rapid development of disability, surgical treatment is indicated. A sympathectomy or desympatization operation is performed. The purpose of this intervention is to weaken the sympathetic influences on the vessels in order to prevent spasm.

Surgical intervention has its contraindications, and, according to modern data, even correctly performed desympatization has only a temporary and insignificant effect, so Raynaud's syndrome must be treated from the very beginning, precisely by preventing an attack.

How to behave if an attack does develop?

Stopping an attack “with your own hands”

The main healing factor is heat, which helps relieve vascular spasm. If you feel that your hands have become very cold, tingling, have lost sensitivity, and have acquired a porcelain-white hue, then you need to:

1. Urgently get to a warm place, or at least hide your hands under clothes;
2. Vigorous rubbing and massage can help restore blood flow. You can rub only if there are no trophic lesions on your hands, otherwise you can only aggravate the situation;
3. If possible, place your hands under warm water that is only slightly above body temperature. Too hot water can cause a paradoxical increase in spasm (after all, when you first enter a hot steam room, many people experience “goose bumps” for a short time);
4. Sometimes, at the very beginning of the onset of unpleasant sensations, vigorous shaking of the arms raised above the head helps.

The use of folk remedies

Treatment of Raynaud's disease with folk remedies includes effects aimed at increasing blood flow. So, a good remedy may be the use of coniferous or turpentine baths, taking adaptogens, such as tincture of lemongrass, currant buds, and eleutherococcus.

Pillows stuffed with hop cones and valerian, or small bags that are placed next to the face before bed, are quite capable of preventing attacks of vasospasm. This allows you to calm the nervous system and reduce sympathetic influences.

Forecast

In most cases, Raynaud's disease has a good prognosis for life, but not for quality of life. Making it tall is completely in your hands. The symptoms and treatment of Raynaud's disease that we have looked at make it clear that the main treatments that can be used for many years revolve around preventing attacks.

Raynaud's disease occupies a central place among functional vascular diseases and is a typical example of angiotrophoneurosis.

The first scientific description of this pathology dates back to 1629. However, it was only in 1862 that the French neurologist Maurice Raynaud first systematized scattered literary reports and his own observations and for the first time identified an independent disease, defining it as “local asphyxia and symmetrical gangrene of the fingers.” Subsequently, this pathology was named after the author - “Raynaud's disease.”

Raynaud's disease is a disease characterized by paroxysmal disorders of the arterial blood supply, mainly to the hands and feet, leading to trophic tissue disorders. For a long time, all cases accompanied by attacks of asphyxia of the fingers, the formation of ulcers and other pathological changes in the distal parts of the extremities were attributed to Raynaud's disease. Only in 1896, Hutchinson was one of the first to propose a distinction between Raynaud's disease itself (idiopathic form) and Raynaud's syndrome (a secondary symptom complex similar in clinical manifestations to diseases of different nature or external damaging influences). Among the total number of patients with paroxysmal circulatory disorders in the extremities, 70-85% are people with Raynaud's syndrome. The relative rarity of Raynaud's disease should obviously be explained by the individual characteristics of the manifestations of these two

various pathological conditions, their similarity, creating difficulties in differential diagnosis.

Over 70 different diseases and pathological conditions are known that are accompanied by Raynaud's syndrome and are conventionally divided into 7 groups.

▲ Diseases of the vascular system (thromboangiitis obliterans, atherosclerosis obliterans, angiodysplasia, Barre-Masson glomerular tumors).

▲ Collagenosis (systemic scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, periarteritis nodosa, etc.).

▲ Blood pathology (cryoglobulinemia, hyperviscosity syndrome).

▲ Diseases with compression neurovascular syndrome (cervical rib, anterior scalene muscle syndrome, osteoclavicular syndrome, pectoralis minor syndrome, hyperabduction syndrome; spinal pathology - deforming spondylosis, osteochondrosis, scoliosis, kyphosis, etc.).

▲ Poisoning and hypersensitivity to drugs (salts of heavy metals, erto-tamine, cytostatics, hormonal contraceptives).

▲ Neurological diseases (syringomyelia, ankylosing spondylitis, multiple sclerosis, poliomyelitis, radiculitis, etc.).

▲ Relatively rarely, Raynaud's syndrome occurs with hypothyroidism, primary pulmonary hypertension, primary biliary cirrhosis, and osteochondropathy.

Establishing a diagnosis of Raynaud's disease or syndrome in each specific case is of fundamental importance, since persistent positive results of usually complex and long-term therapy for secondary arteriopathies are possible only by eliminating or influencing the root cause of Raynaud's syndrome.

Etiology Raynaud's disease has not yet been specified, but there are a number of factors predisposing to its development: heredity, constitutional deficiency of the vasomotor innervation of the terminal vessels; psychogenic factors; CNS injuries; chronic intoxication with nicotine, alcohol; endocrine disorders; infectious diseases; overwork and overheating. Meteorological influences and occupational hazards play a special role in the occurrence of the disease. Thus, various vasospastic disorders are observed in 12-15% of the population living in damp and cold climates; 30% of workers in chemical production; 50% of miners and fishermen and 40-90% of timber harvesters. A relatively high incidence is observed in people who often overexert their hands and fingers (milkmaids, typists, pianists, etc.). In 4.5% of patients, Raynaud's disease is hereditary.

Pathogenesis Raynaud's disease has not been precisely established, but the leading role in its development is played by the sympathetic nervous system and the characteristics of the skin blood flow, in particular the hands and feet, where in the vast majority of cases convulsive vascular diseases are observed attacks (crises). The lumen of skin vessels, and especially numerous arteriovenous anastomoses, is entirely determined by neurogenic impulses, and skin vessels have increased sensitivity to sympathetic influences and the action of catecholamines. Extremely pronounced and unopposed (with a decrease in blood flow and a decrease in tissue metabolism in the hands and feet in response to ischemia, bradykinin and kallidin, which dilate blood vessels, are not formed) sympathetic control over the blood circulation of the distal extremities explains the originality and local nature of the changes in Raynaud's disease. The primacy of it

Rotrophic disorders are emphasized by all authors. Along with neurogenic functional mechanisms, local structural changes in blood vessels and their increased thermoresponsiveness, which persists even after denervation, are also important. In the initial period of the attack, spasm of small arteries, arterioles and arteriovenous anastomoses predominates. As it resolves, hypertonicity of the postcapillary sphincters, paresis of venules and small veins occurs, which is manifested by a change in pallor of the skin to cyanosis.

One explanation for the origin of Raynaud's disease is the local defect theory. It is believed that the blood vessels of the extremities have increased sensitivity to cold. A local defect at the level of the digital arteries is caused by excitation of α2 receptors involved in vasoconstriction. The essence of the pathophysiological defect is the impossibility of restoring vascular tone after cold provocation. Serotonin has an additional vasoconstrictor effect.

Recent research suggests that in Raynaud's disease, the formation of a neuropeptide called calcitonin gene-related peptide (CGRP), which has a powerful vasodilator effect, is impaired.

Schematically, the general model of the pathogenesis of Raynaud's disease can be presented as follows: when the function of the nervous system, especially its autonomic part, is impaired at all levels and the presence of endocrine disorders, the overall resistance of the body to external unfavorable factors weakens. Adaptation mechanisms are disrupted, and against this background a disease develops.

Clinical picture. Raynaud's disease occurs predominantly in young women (more than 90%)

at the age of 25-35 years, very rarely - in children and elderly people.

As a rule, the II-IV fingers of the hands and, less commonly, the feet are primarily affected. Later, the process can also affect other parts of the body that are subject to cooling (nose, ears, chin). Raynaud's disease is characterized by strict symmetry of the lesion and earlier involvement of the arms than the legs. In 40% of patients, vascular crises are simultaneously observed on the hands and feet. Localization of attacks on the face (lips, nose, chin, tips of the ears) is observed in 8% of patients.

The detailed clinical picture of Raynaud's disease is represented by four main syndromes: vasomotor (local syncopation, asphyxia and hyperemia); trophic (from compaction, swelling of the skin to dry necrosis); impaired skin sensitivity (paresthesia, pain, less commonly hyperpathia); secretory disorders (hyperhidrosis, anhidrosis). In fact, clinical manifestations depend on the stage of Raynaud's disease. There are four stages.

I stage characterized by short-term, within a few minutes, attacks of ischemia, which manifests itself in sudden (in response to cold or psycho-emotional effects) numbness, usually of the distal parts of the fingers. They become cold, turn pale and lose sensitivity. Aching pain and a burning sensation appear in them. When exposure to cold ceases and the symptoms are warmed up, the symptoms disappear and the fingers gradually, in some patients through reactive hyperemia, acquire normal color with the restoration of temperature and sensitivity. Attacks, especially in the warm season, are rare; There are no trophic tissue disorders. As the disease progresses, attacks become more frequent and interictal periods shorten.

IIstage occurs on average 6 months after the onset of the disease and

characterized by an increase in the duration of attacks up to an hour or more; Sensitivity to cold increases sharply. After syncopation (pallor of the fingers), deep cyanosis (asphyxia) occurs, sometimes with moderate swelling of the tissues. Against the background of cyanosis, intense, paroxysmal, burning or tearing pain occurs. In the short intervals between attacks, slight swelling of the fingers persists. Hyperhidrosis is pronounced. In most patients, the disease stabilizes at this stage and can last for many years.

III stage occurs on average 1-3 years from the onset of the disease and is observed in a minority of patients. Accompanied by all, but more pronounced symptoms of the previous stage. A distinctive feature is significant trophic disorders (phlyctenas, extremely painful superficial ulcers on the fingertips, acrosclerosis). Some patients have sclerodactyly, connective tissue calcification, and dystrophic changes in the nails. Characterized by increased vulnerability of the fingers and absolute intolerance to low temperatures.

IV stage not highlighted by all authors, but it naturally occurs in all patients with III stage of the disease. Patients often experience mental and physical exhaustion, constant pain, and intoxication. The affected fingers are thickened, the joints are stiff, the skin cyanosis is constant. In addition to various tissue trophic disorders, dry necrosis of the nail phalanges often occurs.

Many authors also distinguish two clinical forms of Raynaud's disease: benign (primary chronic) and malignant (subacute or acute). The most important differences between the benign form of Raynaud’s disease are the predominance of angioneurotic processes over trophopathic processes.

ralistic, lack of expression of trophic changes and the presence of long-term remissions. The disease in this form continues for many years, even decades, and is observed in 80% of patients.

In a malignant course, usually during the first 1-2 years, severe trophic disturbances occur, since trophoparalytic mechanisms of disease development prevail over vasomotor ones. A similar course of the disease occurs in 20% of patients.

The complaints of patients are varied and can be conditionally divided into general and local. General complaints reflect the presence of dysfunction of the central and autonomic nervous system, often psychasthenia. Among them, the most typical are a decrease in overall performance, fatigue, irritability, poor sleep with frightening dreams. Headache, tremors of hands, eyelids are common. About 2% of patients (with spasms localized to the face) experience short-term attacks of blindness.

Local complaints indicate impaired vascular innervation and progressive tissue degeneration. The most common symptoms are increased chilliness of the fingers or toes, decreased muscle strength, pain in the distal parts of the extremities, increased vulnerability of the terminal phalanges, impaired sensitivity and sweating, as well as progressive deformation of the fingers.

Forecast for Raynaud's disease depends on the form of its course (benign or malignant). In malignant forms, the prognosis for restoration of hand and finger function is usually unfavorable due to early and deep trophic tissue damage. With a benign course of the process, self-healing is possible with complete regression of all previously existing symptoms. Regardless of the clinical form of Raynaud's disease, prognosis

In relation to the life of patients, it is favorable, but the ability to work is not completely restored due to the loss of the ability to perform fine manual manipulations.

Diagnostics is aimed at establishing the presence of Raynaud's disease and determining the stage of the disease. The main task is to differentiate the disease and Raynaud's syndrome. The latter is accompanied by similar local circulatory disorders, but is always secondary to the previously listed diseases and pathological conditions.

To recognize true Raynaud's disease, American researchers E. Allen and G. Brown in 1932 developed 5 differential diagnostic criteria to exclude Raynaud's syndrome.

Raynaud's disease is characterized by the following symptoms.

g Episodic appearance of attacks of pallor or asphyxia in the fingers, toes, protruding parts of the face, occurring under the influence of cooling or emotional stress.

▲ Mandatory symmetry of vascular or trophic disorders.

▲ No gangrene or minimal skin necrosis.

The patient does not have any diseases that can secondary lead to vascular dyscirculation.

The need to monitor patients with suspected Raynaud's disease for at least 2 years (during this period, diseases associated with Raynaud's syndrome are usually detected).

The initial diagnosis of Raynaud's disease is simplified by the fact that the vascular attack can be easily reproduced using cold influences. P.P. Alekseev’s cold test (determining the time for reheating the limb) is informative. Test method: after adaptation of the patient to the study room at a temperature

20-21 °C skin temperature is measured at the tips of the fingers or toes. Then the hand (foot) is immersed in cold (5 ° C) water for 5 minutes. After cooling, the skin temperature is recorded again and again at the same points until it is restored to the original level. In healthy individuals, reheating of the limb occurs in 10-12 minutes, and in case of Raynaud's disease, during the same time, depending on the stage, it occurs only by half. Full recovery takes tens of minutes. The temperature comfort zone in Raynaud's disease increases significantly (in healthy individuals it is 33-34 ° C).

They also use bone radiography (detects osteoporosis), thermal imaging, capillaroscopy, rheovaso- and plethysmography, which confirm disorders of the arterial blood supply to tissues and help in establishing the stage of the disease. Angiography is not very informative, but in the later stages of the disease it allows one to determine the presence of stenosis of the digital arteries. The great vessels in Raynaud's disease are always intact. Laboratory methods for Raynaud's disease demonstrate a significant increase in blood viscosity, an increase in the titer of Coldov and antivascular antibodies in the later stages.

To exclude obliterating diseases, primarily thrombus angiitis, it should be taken into account that this disease affects almost exclusively men, while Raynaud's disease is observed mainly in women. In obliterating diseases, pathological changes in blood vessels primarily occur in the lower extremities, and in Raynaud's disease - in the upper extremities. There is no intermittent claudication in Raynaud's disease. Raynaud's syndrome with thromboangiitis is more common in the later stages of the disease and is often localized on one or two fingers of the affected limb. Raynaud's syndrome in patients with obliterative

atherosclerosis is rare, and vasospastic disorders are usually limited to only paleness of a few fingers without subsequent cyanosis. Detection of vascular murmur and disappearance of pulsation at typical points resolves diagnostic doubts.

In general, recognition of Raynaud's disease is a diagnosis by excluding by various methods all diseases accompanied by vasospastic disorders, and primarily connective tissue diseases, where these disorders (Raynaud's syndrome) are observed most often and early.

Treatment of Raynaud's disease and syndrome includes conservative and surgical methods. Treatment always begins with conservative measures and continues with courses at least 2 times a year and at least 2 years. The earlier treatment is started, the better the results. Only complex, multicomponent therapy aimed at preventing and eliminating all unfavorable factors involved in the formation of the disease can be highly effective. It should be emphasized that conservative treatment for Raynaud's syndrome is identical to that for Raynaud's disease, however, the main attention in these patients must be paid to the impact on the causative factor, i.e. on the underlying disease that provokes acrospasm.

Therapeutic programactivities includes:

Elimination of risk factors (cessation of smoking and drinking alcohol; release from work associated with cooling the hands and feet, overexertion of the hands; moving to live in an area with a warm and mild climate; normalization of blood pressure).

Sedative therapy (Relanium, Elenium, Sibazon, meprobamate, etc.; psychotherapy and reflexology; hypnosis and autogenic training).

3. Elimination of vasoconstriction (novocaine blockade of sympathetic ganglia; physiotherapy - amplipulse, phonophoresis, magnetotherapy, balneotherapy). The first choice drug is calcium antagonists (Corinfar, verapamil). Vasoconstriction inhibitors (cinnarizine, flunarizine) are prescribed. The use of alpha-blockers (phentolamine, prazosin) has a good effect. It is advisable to prescribe sympatholytic drugs (isobarine, reserpine, dopegit, raunatin, etc.). Intravenous infusions of vasodilating mixtures (novocaine, antispasmodics, vitamins, nicotinic acid derivatives) are mandatory for the period of inpatient treatment and during exacerbation of the disease. A direct vasodilator effect can be achieved by using an angiotensin-converting enzyme inhibitor, capoten.

4. Fighting pain (novocaine blockade of sympathetic ganglia, analgesics, neuroleptics, narcotics).

5. Improvement of microcirculation (prodectin, xanthinol nicotinate).

Correction of rheological disorders (dipyridamole, ticlopidine, pentoxifylline, microdoses of aspirin, low-molecular dextrans, vasaprostan, as well as plasmapheresis and plasma replacement).

Combating autosensitization and correcting immunodeficiency (pre-nisolone, dexamethasone, indomethacin-type drugs, immunomodulators).

Improving tissue trophism and strengthening the vascular wall (ATP, vitamins B, A, E, cocarboxylase, vitamin C, nicotinic acid, ascorutin, troxevasin, aescusan, etc.).

Desensitizing agents (calcium chloride, diphenhydramine, pi-polfen, tavegil, suprastin).

It should be remembered that pregnancy and childbirth often lead to spontaneous recovery of Raynaud's disease.

If conservative treatment is ineffective, indications are given for surgical interventions- de-sympathization or amputation. Amputations and disarticulations of the affected phalanges of the fingers, an extreme and necessary measure, are performed in less than 1% of patients. Resection of the sympathetic trunk and ganglia is of primary importance: in case of damage to the upper extremities - II-IV thoracic ganglion, and in case of localization of the process on the feet - II-III sympathetic ganglion in the lumbar region of the border trunk. Some authors believe that in case of damage to the upper extremities, preganglionic ramicotomy (in the area from the IV cervical to the I thoracic node) in combination with periarterial digital sympathectomy is most effective. The previously widely used stellatectomy (removal of the cervicothoracic sympathetic ganglion) should be avoided due to its lower effectiveness and the resulting cosmetic defect (Bern-ra-Horner syndrome). If the upper and lower extremities are simultaneously affected, isolated resection of the left III the thoracic ganglion, which is “the center of sympathetic innervation of the entire arterial system.” According to many authors, preference should be given to endoscopic desympathetic techniques.

The results of sympathectomies in the disease, and especially in Raynaud's syndrome, are difficult to predict, and prognostic tests are unreliable, but in the majority of operated patients a clear positive effect is observed.

A combination of conservative and surgical treatment methods gives positive results in 79-83% of patients. The stability of the results is determined by compliance with preventive measures, as well as the duration of clinical observation and treatment of patients with Raynaud's disease and syndrome.

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What is Raynaud's syndrome and Raynaud's disease?

Raynaud's syndrome is a phenomenon in which reversible spasm of blood vessels in the fingers and toes occurs periodically in response to stress or cold. Raynaud's disease is a similar ailment, which, however, developed against the background of some systemic disease. This pathology is named after the scientist Maurice Raynaud, who, while still a medical student, first described a case of episodic, symmetrical spasm of the blood vessels of the hands, characterized by pallor and a feeling of pain.

With the disease and with Raynaud's syndrome, there are identical changes in blood circulation at the level of the extremities, which are manifested by absolutely identical signs. However, as mentioned earlier, Raynaud's disease occurs as one of the manifestations of a systemic (encompassing several organs or organ systems) disease, while Raynaud's syndrome is a primary phenomenon, the pathological substrate of which has not been identified or is unknown.

In most cases, Raynaud's disease develops against the background of an existing autoimmune disease (sometimes the syndrome may occur earlier). Almost 90% of people suffering from systemic scleroderma experience Raynaud's phenomenon to one degree or another. In other systemic connective tissue diseases, the incidence of this pathology is somewhat lower.

It is necessary to understand that Raynaud's phenomenon itself is not a dangerous pathology, and with proper treatment, the prognosis for patients is extremely favorable. However, in some cases, due to too long vascular spasm or due to association with another disease, this syndrome can lead to ischemia (lack of blood circulation) of the fingers or even a limb, followed by necrosis (death) of tissue, which most often occurs in the third stage of the disease .

Primary Raynaud's syndrome and secondary Raynaud's syndrome

In clinical practice, it is customary to distinguish between primary (Raynaud's syndrome itself) and secondary Raynaud's syndrome (Raynaud's disease). This division is based on the presence of concomitant systemic pathologies, which often act as causes of the disease.

The following forms of Raynaud's phenomenon are distinguished:

• Primary Raynaud's syndrome. Primary Raynaud's syndrome is a pathology, the exact cause of which is unknown. This disease develops independently and is characterized only by periodic spasms of blood vessels in the fingers. The course is usually mild, and with proper attention and monitoring there is no need to resort to drug treatment.

• Secondary Raynaud's syndrome. Secondary Raynaud's syndrome develops against the background of another disease. Most often, the disease occurs as a result of damage to connective tissue during autoimmune processes, but often the cause can be certain medications or other diseases (vibration disease and intoxication with heavy metal salts). Unlike the primary pathology, in the later stages of this form of the disease, irreversible changes may occur in the affected limbs with the formation of ulcers or even tissue death (due to severe circulatory disorders).

Causes of Raynaud's syndrome

Raynaud's phenomenon is an intense spasm of blood vessels in one or more parts of the body, accompanied by a change in color followed by hyperemia (redness caused by a significant rush of blood). To date, the cause of Raynaud's syndrome is still unclear. Several putative mechanisms responsible for the development of clinical manifestations of this pathology have been studied, but the possibility of the presence of other pathological pathways of the disease cannot be ruled out.

The following groups of possible mechanisms for the occurrence of Raynaud's syndrome are distinguished:

• Vascular disorders. A lack of biologically active substances responsible for the normal physiological response to a stress factor can cause excessive spasm or insufficient relaxation of blood vessels.
• Neurological disorders. It is assumed that in case of Raynaud's syndrome and disease, the nervous regulation of vascular motor activity is somewhat impaired, resulting in an inadequate response to certain factors of the external or internal environment.
• Intravascular changes. Changes in the structure or surface of a blood vessel, combined with impaired endothelial cells (the cells that form the vessel wall), can lead to poor circulation, worsened by arterial spasm.

It is necessary to understand that Raynaud's phenomenon is extremely important to distinguish from other possible causes of circulatory disorders in the limb, which are often irreversible and can lead to tissue death.

Raynaud's syndrome should be distinguished from the following pathologies:

• Thrombosis. Thrombosis is an extremely dangerous condition in which a blood clot (thrombus) is located in the lumen of a blood vessel, which blocks blood circulation. Typically, blood clots form in the veins, where the blood flow rate is much slower. In some cases, blood clots enter the arterial system, resulting in oxygen starvation of the tissues, followed by their death. Symptoms of thrombosis of an artery in the arm or leg are similar to Raynaud's phenomenon, but they are irreversible and much more severe. It is necessary to understand that without medical assistance, this condition poses a great danger not only to a person’s health, but also to his life.
• Vasculitis. With vasculitis, blood vessels become inflamed, resulting in significant disruption of their structure and function. There is a gradual decrease in blood circulation at the level of the extremities, which can provoke both thrombosis and other complications with the occurrence of irreversible cessation of blood flow.
• Vessel damage. If a vessel is damaged as a result of injury, blood circulation in the extremities may also decrease.

Attacks of both primary and secondary Raynaud's syndrome in the vast majority of cases develop against the background of certain provoking factors, which to varying degrees affect the vessels and limbs and blood circulation.

Raynaud's syndrome can be caused by the following factors:

• washing hands with cold water;
• psycho-emotional stress;
• vibration;
• use of vasoconstrictor drugs;
• contact with polyvinyl chloride, heavy metals.

In the later stages of Raynaud's disease, attacks of vasospasm may occur spontaneously, without the presence of any provoking substrate.

It should be borne in mind that it is possible to establish the causes of only secondary Raynaud's syndrome, since it accompanies a number of systemic pathologies. The possible causes of primary Raynaud's syndrome still remain unclear, and at the moment only the mechanisms of occurrence of periodic arterial spasms are clear. Among the causes of secondary Raynaud's syndrome, the most important are autoimmune diseases and other diseases associated with damage to connective tissue and blood vessels.

The following pathologies most often act as causes of secondary Raynaud's syndrome:

• scleroderma (systemic sclerosis);
• systemic lupus erythematosus;
• vascular diseases;
• carpal tunnel syndrome;
• vibration disease;
• intoxication with polyvinyl chloride;
• cryoglobulinemia.

Raynaud's syndrome in systemic scleroderma

In autoimmune processes, an excessive and inadequate immune reaction occurs, directed against the structures of one’s own body. In most cases, connective tissue is affected, that is, an elastic framework involved in maintaining and forming the structure of organs and tissues.

An autoimmune disease can develop due to a number of different reasons, but the most common are genetic abnormalities, against the background of which the mechanism for regulating the intensity of the immune response changes. Often, an infection acts as a provoking factor, which triggers a cascade of immune reactions that attack both bacterial cells and one’s own tissues.

Systemic scleroderma is an autoimmune pathology, which in almost 90% of cases is combined with Raynaud's phenomenon. This occurs due to the proliferation of fibrous tissue in the structure of the vessel, which leads to a gradual narrowing of the lumen of the artery and its inadequate adaptation to temperature changes or other stress.

It should be noted that with scleroderma, there are five classic manifestations that usually accompany Raynaud's syndrome. These symptoms are combined under the general term CROSS syndrome, which is an acronym (abbreviation) for the identified pathologies.

CROSS syndrome includes the following diseases:

• Calcification. Calcinosis is the excessive accumulation of calcium salts in soft tissues or organs. Often, calcium crystals are deposited in the skin or subcutaneous tissue, deep in the muscles or in internal organs. In this case, the normal function of tissues is disrupted, their mobility changes and elasticity decreases.
• Raynaud's syndrome. Blood circulation is disrupted at the level of the fingers, and sometimes the toes, nose, ears, and tongue.
• Impaired mobility of the esophagus. Due to sclerosis, that is, the replacement of normal muscle tissue of the esophagus with non-functional connective tissue, the mobility of the esophagus decreases and the swallowing process is impaired.
• Sclerosis of the skin of the fingers. The skin of the fingers loses elasticity, becomes rougher, drier and colder.
• Telangiectasia. Telangiectasias (spider veins) form on the body, which develop due to dysfunction of skin vessels.

Raynaud's syndrome in systemic lupus erythematosus (and other autoimmune diseases)

Systemic lupus erythematosus is a fairly common autoimmune disease in which antibodies are produced against one's own DNA (genetic material), cells and tissues. This disease usually affects a large number of organs and systems and, without proper treatment, progresses quite quickly.

Systemic lupus erythematosus is based on damage to the connective tissue, which is manifested by damage to the skin with the appearance of a classic rash on the face, baldness, and the development of ulcers. Often joints, kidneys, hematopoietic organs, and heart are affected. The vessels of the extremities are often affected with the development of spasm - secondary Raynaud's syndrome develops.

Raynaud's syndrome in vascular disease

Abnormal vascular structure combined with impaired physiological function are the main problems in Raynaud's syndrome. Many studies have revealed that in this pathology, circulatory disorders occur due to a lack of biologically active substances that take part in the regulation of adaptive changes in the arteries.

With Raynaud's syndrome, there is a deficiency of nitric oxide, a substance that has a pronounced vasodilating effect. In addition, there is a slightly increased level of endothelin-1, which has a powerful constricting effect on blood vessels. Activation of this substance occurs under the influence of other factors that can develop against the background of genetic abnormalities or due to autoimmune processes.

It should be noted that in addition to changes in the structure and function of the vascular wall, Raynaud's syndrome can develop with intravascular anomalies, that is, with disorders the main consequence of which is changes directly in the lumen of the vessel.

Raynaud's syndrome can occur due to the following intravascular pathologies:

• Increased platelet activation and aggregation. Platelets are blood cells that take part in the formation of blood clots. This happens in several stages, among which the key ones are platelet activation and their aggregation (sticking together). When the functioning of these cells is disrupted, blood clots form in the lumen of the vessel, which impair blood circulation and provoke attacks of ischemia.
• Excessive production of thromboxanes. Thromboxanes are substances that have a pronounced vasoconstrictor effect, which is combined with platelet activation.
• Disturbed process of resorption of blood clots. In systemic scleroderma, as in some other pathologies, the function of the fibrinolytic system, which is responsible for the destruction of the fibrin protein, the main component of the blood clot, is impaired.

Raynaud's syndrome in carpal tunnel syndrome

With carpal tunnel syndrome, compression of blood vessels and nerves occurs by the connective tissue that forms the ligamentous apparatus at the level of the wrist. As a result, a circulatory disorder occurs at the level of the fingers.

Most often, carpal tunnel syndrome occurs due to excessive dynamic or static load on the wrist joint. This pathology usually affects people who work a lot at the computer (severe tension in the joints and ligaments when working with the keyboard and mouse). At the same time, this syndrome often develops in people who actively practice sports - bodybuilders, weightlifters, as well as in those who are engaged in physical labor with a high level of stress on the ligamentous apparatus of the hands.

Raynaud's syndrome due to vibration disease

Vibration disease is a pathology that develops due to prolonged exposure to vibrations on the human body. Typically, this disease affects people with physical labor who work with machinery and mechanisms subject to vibration (tractors, ramming machines, powerful power tools and other equipment).

The basis of this pathology is a disruption of the functioning of nerves and blood vessels at the level of the extremities, which are manifested by periodic disturbances of blood circulation, up to its almost complete stop; in other words, Raynaud's syndrome develops.

Raynaud's syndrome due to polyvinyl chloride intoxication

Intoxication with polyvinyl chloride (PVC), as well as poisoning with other plastics or heavy metal salts, often leads to disruption of the autonomic nervous system, which is responsible for the stable and coordinated functioning of blood vessels and their adaptation to the external environment.

Typically, intoxication occurs as a result of prolonged contact with toxic substances. In most cases, the toxin enters the body through the respiratory tract (by inhaling vapors or small particles), but the food route cannot be ruled out.

Common signs of poisoning include nausea, vomiting, diarrhea, abdominal pain, headaches, and fever. Raynaud's syndrome develops quite rarely, but in some cases it may be the first sign of the disease.

Raynaud's syndrome with cryoglobulinemia

Cryoglobulinemia is a systemic disease in which there is an increased level of special proteins in the blood - cryoglobulins, which can precipitate at temperatures below 36.6 degrees. As a result, these proteins are deposited on the vascular wall, thereby causing an inflammatory response with the initiation of a series of cascade pathological reactions. Among the most significant changes should be noted a slowdown in blood circulation with vasospasm, blood clots and ischemia of the limbs (Raynaud's syndrome occurs).

Cryoglobulinemia in most cases is a secondary pathology, that is, it develops against the background of other diseases. It is usually triggered by autoimmune processes, but it can be triggered by bacterial or viral infections, as well as many other ailments.

Chronic arterial insufficiency (CAI) and Raynaud's syndrome

Chronic arterial insufficiency is a condition in which, due to constant narrowing of the lumen of the vessel, circulatory failure develops at the level of the extremities (in the vast majority of cases we are talking about the lower extremities). This pathology as such is not the cause of Raynaud's syndrome, but it can act as a factor that can significantly aggravate the course of the disease.

HAN most often occurs due to atherosclerotic changes in blood vessels. This process develops against the background of impaired fat (cholesterol) metabolism, which is deposited in the vascular wall and, thereby, causes a narrowing of the lumen of the arteries.

It should be noted that atherosclerosis of the vessels of the lower extremities is a serious risk factor for the development of thrombosis of the lower extremities. This is due to the fact that when an atherosclerotic plaque is exposed, platelets, fibrin, and red blood cells begin to attach to it, as a result of which in a short time the lumen of the artery becomes completely closed. Ischemia develops followed by necrosis.

Symptoms of Raynaud's syndrome

Clinically, Raynaud's syndrome is characterized by a predominant lesion of the fingers (usually the index, middle and ring fingers, less often the thumb and little finger), manifested by a staged change in the condition of the blood vessels and tissues of the affected area. The severity of these manifestations is determined by the stage of the disease and the duration of its course. Much less commonly affected are other exposed areas of the body (toes, chin, tips of the ears and nose), which are also regularly exposed to cold or heat and other risk factors.

The clinical picture of Raynaud's syndrome includes:

• first stage;
• second stage;
• third stage.

First stage of Raynaud's syndrome

The first stage is also called angiospastic, which is due to the nature of the damage to the blood vessels (that is, their spasm, narrowing). At this stage of development, the first symptoms of the disease appear, which are short-lived.

The first stage of Raynaud's syndrome can manifest itself:

• Change in skin color. It is the first manifestation of the disease. The first occurrence of this symptom is associated with a violation of the nervous and hormonal regulation of vascular tone, which is always caused by the action of provoking or predisposing factors. As a result of a sharp spasm of small blood vessels (arterioles), the blood supply to the vessels decreases. Since the pinkish color of the skin is due to the presence of blood in the capillaries, with vasospasm the skin of the affected area becomes pale in color. A characteristic feature of Raynaud's syndrome is a clear limitation of damage to unaffected areas (a person may feel as if his fingers were dipped in paint). Vascular spasm lasts for a fairly short period of time (2 - 4 minutes), after which their reflex expansion occurs, the vessels overflow with blood and the skin becomes bright red. At this stage, swelling may appear in the joint area, which is due to increased permeability of the vascular walls and the leakage of the liquid part of the blood into the surrounding tissues. Within 10 to 30 minutes, vascular tone is normalized, the skin acquires its normal color and all clinical manifestations disappear.
• Decrease in tissue temperature in the affected area. A constant body temperature is maintained by blood circulation, which heats up as it passes through internal organs (liver, muscles) and cools in the area of ​​the skin and other peripheral tissues. When the blood vessels spasm, blood stops flowing to the area of ​​the fingers, as a result of which the skin quickly cools down (the local temperature can drop by 2 - 4 degrees or more).
• Numbness of fingers. Numbness in the affected area occurs as a result of impaired delivery of blood and nutrients to nerve fibers, which are extremely sensitive to hypoxia (lack of oxygen). At the beginning of the attack, the patient may feel a slight tingling sensation or “crawling on the skin” (these symptoms are characteristic of the initial stage of nerve damage), but after a few minutes the sensitivity decreases significantly until it disappears completely.
• Pain. The occurrence of pain is also due to impaired blood circulation in the fingers. The fact is that under normal conditions, the cells of the body constantly release by-products of their vital activity (lactic acid and others), which are carried away with the bloodstream to the place of neutralization in other organs. When arterioles spasm, blood circulation is disrupted, as a result of which metabolic by-products accumulate in the area of ​​formation and lead to pain (pain in this case can be burning, stabbing, aching). After normalization of blood circulation, toxic substances accumulated in large concentrations are carried through the bloodstream into nearby tissues, which can lead to a short-term increase in pain in the phase of reflex vasodilation.

Second stage of Raynaud's syndrome

The second stage develops approximately six months after the appearance of the first symptoms of the disease and is characterized by a more pronounced disruption of the mechanisms of regulation of vascular tone. Characterized by a decrease in the frequency and increase in the duration of attacks, which can occur as a result of exposure to provoking factors or spontaneously.

A distinctive feature of this stage of the disease is the pronounced cyanosis of the fingertips, which occurs after vasospasm. This is explained by the fact that under normal conditions, the oxygen contained in blood cells (erythrocytes) is transferred to the cells of various tissues, which in return release carbon dioxide (a by-product of cellular respiration). Oxygen-rich blood (arterial) is red in color, while venous blood (saturated with carbon dioxide) is bluish. Normally, the carbon dioxide released by the cells is carried rather quickly through the bloodstream into the lungs, where it is released with exhaled air. However, under conditions of impaired blood circulation, the concentration of carbon dioxide in the blood increases significantly, as a result of which the skin acquires a bluish tint.

It is also worth noting that the second stage of Raynaud’s disease is characterized by pathological dilation of the venous vessels, which further enhances the manifestations of the disease. After a prolonged spasm of blood vessels, the pain is usually more intense and lasting than in the first stage.

Third stage of Raynaud's syndrome

It develops 1–3 years after the onset of the disease and is characterized by irreversible tissue damage to the fingers associated with circulatory disorders. Attacks of spasm of blood vessels followed by their expansion can have varying frequency and intensity, and are accompanied by severe pain.

The third stage of Raynaud's disease is characterized by the following complications:

• Necrosis (necrosis) of soft tissues. Due to insufficient blood supply to tissues, cell death occurs in the most affected areas (skin of the fingertips). Dead tissue is rejected over time, and ulcers appear in their place. They can reach several millimeters in depth, rarely bleed, and are painless. Healing of ulcers occurs over a long period of time (days, weeks) and leads to the formation of dense scars.
• Infectious complications. Circulating blood contains immune cells that protect the body from infection. If local circulation is impaired, the risk of developing infectious diseases of the skin and soft tissues of the fingers increases, which is also facilitated by local ischemia and necrosis.

Raynaud's syndrome of the lower extremities

When the lower extremities are predominantly affected, the symptoms of the disease are similar to those when the upper extremity is affected. Initially, a painful spasm of blood vessels occurs with paleness of the fingers and a change in temperature, which lasts 10 to 30 minutes. In later stages, the spasm becomes longer lasting, and during an attack, blueness of the limb may occur.

It should be noted that with Raynaud's syndrome affecting the lower extremities, their function is significantly impaired, which is manifested by lameness and severe pain during attacks when walking or standing.

Manifestations of Raynaud's syndrome in women and men

The clinical manifestations of Raynaud's syndrome in men and women are absolutely the same and develop in three successive stages described above. However, men with this pathology are characterized by a much higher risk of developing an autoimmune disease within 1 – 2 or more years after the onset of pathology than women. The exact cause of this relationship has not been identified, but current statistics suggest that men may develop Raynaud's syndrome several years earlier than the underlying autoimmune disease.

Raynaud's syndrome in children

Raynaud's syndrome in children usually debuts at the age of 11 - 12 years, but in some cases it can begin to develop at an earlier age. The clinical manifestations of this disease are not much different from the symptoms of adults and also include paleness, pain, and decreased temperature of the fingers.

However, when identifying Raynaud's syndrome in children, special attention is paid to the presence of other pathological symptoms that may indicate the onset of an autoimmune process.

Secondary Raynaud's syndrome in children can be combined with the following symptoms:

• nail plastics in the form of watch glasses;
• sores on fingertips;
• nodules on palpation of the fingers;
• persistent redness of the face;
• pain and stiffness in the joints;
• swelling of the skin;
• general weakness not associated with other health problems;
• sores in the corners of the mouth.

These and other manifestations are not a 100% guarantee of the presence of autoimmune pathology, but they are quite often combined with it. Therefore, if Raynaud's syndrome is suspected in combination with these clinical symptoms, a more thorough and detailed examination should be carried out in order to early diagnose potentially dangerous ailments.

Diagnosis of Raynaud's syndrome

Raynaud's syndrome is diagnosed based on data obtained during a clinical examination and during a conversation with the patient.

The following diagnostic criteria for primary Raynaud's syndrome are distinguished:

• attacks develop in stressful situations or during hypothermia;
• both limbs are involved (symmetrically);
• absence of necrotic changes;
• absence of an obvious cause of impaired blood circulation;
• absence of inflammatory markers in the tests.

X-ray studies, including contrasting of blood vessels, as well as thermography of the extremities, were used in clinical practice some time ago to confirm this pathology. To date, this diagnostic tactic has been abandoned, since it has no clear advantages over a clinical examination and conversation with the patient.

Laboratory tests are used to rule out other conditions similar to Raynaud's syndrome, as well as to identify possible causes of the disease.

When diagnosing Raynaud's syndrome, the following laboratory tests are used:

• General blood analysis. Allows you to identify disorders of the hematopoietic system, excess red blood cells, and suggest an autoimmune process.
• Blood chemistry. A biochemical blood test allows you to measure the level of many substances in the blood plasma, thereby allowing you to identify disorders in a particular organ. In Raynaud's syndrome, markers of renal and hepatic function are informative, elevated levels of which may indicate the presence of another pathology.
• Determination of the level of autoimmune antibodies. During an autoimmune process, the body produces antibodies to its own tissues, which can be detected using a number of laboratory tests.

Treatment of Raynaud's syndrome

Treatment of Raynaud's syndrome is a complex process, which, first of all, involves lifestyle changes with the elimination of provoking factors. Drug or surgical treatment is necessary only in cases where the disease cannot be controlled by other means.

Which doctor treats Raynaud's syndrome?

Raynaud's syndrome is treated by specialists from many medical specialties. However, general practitioners and family doctors most often face this problem. They are the ones who usually diagnose the pathology and prescribe the necessary treatment. However, in the case of secondary Raynaud's syndrome, which has developed or is combined with a systemic connective tissue disease, treatment and diagnosis pass into the hands of a rheumatologist, who is a specialist in autoimmune diseases.

Regardless of which specialist diagnosed this pathology, the effectiveness of therapy depends entirely on the behavior and consciousness of the patient, since the main method of treatment is changing lifestyle with the elimination of possible provoking factors (cold, stress, vibration, smoking, alcohol).

Drug treatment of Raynaud's syndrome

Drug treatment for Raynaud's syndrome is indicated only in cases of poor control of the disease by non-pharmacological methods or in the presence of an autoimmune process that provoked this phenomenon.

In case of primary Raynaud's syndrome, it is advisable to treat with medications in the cold season to prevent attacks of the disease and complications. For secondary Raynaud's syndrome, treatment should be long-term and regular.

To treat the symptoms of vasospasm, several groups of drugs are used, the mechanism of which is vasodilation (vasodilation) and improvement of the rheological properties of blood.

For the drug treatment of Raynaud's syndrome, the following groups of drugs are used:

• calcium channel blockers;
• vasodilators and antiplatelet agents;
• alpha-blockers.

Calcium channel blockers dilate small vessels of the upper and lower extremities and reduce the frequency of vasospasm attacks. Drugs in this group are effective in almost all patients suffering from Raynaud's disease. Today they are the drugs of choice in this pathology.

Calcium channel blockers

Prescribed in the cold season in courses of 4 weeks followed by a break for a month. In cases where the therapeutic effect is insufficient, calcium channel blockers are combined with other groups of drugs.

Calcium channel blockers are contraindicated in the following cases:

• lactation period (breastfeeding);
• age under 18 years;
• arterial systolic pressure below 90;
• aortic and mitral stenosis;
• less than four weeks after myocardial infarction;
• tachycardia (heart rate greater than 80 - 90).

The next group of drugs, vasodilators and antiplatelet agents, reduce blood viscosity, reduce platelet aggregation (prevent platelets from sticking together), increase tissue oxygen saturation, and dilate blood vessels.

Vasodilators and antiplatelet agents used to treat Raynaud's syndrome

Drug name	Composition and release form	Dosage and regimen
Pentoxifylline (Trental, Pentilin)	Tablets 100 mg, 400 mg	400 mg 2 – 3 times a day.
Dipyridamole (Chimes)	Tablets 25 mg and 75 mg	25 – 75 mg 3 times a day.
Xanthinol nicotinate	Tablets 150 mg	1 – 3 tablets 3 times a day after meals.
Papaverine hydrochloride	Tablets 40 mg and suppositories 20 mg	Orally 40–60 mg 3 times a day or rectally 20 mg 2–3 times a day.
Nitroglycerine	Ointment 2% in tubes	The ointment is applied topically to the fingers and toes, 2 - 3 times a day. Effective in primary and secondary forms of the disease, as well as in the healing of ulcers.

Medications are prescribed in long courses of 1–2 months.

The next group of drugs, alpha-blockers, blocks the action of norepinephrine, a hormone that is responsible for vasoconstriction. Thus, the main pathological link of the disease is eliminated and blood circulation at the level of the extremities is stabilized. However, under conditions of severe stress, this action may not be enough.

Alpha blockers used to treat Raynaud's syndrome

Surgical treatment of Raynaud's syndrome

Surgical treatments are rarely used for Raynaud's disease. They are recommended only in cases where the risk of necrosis of the soft tissues of the fingers of the upper or lower extremities is very high.

Several types of surgery are used:

• Truncal sympathectomy. With this intervention, a section of the sympathetic nerve in the arms and legs, which is responsible for vascular spasm in the extremities, is crossed. The frequency and duration of attacks of the disease are reduced.
• Chemical injections. Surgical injections of medications (anesthetics or botulinum toxin type A) can block the transmission of nerve impulses in the sympathetic nerves responsible for narrowing the blood vessels of the arms and legs.

A significant disadvantage of these operations is that the resulting effect can be quite short-lived.

Pregnancy and Raynaud's syndrome

Raynaud's syndrome does not have a significant effect on the course of pregnancy. Treatment of this pathology during pregnancy includes, first of all, general measures to prevent attacks of vasospasm - avoid hypothermia, wear mittens and a hat in the cold season, do not drink alcohol and do not smoke.

Physiotherapeutic treatment of Raynaud's syndrome

Physiotherapy is a method of treating the body using various physical stimuli that have a beneficial effect on cell and tissue biology.

Physiotherapeutic treatment of Raynaud's syndrome includes the following procedures:

• Magnetotherapy. Inductors are placed on the cervical and thoracic spine. Duration of exposure is 15 minutes. Daily, 15 sessions per course.
• Electrophoresis. It is carried out with sedatives (diazepam, sodium bromide), with antispasmodic drugs (papaverine, aminophylline, dibazol). The impact is on the feet and palms. Lasting 10 minutes, sessions daily, course of 10 procedures.
• Ozokerite, paraffin applications. The exposure temperature is 38 - 40 degrees in the form of “stockings”, “socks”, “collar”. The duration of the procedure is 15 - 25 minutes. Sessions every day, for 10 - 15 days.
• Mud therapy (hydrogen sulfide, bromine-iodine, nitrogen-thermal mud). Procedures are prescribed lasting 20 minutes, in courses of 10 sessions daily.
• Sulfide baths. The main component of sulfide baths is hydrogen sulfide, which penetrates the skin, thereby improving microcirculation in tissues and stimulating metabolism. The procedures are carried out for 10 - 15 minutes, in courses of 5 - 10 sessions every day.

Traditional methods of treating Raynaud's syndrome

Raynaud's syndrome is a fairly common and well-known disease, the treatment of which has been of interest and practice for a long time, so there are a sufficient number of traditional methods of treating it. However, before turning to traditional medicine methods, it is necessary to consult with a qualified doctor in order to accurately establish the diagnosis, exclude concomitant pathologies that require intensive treatment, and also to ensure the safety of the planned home treatment.

It should be understood that traditional treatment is not an effective means of controlling Raynaud's disease in the later stages, when proven medications are needed to stop the background autoimmune process. That is why in case of Raynaud's disease (that is, with secondary Raynaud's syndrome), traditional medicine methods should be considered only as an addition to the main treatment.

The following traditional medicine methods can be used to treat Raynaud's syndrome:

• A decoction of pine needles and rose hips. Finely chopped young pine needles must be mixed with half a glass of honey, half a glass of onion peel and 2 - 3 tablespoons of rose hips. The resulting mixture should be poured with boiling water, then boiled for 10 minutes and left for 8 to 12 hours. This decoction can be taken half a glass 3 to 5 times a day, preferably after meals.
• Baths with fir oil. You need to add a few drops (usually 4-7 drops) of fir oil to a warm bath, and then take it for at least 20-25 minutes.
• Bee honey with onion juice. One hundred milliliters of fresh onion juice must be mixed with the same amount of bee honey. The resulting mass can be consumed three times a day before meals, one tablespoon.
• An infusion of mint, motherwort, yarrow and dill. A mixture of mint, motherwort, yarrow and dill in equal proportions must be poured into 200 ml of boiling water, then left for one hour. The resulting infusion must be filtered and drunk throughout the day.

Most of the proposed methods of folk treatment are aimed at normalizing the general condition of the body, improving adaptive properties, and also has some vasodilating effect that prevents the occurrence of spasm of the arteries of the extremities.

Consequences of Raynaud's syndrome

Raynaud's syndrome is a pathology that rarely leads to any irreversible consequences. This disease, if properly controlled, does not pose a threat to human life or health. However, secondary Raynaud's syndrome, which developed against the background of an aggressive autoimmune process, in some situations can cause quite serious and long-term changes in blood circulation at the level of the extremities, which can cause unpleasant consequences.

The most noticeable consequence of uncomplicated Raynaud's syndrome is the need for some limitation of daily activities with the elimination of the influence of provoking factors (cold, stress, vibration).

Disability in Raynaud's syndrome

Disability, as a consequence of Raynaud's syndrome, is an extremely rare phenomenon and occurs only in exceptional cases. It usually occurs due to the loss of one of the limbs against the background of prolonged and intense spasm of the vessel. Typically, such a course of the disease occurs in the later stages of untreated secondary Raynaud's syndrome.

It is necessary to understand that if all preventive measures are followed and the necessary medications are taken in a timely manner, the risks associated with irreversible tissue changes are minimal.

Raynaud's syndrome and military service

In most post-Soviet countries, Raynaud's syndrome is classified as a disease that does not affect military conscription. Young people with Raynaud's syndrome of the first degree are fit for service without any restrictions. Conscripts with Raynaud's syndrome of the second and third degrees are also fit to serve in the army, but with some restrictions that depend on local legislation.

Prevention of Raynaud's syndrome

Prevention of Raynaud's syndrome is a measure that allows you to avoid attacks of vascular spasm in everyday life. In most cases, preventive measures are aimed at eliminating provoking factors that can cause an attack or aggravate the course of the disease.

Prevention of Raynaud's syndrome includes the following measures:

• wellness massage of hands and feet;
• to give up smoking;
• timely diagnosis of autoimmune diseases;

• eating large amounts of plant foods;
• taking enough vitamins and minerals;
• thorough treatment of background pathology in secondary Raynaud's syndrome.

What should you not do if you have Raynaud's syndrome?

The main measures to prevent Raynaud's syndrome are based on a number of restrictions that can significantly reduce the risk of developing vasospasm.

If you have Raynaud's syndrome, you must adhere to the following rules:

• You should not stay outside for a long time at low temperatures, in a cold room or in conditions of high humidity;
• You cannot go outside in the cold season without gloves or mittens, a hat, and warm socks;
• you should not smoke, you should avoid coffee and drinks that contain caffeine (including limiting your tea consumption);
• you cannot use medications that contain pseudoephedrine, ergotamine, beta-blockers, as these drugs can provoke vasospasm;
• you should avoid choosing professions associated with vibration, exposure to cold, working with heavy metals (lead), silicon, plastic (polyvinyl chloride);
• You should not be exposed to psycho-emotional stress.

Before use, you should consult a specialist.

The name "Raynaud's disease" means nothing to most people. For the same reason, having heard such a diagnosis, it is difficult to immediately understand how to behave. But this fact does not exclude the possibility that someone may encounter a situation where help will be needed for a patient with this disease.

This is not the most common disease, but it will still be useful to know what Raynaud's disease is, the symptoms and treatment of this disease, including treatment with folk remedies.

What it is?

Raynaud's disease (ICD 10 code I73.0) is a rare disease of the arteries in the extremities.

The main manifestation of this disease is a sharp contraction of the artery walls. As a result, some area of ​​the affected limb stops feeding due to a sharp decrease in the amount of incoming blood. Then the color of the area changes. It is the change in skin color that is one of the main visual signs of Raynaud's disease.

The most common localization of the disease is the peripheral parts of the extremities, that is, the feet and hands. Damage to the limbs in most cases occurs symmetrically.

Although the disease is rare, it is important to know the factors that cause Raynaud's disease, the symptoms and treatment of this disease. It will also be interesting to understand a little terminology. For example, see the difference between Raynaud's disease and Raynaud's syndrome.

Regardless of whether you have to face the disease, being prepared to fight it never hurts.

Raynaud's disease: causes and predisposing factors

The causes of this disease are currently not well understood. But observations show that some factors can be identified that significantly increase the risk of developing the disease. These factors include:

• Hypothermia. The disease is more likely to occur in people whose hands and feet often get cold. In addition, symptoms sometimes go away when a person moves to a place where the climate is warmer than in the place where the symptoms of the disease appeared.
• Injuries. Physical injuries are also dangerous, which include excessive compression of the limbs, excessive and intense stress, and injuries associated with exposure to chemicals. In cases where a sick person, due to his occupation, needs to come into contact with such factors, it is advisable for him to change his place of work or at least reduce his workload.
• Smoking.
• Excessive emotional stress, great stress.
• Disturbances in the functioning of endocrine organs.

As medical history often shows, Raynaud's disease most often develops in women under 40 years of age. People who have migraine attacks are also susceptible to it.

Raynaud's syndrome and Raynaud's disease: what is the difference?

There is also the term “Raynaud’s disease” and “Raynaud’s syndrome”. It is widely believed that these are simply different names for the same phenomenon or disease. But in reality, this statement is not entirely true.

Raynaud's disease is an independent disease. Raynaud's syndrome is a syndrome that is a manifestation of other diseases, especially often it is observed in patients or in the presence of pathological characteristics of connective tissue.

Raynaud's syndrome and Raynaud's disease differ not only in etiology, but also in manifestations. Although the symptoms are almost the same, with Raynaud's syndrome they do not appear so quickly, their appearance is not so expressive, and the lesions of the extremities are rarely symmetrical. The history usually contains references to the presence of other vascular or autoimmune diseases in the person.

And, of course, the treatment for these conditions varies. With Raynaud's syndrome, it is necessary to treat the underlying disease; with Raynaud's disease, this particular disease must be treated. Therefore, it is worth considering separately Raynaud’s disease, the symptoms and treatment of this particular

Stages of disease development

There are three stages of development of Raynaud's disease.

During the first stage of the disease, the tone of the vascular walls increases, that is, hypertonicity of the arteries of the extremities occurs. Because of this, their short-term spasm may occur. In this case, the skin of the affected area noticeably turns pale, becomes cold, the patient feels acute pain, but sensitivity to external stimuli is lost. The attack usually does not last long, after which the pain goes away and the skin color returns to normal. Such phenomena are the main symptoms of the disease at this stage.

The second stage is characterized by the addition of other symptoms of the disease to the listed signs. For example, the skin color at this stage is no longer just pale, but with a bluish tint, the color of the skin becomes “marbled”. Swelling may occur in the affected limbs, especially in areas affected by the disease. The pain during an attack becomes stronger and more intense.

The duration of the first two stages of Raynaud's disease is up to 5 years.

During the third stage, necrosis or tissue death begins in the affected areas of the limbs. Since blood circulation is already very severely impaired, the resulting wounds heal very poorly, and often do not heal at all and begin to fester. As a result, problems also arise associated with the addition of secondary infections, and in severe cases, with the development of sepsis.

In addition to local manifestations, people suffering from Raynaud's disease often have neurotic complaints. They may talk about problems with sleep, headaches, and a feeling of heaviness in the limbs.

How to diagnose the disease

In order to determine the presence of Raynaud's disease, several points are assessed:

• How bad is the blood circulation? Particular attention should be paid to the study of the blood supply to the extremities and their peripheral parts.
• Are the affected areas symmetrical? In Raynaud's disease, in the vast majority of cases they will be symmetrical.
• How long does it take for a patient to have complaints similar to those of Raynaud's disease? An accurate diagnosis is possible if symptoms appear over a period of at least 2 years.

Special samples are also used:

• Capillaroscopy - the nail bed is examined. With this study, you can visually see the changes in the arteries, both structural and functional.
• Cold tests - limbs are immersed in cold water (approximately 10°C) for 2 or three minutes, and then their condition is assessed.

But we should not forget that making a diagnosis is not so easy - it involves excluding about 70 types of diseases in which Raynaud's syndrome may be present. And this is very important in order to choose the right treatment option.

Treatment methods

The disease is diagnosed quite rarely, so the question of how to treat Raynaud's disease, or rather how to do it correctly, with the greatest effectiveness, is discussed from different points of view. As mentioned above, first of all, dozens of other diseases with similar symptoms should be excluded. Regarding how Raynaud's disease manifests itself, symptoms and treatment, reviews are varied, but they allow us to determine the main aspects of this issue.

Treatment is aimed at eliminating the already manifested symptoms of the disease and preventing attacks, eliminating provoking factors.

The first stage of Raynaud's disease requires only conservative treatment. When an attack occurs, it is removed by making a warm bath, wrapping the area where the attack developed, or massaging the patient’s limb.

In order to prevent the development of attacks, it is necessary to exclude or at least limit the influence of hypothermic factors, injuries, and excessive emotional stress.

It is necessary to know what symptoms Raynaud's disease has and to prescribe medication treatment in a timely manner. So, it is prescribed when a vasodilator effect is required. For this, various vasodilating drugs are used. If there are wounds and necrotic areas, it is necessary to prescribe drugs that promote wound healing. Treatment with drugs is relevant for the first few years, then attacks of vascular spasm in the extremities lose sensitivity to drug effects.

In such cases, surgical intervention is indicated - sympathectomy. The essence of this treatment is the surgical removal of the nerve fibers that are responsible for the resulting vascular spasms. There are several options for surgical treatment, the most optimal one is selected by the attending physician depending on the characteristics of the disease in a given patient.

Some people who have been diagnosed with this study study Raynaud's disease, symptoms and treatment with folk remedies. This issue deserves serious study. For patients diagnosed with Raynaud's disease, treatment with folk remedies often helps alleviate the condition, so it will be useful to consider some of them.

Tincture of elecampane

To prepare the tincture, you need one bottle of vodka and 30 grams of crushed elecampane root. All this is mixed and placed in a cool place. After two weeks, the medicine is ready for use, all that remains is to strain.

The tincture is taken three times a day, the dose for each dose is two tablespoons. The entire course of treatment requires one and a half liters of tincture.

Fir essential oil

When diagnosed with Raynaud's disease, treatment with folk remedies often includes the use of fir essential oil. Fir oil is used both externally and for oral administration.

Taking fir baths for patients has a good healing effect. To do this, add 5 or 6 drops of fir essential oil to the bath. The water temperature should be moderate, close to 37°C. The time for taking such a bath is approximately 15 minutes.

For oral administration, drop the oil (1 or 2 drops) onto a piece of bread and quickly swallow. But at the same time, it is important to exclude contact of the oil with tooth enamel and remember that there may be contraindications for this method of treatment for certain diseases of the stomach, intestines, and pancreas.

Onions and honey to treat Raynaud's disease

To prepare the medicine, take equal amounts of honey and onion juice and mix thoroughly. The mixture is ready for use immediately after preparation.

The course of treatment is 3 weeks. During this time, you should take a tablespoon of medicine three times every day. Each dose should be an hour before meals.

If treatment needs to be continued, the course of treatment can be repeated. But be sure to take a two-week break.

Needles, rose hips, honey and onion peels

This mixture is more difficult to prepare.

Required ingredients:

• young pine needles (you can also use spruce, fir or juniper needles), pre-crushed;
• 5 tablespoons of honey;
• 3 tablespoons rose hips;
• 3 tablespoons onion peels.

All ingredients must be mixed and filled with water (a liter per amount corresponding to the amount described above). The mixture is boiled for 10 minutes, poured into a thermos and left to stand overnight. After the medicine has infused, it needs to be strained.

Take half a glass of the mixture. Every day the reception is repeated 4 times.

When using this treatment option, you must be extremely careful, and it is best to replace it with another option for people who suffer from diseases of the stomach or pancreas.

Infusion of wild rosemary

To prepare the medicine, you need to take two tablespoons of crushed wild rosemary and 5 tablespoons of sunflower oil, mix and leave for 12 hours in a sealed container or container.

While the mixture is infusing, it must be stirred from time to time and ensure that the temperature of the mixture remains warm. When the medicine is infused, it needs to be strained. After this it is ready for use.

The infusion is used externally - it is used for baths and in the form of compresses.

Herbal collection

An herbal mixture containing the following medicinal herbs is considered effective in the treatment of Raynaud's disease: garden rue, creeping thyme and lemon balm.

To prepare it, take rue and thyme in equal quantities and about one and a half times more lemon balm herb. It all gets mixed up. A teaspoon is taken from the mixture and poured with one glass of boiling water, infused for 2 hours (preferably in a thermos - to maintain a high temperature throughout the entire time of preparation of the medicine). Then the mixture must be thoroughly strained.

The remaining liquid is divided into parts of 50 ml each and drunk in four doses over one day.

A mixture of honey and garlic

To prepare the mixture, you need to take honey and garlic pulp in equal quantities and mix together. The mixture is placed in a container that closes very tightly and left for two weeks. It needs to be stirred from time to time.

After the mixture has infused, it should be taken 3 times every day half an hour before meals. The course of treatment lasts two months. If treatment needs to be continued, the course is repeated after a month's break.

When using traditional methods of treatment, it is important to remember that Raynaud’s disease, symptoms and treatment cannot be ignored, and cannot be limited only to traditional methods. Moreover, many of them may have side effects. Careful medical observation, monitoring of the course of the disease, and drug treatment are necessary. Only with complex treatment is it possible to achieve the best result.

Good awareness of the disease by the sick person is also of great importance. Before choosing a treatment option, it is best to familiarize yourself with information about what Raynaud's disease is (photos depicting the symptoms of the lesion can be found in a medical reference book) and what the results of various treatment options are.