Raynaud's Disease
Definition
is a peripheral vascular disease causing vasospasm and ischemia of the fingers and toes and other regions like the nose, ears or lips on exposure to cold or stress.
Smaller arteries that supply the skin are involved
Also known as Raynaud's syndrome or Raynaud's phenomenon
Incidence and Etiology
Women > men
More common in people in colder climates
Primary disease : between 15 and 30
Two types : Primary - cause unknown; Secondary - due to connective tissue disorder such as scleroderma or lupus erythematosus, injuries to hands, smoking, and medications such as contraceptive pills, beta blockers, ergotamine, sumatriptan
Diseases of the arteries like Buerger's disease, atherosclerosis,Carpal tunnel syndrome, Repetitive action or vibration like typing, playing piano, vibrating tools, smoking, injuries to the hands or feet such as fracture of the wrist, surgery or frostbite
Family history - first-degree relative affected - parent, sibling or child affected
Clinical Features
Frequency, duration and severity vary
Fingers or toes, or nose turn white (ischaemia) or blue (cyanosis) on exposure to cold/emotional stress
As the blood flow returns the area turns red and burns
Pain in the extremities
Sensation of cold and numbness; tingling+
Swelling
Episodic
Last fofr a few minutes to several hours
Severe disease - skin sores or gangrene
In pregnancy these signs usually disappear
Can occur in breast-feeding mothers causing nipples to turn white and painful
Migraine and angina may develop
Investigations
Nail fold capillaroscopy
Antinuclear antibodies test
ESR
Treatment
Avoid cold
Discontinue nicotine (tobacco)
Avoid Caffeine
Avoid vibration
Avoid actife, sudafed and other pseudoephedrines
Avoid Beta blockers like inderal, metoprolol
Avoid AC
Avoid rapidly changing temperatures
Do exercises
Control stress
Wear woolen gloves and socks esp when using the fridge
Get indoors from cold atmosphere
Wriggle the fingers and toes
Place hands under armpits
Make wide circles with the arms
Run warm - not hot - water over the fingers and toes
Massage the hands and feet
Medical treatment:-
Calcium Channel blockers : nifidipine
Alpha blockers :; Minipress (Prazosin), Doxazosin
Vasodilators :; Nitroglycerine cream to help heal ulcers, Losartan, Sildanafil (viagra), Prostaglandins
Surgical treatment:-
Sympathectomy
Chemical injection to ablate the sympathetic supply
