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Raynaud's disease cannot be worked anywhere. Raynaud's disease (syndrome)

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 neuropathologist 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 obviously needs to be explained individual characteristics 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).

▲ Collagenoses (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 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 chemical production workers; 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 predominates small arteries, arterioles and arteriovenous anastomoses. 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.

Research recent years suggest that in Raynaud's disease the formation of a neuropeptide called calcitonin gene-related peptide (CGRP), which has a powerful vasodilatory effect, is impaired.

Schematically, the general model of the pathogenesis of Raynaud's disease can be presented as follows: with dysfunction nervous system, especially its vegetative department, at all levels and the presence of endocrine disorders, the body’s overall resistance 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 in the hands and feet. Localization of attacks on the face (lips, nose, chin, tips of the ears) is observed in 8% of patients.

Expanded clinical picture 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 and 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 function of the hand and fingers 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 a 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 the patient has adapted 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. Main vessels with Raynaud's disease they are always intact. Laboratory methods for Raynaud's disease demonstrate a significant increase in blood viscosity, an increase in the titer of cold and antivascular antibodies in late 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. For obliterating diseases pathological changes vessels are primarily found 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, recognizing Raynaud's disease is a diagnosis by exclusion. 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. Good effect gives the use of alpha-blockers (phentolamine, prazosin). 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 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 for lesions of 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.

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 for a patient with this disease will be needed.

What is Raynaud's disease. Causes of the disease

Raynaud's disease in women is “numbness” due to damage to the small terminal vessels of the fingers, mainly on the hands, rarely on the feet, which, with the development of the disease, can develop into tissue necrosis, bone destruction or complete loss of the diseased fingers.

The attack occurs due to severe vasoconstriction. It can be triggered by frequent or prolonged severe hypothermia. upper limbs, chronic finger injuries, for example, in pianists and typists), brain injuries, smoking, physical activity, . In women, this disease occurs three times more often than in men: people over forty suffer.

The main symptoms of the disease are constantly cold hands, even when the person is in a warm room. Numbness or tingling occurs more often in the morning, giving the impression that the arm is numb. The tips of the fingers turn blue and swell.

The course of the disease is paroxysmal: the hands sometimes become cold, sometimes as if they are burning. As a rule, inflammation is symmetrical on both hands. The disease is dangerous because many people mistakenly consider the symptoms to be the body’s normal reaction to hypothermia.

Diagnostics

An accurate diagnosis is possible if symptoms have been present for at least two years. Capillaroscopy is used - an examination of the nail bed, in which you can visually see the changes in the arteries that are present.

Cold tests are carried out when the limbs are lowered into cold water, the temperature of which is about 10 degrees C. The diagnosis is difficult to make: it involves excluding about 70 types of diseases.

Course of the disease

There are three stages of Raynaud's disease. Angiospastic, in which short-term spasms of the vessels of the terminal phalanges of the fingers (usually the 2-5th or less often the 1st-3rd toes) occur. Spasms are quickly replaced by dilation of blood vessels with redness of the skin and warming of the fingers.

At angioparalytic stage the hands and fingers become bluish and swell. On trophoparalytic stage Raynaud's disease may develop acute purulent inflammation of the tissues of the fingers, ulcers and even necrosis of the skin on soft tissues terminal phalanges.

It is impossible to be completely cured, but it is possible to slow down the progression of the disease. The first stage of Raynaud's disease requires only conservative treatment. The attack is relieved 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, the influence of hypothermic factors, injuries, and excessive emotional stress is limited. Drug therapy is used only after examination and strictly as prescribed by the doctor!

Nifedipine-based vasodilators are indicated ( nifedipine, cordaflex, osmo-adalat, corinfar, cordipin, nifecard CL, phenigidine), and also nicardipine and verapamil-based products ( isoptin, finoptin, verogalide EP).

Inhibitor drugs ( capoten, captopril), ketanserin as a blocker of the effects of serotonin; to normalize blood composition, to improve its microcirculation trental, agapurine, pentoxifylline, dipyridamole, vasonite; drugs from the group of lipid physiological active substances (vap, vazaprostan, alprostan caverject).

Conservative therapy is necessarily complemented by physiotherapeutic methods of treatment. Well-proven procedures include galvanic baths, mud therapy, UHF, hyperbaric oxygenation (a method of using oxygen under high pressure for medicinal purposes), reflexology, and exercise therapy.

Treatment with drugs is relevant for the first few years, then attacks of vascular spasms in the extremities lose sensitivity to drug effects. In such cases, surgical intervention is indicated ( sympathectomy).

Its essence is the surgical removal of nerve fibers that are responsible for the resulting vascular spasms. The optimal surgical treatment option is selected by the attending physician.

The goal of treatment is to restore the functionality of blood vessels and the central nervous system. At the onset of the disease, its symptoms can be eliminated by changing jobs, avoiding hypothermia and stress.

The patient is advised to dress warmly to normalize blood circulation in the extremities, and also to drink a lot of hot drinks (but not coffee) to warm up and protect the body from dehydration - one of the causes of attacks.

Smoking is contraindicated because nicotine causes blood vessels to narrow. You should not use devices that can provoke an attack (electric drill, mixer, food processor, vacuum cleaner).

It is useful to massage your feet and toes daily, using sea buckthorn oil or herbal infusions that dilate blood vessels. In winter, walk in the house without slippers, and in summer, walk in nature barefoot. Take a contrast shower to strengthen blood vessels and restore thermoregulation.

The menu should include buckwheat, milk, rabbit meat, squid, cod, citrus fruits, currants, and porcini mushrooms. It is advisable to eat lemons with honey more often. Be sure to exclude fatty foods from your diet.

Fir oil

For Raynaud's disease, treatment with folk remedies includes the use of fir essential oil both externally and for oral administration.

Patients receiving fir baths for 15 minutes have a good therapeutic effect. To do this, add 5 or 6 drops of fir essential oil to the bath. The water temperature should be about 37°C.

You can also drip 1-2 drops of fir oil onto a small piece of bread and eat it in the morning. But there are contraindications for some diseases of the stomach, intestines, and pancreas.

Onion juice with honey

Take 150 ml and add the same amount of liquid natural honey. Mix thoroughly and take 2-3 teaspoons orally in the morning, lunch and evening 30 minutes before meals. The course is 60 days, after which you need to pause for 45 days.

Rosemary oil infusion

Mix 2 tbsp. spoons of chopped and 5 tbsp. spoons of sunflower oil and leave for 12 hours in a sealed container, stirring from time to time. Keep the temperature of the mixture warm. When the medicine is infused, strain, use for baths and in the form of compresses.

Rue, creeping thyme, lemon balm

Take in equal quantities medicinal herbs- rue and thyme and one and a half times more lemon balm. Pour 1 teaspoon of the mixture into 1 glass of boiling water and leave for 2 hours (preferably in a thermos - to maintain a high temperature throughout the entire time of preparation of the medicine). Strain and divide the remaining liquid into parts of 50 ml each. Take 30 minutes before meals and at night.

Natural honey with garlic

Mix honey and garlic pulp in equal quantities and place in a container that closes very tightly. Leave for two weeks, stirring occasionally. Take 2 teaspoons 3 times a day half an hour before meals for 2 months. If treatment needs to be continued, repeat the course after a month's break.

Drink decoctions or infusions of red clover. Take 20g red clover flower heads and boil them for 5 minutes in 300ml water. Leave for 1 hour, strain, take 100 ml 30 minutes before meals for fourteen days. After taking a two-week break, the course can be repeated.

Water infusion of elecampane roots

An infusion of elecampane root is effective in treating. Grind the root, take 50 g and pour into a bottle of vodka. Leave for two weeks, then filter and take 2 teaspoons daily 3 times a day before meals. The course of treatment should continue until you drink 1.5 liters of tincture.

Decoction of wild strawberry leaves

Boil wild strawberry leaves at the rate of 4 tablespoons per glass of water. Take one glass twice a day.

And remember that if you have Raynaud's disease, you must visit your doctor regularly.

Learn about the symptoms of Raynaud's disease in women.
This disease is a disorder in the supply of arterial blood to tissues.
A special feature is the direct dependence on temperature indicators.

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What is Raynaud's disease, symptoms in women

The disease develops due to insufficient arterial blood supply and makes itself felt on the tips of the fingers and toes. Which, as a result of inadequate blood saturation, acquire a pale, bluish tint and become cold. The outcome of this process is necrosis of the affected skin areas.

In most cases, the trigger mechanisms for the manifestation of the disease are hypothermia, especially for residents of cold cities, frequent stress, emotional and mental stress.

Vascular spasm of the fingers or toes, as usual, is located symmetrically. Females are the most susceptible to developing a pathological condition, while the manifestation of the disease in men is almost five times less common.

In parallel with the development of vascular spasm, asphyxia makes itself felt, that is, a condition in which the body lacks oxygen and attacks of suffocation begin. This is due to a decrease in oxygen levels in the bloodstream and tissues, and an increase in the concentration of carbon dioxide.

In addition to the characteristic rigor, acquiring a pale tint, pain in disease-prone areas can make itself felt.

Reasons painful sensations become irritation reactions that are mediated by the action of toxic elements produced in the ischemic zone. These products of a toxic nature, affecting sensitive nerve fibers, give rise to a feeling of pain.

How does the syndrome differ from a disease of the same name?

Between the concepts of disease and Raynaud's syndrome, which are combined common name, there is no clear boundary; the symptoms accompanying the two processes presented are almost identical.

Therefore, in many cases the syndrome is synonymous with the disease. However, there is still one central point by which one can judge the presence of a syndrome or disease.

It is believed that Raynaud's disease makes itself felt as an independent form, while the syndrome manifests itself in parallel with some other disorders in the body, that is, it is secondary in nature.

Raynaud's syndrome often makes itself felt if it is accompanied by pathologies such as:

Systemic scleroderma, lupus erythematosus, rheumatoid arthritis.
Scalenus syndrome.
Atherosclerosis.
Osteochondrosis.
Conditions in which blood viscosity increases.
Pathological conditions of the central nervous system.

The fundamental factors that determine the development of this disease are excessive energy of the vasomotor centers and local damage to the muscular vascular wall.

Under normal conditions, the reflex process to the effects of cold is accompanied by the fact that the lumen of small vessels decreases.

This happens in order to reduce the volume of blood flowing to the body and, therefore, reduce heat transfer.

In pathology, this function is disrupted; the mechanisms that lead to changes in this function have not been clarified, however big role assigned to a variety of external and internal environmental factors.

The causes may be endocrine pathologies that manifest themselves various diseases thyroid gland, pituitary gland, adrenal glands. Infectious diseases play a certain role viral diseases, stress, emotional overstrain.

Signs of various phases of the disease

In its development, the designated disease goes through three fundamental stages:

In the first phase of the disease, the formation of a sharp arterial and capillary spasm is observed, which is localized in a certain area. Characteristic symptoms at this stage: the painful area becomes cold, pale in color, and in addition there is a decrease in sensitivity. This condition lasts from a couple of minutes to an hour or, in severe cases, can last up to several hours. Then the areas subject to spasm come into normal condition, their functional ability returns. Such attacks can manifest themselves repeatedly at various intervals.
The second stage is formed due to asphyxia, that is, lack of oxygen in the body. A picture of a spasm in the form of a blue or purple color of the affected skin is observed. In parallel with this process, a specific tingling sensation develops, and sometimes there is pain. As during the first stage, there is a decreased sensitivity of the skin, which is subject to asphyxia. After some time, everything returns to normal, the tissue is restored.
The formation of the third stage is associated with long-term asphyxia. At this stage, the skin swells, acquires a distinct purple tint, and in addition, blisters with blood exudate appear. After opening the vesicle, necrosis of the epidermis on which it was located is noted. In severe situations, necrosis can be observed not only superficially, but also up to bone tissue. The whole process ends with the formation of scars on the surface of the former ulcers.

These stages do not necessarily follow strictly one after another.

In some cases, only the first phase appears; in other situations, only the presence of the second stage is visible.

It may be that the first stage is a predecessor of the second, which accordingly gives rise to the third stage. There is a chronic type of disease that is accompanied by long course up to several decades.

Diagnosis of this pathology

Diagnosis can be carried out by several specialists. In overwhelming cases, this problem should be addressed to a therapist.

However, if the disease arose as a secondary one, that is, we are talking about Raynaud's syndrome, a rheumatologist will be involved in diagnosis and treatment.

Recognition of pathology goes the way identifying the main clinical picture.

On initial stages diagnostics determine whether the patient suffers from Raynaud's disease or Raynaud's syndrome. The most important manifestations of the disease are swelling, blue discoloration of the fingers or toes; such symptomatic phenomena make themselves felt in the second and third phases of the disease.

When considering the manifestations of Raynaud's syndrome, it is necessary to note the presence of diseases mediated by malfunctions endocrine systems s, scalene muscle syndrome, which manifests itself painful sensations, originating in the neck area, above the shoulder, going down the arm.

In particular, manifestations of the syndrome may include nervous disorders and a state of intoxication due to poisoning by chemical elements.

There are a number of markers by which one can judge the presence of the disease:

development of symptoms due to stress, exposure to low temperatures;
inclusion of both limbs in the process;
the absence of necrosis and a pronounced cause for the development of disruptions in blood circulation.

For diagnosis, a cold test is used, which allows you to evaluate the skin of the extremities when they are immersed for a couple of minutes in water with a temperature of less than ten degrees.

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Features of the disease in men

In most cases, Raynaud's disease affects only the female half of humanity. According to statistics, men suffer from it five times less often than women.

However, the indicated disease has an individual character, that is, if a person is subject to frequent stress, depression, and various types of mental disorders, then this may serve as a prerequisite for the manifestation of the disease, gender doesn't matter.

The same can be said about hereditary predisposition and peripheral circulation. Such individual characteristics, which determine the formation of the disease, can make themselves felt in both female and male persons.

Due to the fact that the disease is observed in men much less frequently than in women, there are no specific features of the course or nature of the disease. The disease begins with excessive chilliness of the hands or feet.

This is further complicated by the appearance of pallor, a bluish tint of the epidermis, a sharp decrease in the temperature of the affected areas, and paroxysmal loss of sensitivity.

Smoking can be considered a central feature in men, which for the most part is not characteristic of the fair half of humanity. As is known, excessive smoking can lead to asphyxia, and as stated earlier, this factor is fundamental in the second stage of the disease.

In particular, the occurrence of the disease in men can be affected by alcohol abuse. Therefore, in order to protect yourself from the disease, it is necessary to review bad habits and correct them.

Modern treatment of this pathological condition

Treatment of this pathological condition is carried out using various techniques and is based on the severity of the process. In the initial stages, you can “drive away” the disease by placing the person in a warm place, of various kinds warm compresses, baths, wraps, massage of the damaged area.

If similar methods quick resuscitation is powerless; the use of medications is required.

Due to the fact that the disease develops against the background of a narrowing of the lumen of blood vessels, treatment will be based on taking drugs that will have the opposite effect, that is, expand the lumen.

Vasodilators, among which the most widely used drugs are Pentoxifylline, Nitroglycerin, Dipyridamole, Papaverine hydrochloride.
Drugs that block calcium channels, which include Cordaflex, Normodipin, Plendil, Corinfar. Medicines in this group are the most effective in treating this pathology, however, there are a number of cases in which their use must be postponed - pregnancy and breastfeeding, low blood pressure, tachycardia, recent heart attack, age less than eighteen years.
Alpha-blockers are a series of drugs that suppress the action of the hormone, under the guidance of which the vascular lumen decreases. This category includes Doxazosin and Prazosin.

The indicated medications may be in the form of ointments or tablets. The duration of use and dosage are prescribed only by the attending physician.

Traditional therapy

The leading methods of traditional medicine in the fight against Raynaud's disease are:

using fir essential oil for baths, to do this you need to fill the bathtub with not very hot water, sprinkle a few drops of this oil;
finely chop the elecampane root, take a tablespoon from the total mass, which should be mixed with five hundred milliliters of vodka, let it sit for about two weeks, strain, consume a tablespoon three times a day;
you need to combine crushed garlic and honey in equal quantities, leave for a week, take a tablespoon of the mixture half an hour before meals;
strawberry leaves in fresh you need to chop a little, take four tablespoons, which should be combined with a mug of water, boil, then filter the broth, drink one mug twice a day;
onion peels, rose hips and crushed pine needles in the amount of three tablespoons are combined with five tablespoons of honey, then a liter of water is added to the components and boiled for about ten minutes; then stand for twelve hours and, after filtering, drink half a mug three times a day.

In addition to the above folk ways there are no less effective way keeping the body in good shape - contrast shower, which is known to have a beneficial effect on the vascular system.

We must not forget that traditional methods of struggle cannot be compared in effectiveness with medicines, therefore they cannot be used to cure the disease.

The effectiveness of massage

Massage for this disease normalizes blood circulation, relieves spasms, improves trophism, and prevents the development of necrotic changes. The emphasis in the massage is on the back, neck, shoulder blades, upper and lower limbs.

The main movements in the massage are long stroking movements along the pectoral muscle, along the edge of the clavicle bone.

This is followed by a massage of the upper limbs, first the normal limb, and then the one that has been affected by the disease.

The hands and phalanges of the fingers are actively rubbed and massaged deltoid muscle, elbow joint. The duration of massage procedures is from two weeks to a month, depending on the manifestation of the results. The massage is performed every other day.

Outcome of human illness

Raynaud's disease is pathological condition, which in most cases does not lead to pronounced consequences. However, this is achieved if the disease is controlled and measures are implemented to combat it.

The most dangerous complication There may be a change in blood circulation in the limbs, which can cause long-term spasm and, as a result, gangrene.

As a result, you can lose a limb, but cases of such an outcome are very small, similar condition develops as secondary Raynaud's syndrome in the final stages of development, without the necessary treatment.

In most cases, the outcome is favorable, given that it is necessary, whenever possible, to protect yourself from the destructive effects of frost and stress, which have an extremely adverse effect on the functioning of the body as a whole.

Raynaud's disease is a seizure-type disorder in arterial blood supply feet and/or hands, arising from prolonged exposure to stress, cold and some other factors. Raynaud's disease, the symptoms of which appear more often among women, is distinguished primarily by the symmetry of damage to the extremities.

General description

Raynaud's disease, as a rule, is a secondary phenomenon, whose development occurs against the background of various types of diffuse diseases that arise in the connective tissue (in particular, scleroderma), as well as lesions in the area cervical spine spine. In addition, there is a possibility of the appearance of Raynaud's disease against the background of diseases of the peripheral nervous and endocrine systems, arteriovenous aneurysms and digital arteritis, diseases of the accessory cervical ribs, etc.

Raynaud, the French physician who first described this disease, was of the opinion that it was nothing more than a disease that arose as a result of excessive excitability relevant to the vasomotor spinal centers.

Somewhat later, it was determined that the symptom complex characteristic of the disease can act both as an independent disease and as a syndrome arising as a result of certain nosological forms (for example, spondylogenic pathology).

Endocrine disorders (adrenal disorders, thyroid disorders), infections, and congenital deficiency areas of the lateral horns of the spinal cord. There is a dysfunction at various levels in the vasomotor centers, which affects big brain(cerebral cortex), brain stem, hypothalamus and spinal cord. This, in turn, provokes an increase in vasoconstrictor tone.

It is noteworthy that Raynaud's disease is a disease that pianists and typists are particularly susceptible to.

Raynaud's disease: symptoms

Due to the formation of a manifestation characteristic of the disease in the form of vasospasm, the distal parts of the extremities (legs, arms) undergo blanching, in some cases it can also affect the lips, ears and nose. Asphyxia develops - suffocation in the background oxygen starvation in combination with an increase in carbon dioxide in the blood and tissues, in other words, the respiratory function is sharply limited. In the affected area, the temperature drops and tissue necrosis occurs.

The resulting pain is caused by irritation experienced by sensory nerve fibers due to the effects of toxic substances produced in the ischemic area.

As we have already noted, Raynaud's disease is more common in women (about five times) than, accordingly, in men. The incidence is mainly observed among women from 20 to 40 years old; a combination of the course of the disease with migraine is possible. The classic forms of Raynaud's disease define three main stages of this disease.

Stage I. This stage is characterized by the occurrence of a sudden spasm of the arteries and capillaries in a certain area. As a rule, this area becomes deathly pale, becomes cold to the touch, and a decrease in general sensitivity. The duration of an attack can range from several minutes to 1 hour (in some cases, a longer course is possible). Then the spasm ends, after which the previously affected area takes on its normal appearance. Attacks may recur at various time intervals.
Stage II. This stage is caused by phenomena in the form of asphyxia. A spasm appears as a blue-violet color skin. At the same time, tingling occurs, and in some cases severe pain. Places of asphyxia lose their characteristic sensitivity. A significant role in the mechanism of development of the stage we are considering is given to paresis (partial weakening, incomplete paralysis) of the veins. After some time, these manifestations disappear. Cases in which Raynaud's disease occurs only in the first stage, as well as cases in which the disease occurs only in its second stage, are not excluded. The possibility of moving from the first stage to the second is also relevant.
Stage III. The development of this stage occurs after a long course of asphyxia. IN in this case the limb becomes swollen and turns purple-blue; in addition, blisters with characteristic bloody contents form on it. Opening such a bubble makes it possible to detect tissue necrosis in its place, but in more severe cases, necrosis affects not only the skin, but also all tissues, right down to the bone. The completion of the process is characterized by scarring of the formed ulcerative surface. More often characteristic symptoms concentrated in the area of the fingers and toes, with extremely rare concentration in the areas of the tip of the nose and ears.

Regarding chronic form course of the disease, then in this case its duration can be more than one decade. Education is enough rare development Raynaud's disease, in this case, necrosis covers the nail phalanges or parts thereof. Paroxysms (increased manifestations, periodic return of symptoms characteristic of the disease) can be repeated in some patients - several times a day, in others - at intervals of one month or more.

Diagnosis of Raynaud's disease

Diagnosis of the disease is made in accordance with its main clinical manifestations. First of all, it is necessary to determine what exactly we are talking about, Raynaud's disease or Raynaud's syndrome. The disease is particularly characterized by the presence of symptoms in the form of bouts of blanching of the fingers or their cyanosis (cyanosis), which is usually relevant for the second and third stages of the disease. In addition, these manifestations can also affect the higher parts of the face, which is important in case of severe cooling and exposure to irritants of an emotional and other nature. Raynaud's disease is also characterized by the absence of gangrene in the skin of the fingers and the duration of the disease from two years.

As for Raynaud's syndrome, the presence of signs inherent in the underlying disease is typical. These include, in particular, spondylogenic syndrome of the scalene anterior muscle region, endocrine diseases, syringomyelia, intoxication resulting from exposure to certain chemicals, vibration disease, etc. All of the above clinical forms do not have the typical picture characteristic of Raynaud's disease.

In general, specific and unambiguous clinical manifestation There is no indication of the presence of Raynaud's disease. The specialist can additionally conduct some studies of the patient’s extremities to exclude possible compression of the blood vessels, which can act as a simulating factor for the disease in question. Besides, differential diagnosis determines the need to exclude about 70 more types of phlebological and autoimmune diseases accompanied by Raynaud's syndrome and its corresponding symptoms.

Another stage in diagnosing the disease is cold tests, in which the condition of the limbs is assessed from the moment they are immersed in water at a temperature of 10 degrees for several minutes.

Treatment of Raynaud's disease

The relevance of the diagnosis of “Raynaud's syndrome” presupposes the orientation of therapy towards the disease that is the main one in this disease. Raynaud's disease, in turn, involves treatment in a slightly different direction, which consists of relieving the symptoms of this disease, as well as preventing the causes that cause attacks of this disease.

The first stage of treatment for Raynaud's disease involves the use of conservative techniques. Thus, an attack of vasospasm can be easily eliminated through the use of warm baths and wraps, and massage of the affected area of the limb is also used. Regarding drug therapy, then it comes down to taking vasodilator drugs. In addition, you should exclude as much as possible the possibility of hypothermia and injury to the extremities, try to avoid stressful situations, controlling your own attitude towards them.

The stage of ulcer formation with concomitant tissue necrosis requires the appointment of appropriate wound healing therapy. The duration of drug treatment for Raynaud's disease can be on the order of several years, that is, almost until the period until attacks of vasospasms lose sensitivity to the vasodilator medications used in therapy.

When the disease develops in this direction, it is necessary surgery(sympathectomy). In particular, it consists of cupping or removing nerve fibers areas of the sympathetic trunk, which are the main cause of arterial spasms. Less morbidity is observed with endoscopic sympathectomy. Besides this, auxiliary methods Treatment of the disease is plasmapheresis sessions, which allow eliminating metabolic and toxic components from the blood that have a negative effect.

If symptoms characteristic of Raynaud's disease appear, you should contact a vascular surgeon.

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Diseases with similar symptoms:

Pain syndrome – uncomfortable feeling which every person has felt at least once in their life. Almost all diseases are accompanied by such an unpleasant process, so this syndrome has many varieties, each of which has its own causes, symptoms, their intensity, duration and methods of treatment.

– 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. Raynaud's syndrome develops against the background of collagenosis, rheumatoid arthritis, vasculitis, endocrine, neurological pathology, blood diseases, occupational diseases. Clinically, Raynaud's syndrome is manifested by attacks, including sequential pallor, cyanosis and hyperemia of the fingers or toes, chin, and tip of the nose. Raynaud's syndrome leads to gradual trophic changes in tissue. Conservative measures include taking vasodilators, surgical treatment consists of sympathectomy.

ICD-10

I73.0

General information

Raynaud's syndrome is a secondary condition that develops against the background of a number of diseases: diffuse connective tissue pathology (scleroderma, systemic lupus erythematosus), systemic vasculitis, rheumatoid arthritis, diseases of the 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 Raynaud's syndrome, the leading role is given to endogenous vasoconstrictors - catecholamines, endothelin, thromboxane A2. In the development of Raynaud's syndrome, three successive phases are distinguished: ischemic, cyanotic and hyperemic. The ischemic phase develops due to spasm of peripheral arterioles and complete emptying of capillaries; manifested by local blanching of the skin. In the second phase, caused by blood retention in the venules and arteriovenular anastomoses, skin pallor 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 dysfunction, 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 of age who suffer from migraines.

Symptoms of Raynaud's syndrome

The symptoms of Raynaud's syndrome are caused by paroxysmal vasospasm and resulting tissue damage. In typical cases, Raynaud's syndrome affects the fourth and second fingers of the feet and hands, and sometimes the chin, ears and nose. Attacks of ischemia are initially short-lived and rare; occur under the influence of cold agents, as a result of excitement, smoking, etc. Suddenly, paresthesia develops, cold fingers, the skin becomes alabaster-white. Numbness is replaced by a burning sensation, aching pain, and a feeling of fullness. The attack ends with a sharp hyperemia of the skin and a feeling of heat.

The progression of Raynaud's syndrome leads to a lengthening of the time of attacks to 1 hour, their frequency, spontaneous occurrence without visible provocations. After the height of paroxysm, a cyanotic phase begins, and slight swelling of the tissues appears. In the intervals between attacks, the feet and hands remain cold, cyanotic, and wet. Ischemic paroxysms in Raynaud's syndrome are characterized by a symmetrical and sequential development of manifestations: first on the fingers, then on the feet. The consequences of tissue ischemia in the case of prolonged and severe course Raynaud's syndrome can become 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.

Diagnosis of Raynaud's syndrome

A patient with Raynaud's syndrome is referred for consultation with a rheumatologist and a vascular surgeon. In case of Raynaud's syndrome, changes in the distal parts of the arteries can be detected by angiography of the peripheral vascular bed, which identifies areas of uneven stenosis and total vascular obstruction, the absence of capillary networks and collaterals. Capillaroscopy of the nail bed and anterior surface of the eye reveals morphological changes microvascular pattern, indicating perfusion disturbances.

Laser Doppler flowmetry, used to assess peripheral microcirculation, reveals defects in the 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 be used to provoke vasospasm and assess the state of blood flow.

Treatment of Raynaud's syndrome

The first principle of treatment for Raynaud's syndrome is the exclusion of provoking factors - smoking, cooling, vibration and other household and production factors. The primary disease that caused the development of Raynaud's syndrome is identified and treated. Among vasodilators for Raynaud's syndrome, the administration of calcium antagonists - nifedipine, alprostadil, selective blockers - is effective calcium channels- verapamil, nicardipine diltiazem. If necessary apply ACE inhibitors(captopril), selective blockers of HS2-serotonin receptors (ketanserin).

For Raynaud's syndrome, antiplatelet drugs are prescribed - dipyridamole, pentoxifylline, low molecular weight dextrans (reopolyglucin). Progression and resistance of Raynaud's syndrome to drug therapy serves as an indication for surgical sympathectomy or ganglectomy. In case of developing ischemic attack urgent measures is warming the limb in warm water, massaging with woolen cloth, offering the patient a hot drink. In case of a prolonged attack, it is prescribed injection forms antispasmodics (drotaverine, platiphylline), diazepam and other drugs.

For Raynaud's syndrome, non-drug methods are used - psychotherapy, reflexology, physiotherapy, hyperbaric oxygenation. For Raynaud's syndrome caused by systemic collagenosis, extracorporeal hemocorrection sessions are indicated. A new word in the treatment of Raynaud's syndrome is therapy using stem cells, aimed at normalizing peripheral blood flow. Stem cells contribute to the opening of new collaterals in the vascular bed, stimulate the regeneration of damaged ones nerve cells, which ultimately leads to the cessation of paroxysms of vasoconstriction.

Forecast and prevention of Raynaud's syndrome

The prognosis of Raynaud's syndrome depends on the progression of the underlying pathology. The course of the syndrome is relatively favorable, attacks of ischemia 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 secondary prevention of Raynaud's syndrome, i.e., about the exclusion of trigger factors leading to vasospasm - hypothermia, vibration, smoking, psycho-emotional stress.