Raynaud's disease is a disorder of the paroxysmal type in the arterial blood supply to the feet and / or hands, which occurs against the background of prolonged exposure to stress, cold, and some other factors. Raynaud's disease, the symptoms of which are more common among women, is distinguished primarily by the symmetry of the lesion of the limbs.

general description

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

Reynaud, the French doctor who first described this disease, was of the opinion that it was nothing more than that resulting from 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 from certain nosological forms (for example, spondylogenic pathology).

An important role can also be played by endocrine disorders (adrenal disorders, disorders of the thyroid gland), infections, as well as congenital insufficiency of the region of the lateral horns of the spinal cord. There is a violation of functionality at various levels in the vasomotor centers, which affects the large brain (cortex of the hemispheres), the brain stem, the hypothalamus and spinal cord. This, in turn, provokes an increase in the tone of vasoconstrictors.

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 extremities (legs, hands) undergo blanching, in some cases it can also affect the lips, ears and nose. Asphyxia develops - suffocation against the background of oxygen starvation in combination with an increase in the composition of the blood and in the tissues of carbon dioxide, in other words, the respiratory function is sharply limited. In the area of ​​the affected area, the temperature drops, tissue necrosis is formed.

The resulting pain is caused by irritation experienced by sensitive nerve fibers due to exposure to toxic substances produced in the ischemic site.

As we have already noted, Raynaud's disease is more common in women (about five times) than, respectively, in men. Basically, the incidence is 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.

• I stage. This stage is characterized by the occurrence of a sudden spasm of arteries and capillaries in a certain area. As a rule, this area acquires a deathly pallor, it becomes cold to the touch, and there is also a decrease in general sensitivity in it. The duration of the course of an attack can range from several minutes to 1 hour (in some cases, it may last longer). Then the spasm ends, after which the previously affected area acquires its usual appearance. Attacks can be repeated at various time intervals.
• II stage. This stage is caused by phenomena in the form of asphyxia. A spasm appears in the form of a blue-violet staining of the skin. At the same time, tingling occurs, in some cases - severe pain. Places of asphyxia lose their 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 with the first stage, as well as cases with the course of the disease only from its second stage, are not excluded. The possibility of transition from the first stage to the second is also relevant.
• III stage. The development of this stage occurs after a long course of manifestation of asphyxia. In this case, the limb becomes puffy and becomes purple-blue, in addition, blisters form on it with characteristic bloody contents. The opening of such a bubble makes it possible to detect tissue necrosis in its place, while in more severe cases, necrosis affects not only the skin, but also all tissues, up to the bone. Completion of the process is characterized by scarring of the formed ulcer surface. Most often, the characteristic symptomatology is concentrated in the area of ​​​​the fingers and toes, with an extremely rare concentration in the areas of the tip of the nose and ears.

Concerning chronic form course of the disease, in this case its duration can be more than one decade. Education is a rather rare development of Raynaud's disease, in this case, necrosis covers the nail phalanges or parts of them. Paroxysms (intensification of 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 or more months.

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 in particular is characterized by the presence of symptoms in the form of bouts of blanching of the fingers or their cyanosis (cyanosis), which is usually true 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 with strong cooling and exposure to emotional and other stimuli. Raynaud's disease is also characterized by the absence of gangrene in the skin of the fingers and the duration of the course of the disease from two years.

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

In general, there is no specific and unambiguous clinical manifestation indicating the presence of Raynaud's disease. The specialist may additionally conduct some studies of the patient's limbs to exclude possible compression blood vessels, which may act as a mimic for the disease in question. Besides, differential diagnosis determines the need to exclude another 70 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.

Raynaud's disease treatment

The relevance of the diagnosis of "Raynaud's syndrome" suggests the orientation of therapy towards the disease, which is the main one in this disease. Raynaud's disease, in turn, provides for treatment in a slightly different direction, which consists in the relief of symptoms this disease, as well as in the prevention of those causes that cause attacks of this disease.

The first stage of treatment for Raynaud's disease is the use of conservative methods. So, an attack of angiospasm can be easily eliminated through the use of warm baths and wraps, and massage of the affected area of ​​\u200b\u200bthe limb is also used. As for drug therapy, it comes down to taking vasodilating drugs. In addition, the possibility of hypothermia and injury to the limbs should be excluded as much as possible, try to avoid stressful situations by 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 when angiospasm attacks lose sensitivity to the vasodilator medications used in therapy.

With the development of the disease in a similar direction, surgical intervention (sympathectomy) is required. In particular, it consists in stopping or removing the nerve fibers of the sympathetic trunk region, which are the main cause of arterial spasms. Less invasiveness is noted with endoscopic sympathectomy. In addition, auxiliary methods of treating the disease are 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 is an uncomfortable sensation that every person has felt at least once in a lifetime. Such an unpleasant process is accompanied by almost all diseases, so this syndrome has many varieties, each of which is characterized by its own causes, symptoms, their intensity, duration and methods of treatment.

Raynaud's disease is a disease caused by damage to the autonomic nervous system a person, which is manifested by trophic disorders and pains, mainly localized in the fingers. To date, the causes of Raynaud's disease have not been sufficiently studied, but it has been proven that women suffer from this disease 5 times more often than men. Factors contributing to the development of the disease are hereditary predisposition and constitutional deficiency of the vasomotor innervation of the terminal vessels.

Raynaud's disease symptoms

Patients with Raynaud's syndrome note the appearance of a feeling of tingling, burning in the fingertips, blue or whitening of them that occurs after smoking, exposure to cold, or during physical exertion.

Do not confuse the disease and Raynaud's syndrome. In the latter case, the symptoms of the disease appear as a result of another pathology (vibration disease, diencephalitis, rheumatism, scleroderma, etc.) and may disappear on their own when it is cured.

During the course of the disease, 3 main stages are distinguished:

1. The angiospastic stage, which is characterized by short-term spasms of the vessels of the terminal phalanges of the fingers, they become cold to the touch and turn pale, while patients complain of numbness of the fingers. The spasm passes quickly, the skin on the phalanges of the fingers acquires the same color and temperature. Attacks can be provoked by smoking, hypothermia of hands (even washing cold water), physical activity on fingers (playing the piano, guitar, sports activities).
2. The angioparalytic stage may develop after the first stage, but in some cases the disease begins with it. During this period, patients periodically develop cyanosis of the skin of the terminal phalanges, which can persist for several hours. This stage is characterized by the appearance of pain and burning sensation in the fingertips. During bouts of cyanosis, small blisters may appear on the skin, which, bursting, heal over time, but small scars remain in their place.
3. The trophoparalytic stage is characterized by the appearance of severe trophic disorders in the phalanges of the fingers. Non-healing ulcers appear on the skin, which subsequently necrotic. In the most severe cases, gangrene of the fingers develops, and the process may affect the osteoarticular apparatus of the fingers.

Sometimes, some patients may have different stages of Raynaud's disease on different fingers. It should be noted that the disease can affect not only the fingers, but also the legs.

Raynaud's disease treatment

Treatment of Raynaud's disease is usually long-term, and includes a whole range of measures. First of all, it is necessary to identify and eliminate the factors that lead to the onset of seizures. Patients need a complete diet with enough vitamins and minerals. It is also recommended to observe the regime of work and rest, and sometimes a change of residence or work.

Drug therapy is aimed at relieving pain, improving tissue nutrition, preventing ischemia attacks in the terminal phalanges of the fingers, and, if necessary, treating purulent complications.

From medications The following groups of drugs are used in the treatment of the disease:

• antispasmodics (papaverine hydrochloride, no-shpa);
• painkillers (analgin, ibuprofen, ketorol);
• vasodilators (corinfar, diltiazem);
• anti-inflammatory drugs (acetylsalicylic acid);
• local antibacterial drugs (levomekol, baneocin) and systemic action;
• vitamin complexes (biomax, complivit).

The use of acupuncture and physiotherapy increases the effectiveness of treatment. Patients with Raynaud's disease are shown the following types of physiotherapy treatment:

• local darsonvalization;
• ultraviolet irradiation of the upper cervical and lumbar segments of the spine;
• electrophoresis with calcium or lidase;
• radiotherapy;
• diathermy;
• galvanizing baths.

Medical treatment diseases should be prescribed only by a doctor, since the drugs used in treatment regimens have a direct effect on other organs and systems of the body. Conservative treatment of Raynaud's disease can last for several years, until it loses its effectiveness. After that, to alleviate the condition of patients, doctors have to resort to surgical methods of treatment.

Patients undergo a sympathectomy operation, the essence of which is to remove the nerve fibers that cause spasm of the arteries, provoking attacks of the disease. The operation can be performed endoscopically, which reduces the risk of complications and reduces the period of rehabilitation after surgery.

AT recent times information about the development of a fundamentally new method of treating Raynaud's disease using stem cells. The developers of the method claim that in most cases, stem cell therapy can completely stop the progression of the disease or greatly alleviate its course.

Which doctor to contact

Medical treatment of Raynaud's disease includes taking antispasmodics, painkillers, medicines improving microcirculation, vitamin-mineral complexes.

If Raynaud's disease is suspected, it is necessary to contact an angiologist, and if it is impossible to do this, a rheumatologist should be consulted. Additionally, you will need to consult a cardiologist and a vascular surgeon. In the diagnosis of Raynaud's disease, dopplerography of the affected arteries is important.

- a vasospastic disease characterized by a 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 seizures, including sequential blanching, cyanosis, and hyperemia of the fingers or toes, chin, and tip of the nose. Raynaud's syndrome leads to gradual trophic tissue changes. Conservative measures include taking vasodilators, surgery is sympathectomy.

ICD-10

I73.0

General information

Raynaud's syndrome is a secondary condition that develops against a background of a number of diseases: diffuse pathology of the connective tissue (scleroderma, systemic lupus erythematosus), systemic vasculitis, rheumatoid arthritis, diseases of the sympathetic ganglia, endocrine and hematological disorders, diencephalic disorders, compression of the 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 played by endogenous vasoconstrictors - catecholamines, endothelin, thromboxane A2. In the development of Raynaud's syndrome, three successive phases are distinguished: ischemic, cyanotic and hyperemic. The ischemia phase develops due to spasm of peripheral arterioles and complete emptying of capillaries; manifested by local blanching of the skin. In the second phase, due to blood retention in the venules and arteriovenular anastomoses, blanching of the skin is replaced by cyanosis (cyanosis). In the last phase - reactive-hyperemic, reddening of the skin is noted.

In the absence of etiological factors characteristic of Raynaud's syndrome, the presence of Raynaud's disease is suggested. In the occurrence of Raynaud's disease, the role of heredity, endocrine dysfunctions, mental trauma, chronic nicotinic and alcohol intoxication. Raynaud's disease is more common among women in their 20s and 40s with migraine.

Raynaud's syndrome symptoms

The symptomatology of Raynaud's syndrome is due to paroxysmal vasospasm and resulting tissue damage. In typical cases, with Raynaud's syndrome, IV and II fingers of the feet and hands are affected, sometimes the chin, ears and nose. Attacks of ischemia in the beginning are short-term, rare; arise under the influence of cold agents, as a result of excitement, smoking, etc. Paresthesia suddenly develops, coldness of the fingers, the skin becomes alabaster-white. Numbness is replaced by burning, bursting pain, 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 up to 1 hour, their increase, spontaneous emergence no apparent provocation. After the height of the paroxysm, a cyanotic phase begins, a slight swelling of the tissues appears. In the intervals between attacks, the feet and hands remain cold, cyanotic, wet. Paroxysms of ischemia in Raynaud's syndrome are characterized by a symmetrical and consistent development of manifestations: first on the fingers of the hands, then on the feet. The consequences of tissue ischemia in the case of a long and severe course of Raynaud's syndrome can be trophic changes in the form of poorly healing trophic ulcers, areas of necrosis, degenerative 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 a consultation with a rheumatologist and a vascular surgeon. In Raynaud's syndrome, angiography of the peripheral vascular bed allows revealing changes in the distal parts of the arteries, in which areas of uneven stenosis and total obstruction of the vessels, the absence of capillary networks and collaterals are determined. Capillaroscopy of the nail bed and the anterior surface of the eye reveals morphological changes in the microvascular pattern, indicating a violation of perfusion.

Laser Doppler flowmetry, used to assess peripheral microcirculation, reveals defects in the metabolic and myogenic regulation of blood circulation, a decrease in veno-arterial reactions and sympathetic activity. In the period between attacks in Raynaud's syndrome, a cold test can provoke vasospasm and assess the state of blood flow.

Raynaud's syndrome treatment

The first principle of therapy for Raynaud's syndrome is the exclusion of provoking moments - smoking, cooling, vibration and other domestic and industrial factors. The primary disease that caused the development of Raynaud's syndrome is being identified and treated. Among vasodilators in Raynaud's syndrome, the appointment of calcium antagonists - nifedipine, alprostadil, selective calcium channel blockers - verapamil, nicardipine diltiazem is effective. If necessary, ACE inhibitors (captopril), selective blockers of HS2-serotonin receptors (ketanserin) are used.

With Raynaud's syndrome, antiplatelet drugs are prescribed - dipyridamole, pentoxifylline, low molecular weight dextrans (rheopolyglucin). The progression and resistance of Raynaud's syndrome to drug therapy is an indication for surgical sympathectomy or ganglionectomy. When an ischemic attack has developed, urgent measures are to warm the limb in warm water, massage with a woolen cloth, and offer the patient a hot drink. With a protracted attack, injectable forms of antispasmodics (drotaverine, platyfillin), diazepam and other drugs are prescribed.

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

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 may spontaneously stop after a change in habits, climate, profession, sanatorium treatment etc.

The lack of primary preventive measures allows us to speak only about the secondary prevention of Raynaud's syndrome, that is, the exclusion of trigger factors leading to vasospasm - hypothermia, vibration, smoking, psycho-emotional stress.

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Vessels permeate the entire human body, so the symptoms of their defeat are very, very diverse. Many vascular ailments at first do not bother the patient much, but lead to terrible complications, disability and even death. Can a person without medical education identify vascular pathology? Of course, yes, if he knows their clinical manifestations, which this section will tell about.

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Varicose veins (varicose veins) is a disease in which the lumens of some veins (legs, esophagus, rectum, etc.) become too wide, which leads to impaired blood flow in the affected organ or part of the body. In advanced cases, this ailment is cured with great difficulty, but at the first stage it is quite possible to curb it. How to do this, read in the section "Varicosis".

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Stroke (acute cerebral circulation) consistently ranks among the top ten dangerous diseases. People over 55 years of age, hypertensive patients, smokers and those who suffer from depression are at the greatest risk of its development. It turns out that optimism and good nature reduce the risk of strokes by almost 2 times! But there are other factors that effectively help to avoid it.

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heart attack

Myocardial infarction is considered to be a disease of older men. But it still poses the greatest danger not to them, but to people of working age and women over 75 years old. These groups have the highest mortality rates. However, no one should relax: today, heart attacks overtake even young, athletic and healthy people. More precisely, unexplored.

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Pulse disorders

Speaking of pulse disorders, we usually mean its frequency. However, the doctor evaluates not only the patient's heart rate, but also other indicators. pulse wave: rhythm, filling, tension, form ... The Roman surgeon Galen once described as many as 27 of his characteristics!

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Operations

Many diseases of the heart and blood vessels, which 20-30 years ago doomed people to lifelong disability, are successfully cured today. Usually surgical. Modern cardiac surgery saves even those who until recently did not leave any chance for life. And most operations are now carried out through tiny punctures, and not incisions, as before. This not only gives a high cosmetic effect, but is also much easier to tolerate. And also reduces the time of postoperative rehabilitation several times.

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Preparations

“Drugs” is perhaps the most important section of the site. After all, the most valuable information about the disease is how to treat it. We do not give here magic recipes for curing serious ailments with one pill, we honestly and truthfully tell everything about the drugs as they are. What are they good and bad for, who are indicated and contraindicated, how they differ from analogues and how they affect the body. These are not calls for self-treatment, this is necessary so that you are well versed in the “weapon” with which you will have to fight the disease.

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Raynaud's syndrome is a phenomenon in which a reversible spasm of the blood vessels of the fingers and toes periodically manifests itself, as a reaction to stress or cold. There are other provoking factors - systemic diseases. In this case, it is customary to talk about Raynaud's disease.

This pathology is named after Maurice Raynaud, who gave its description while still a medical student. He described it as follows: a case of episodic symmetrical spasm of the blood vessels of the hands, accompanied by soreness and blanching of the skin.

• Show all

  The reasons

  Allocate primary and secondary syndrome:

  1. 1. Primary Raynaud's syndrome. In this case, the cause of the pathology is unknown. The spasm develops independently, has a periodic nature and affects only the vessels in the fingers. The syndrome usually proceeds mildly, with due attention, the patient does not need to resort to medical treatment.
  2. 2. Secondary Raynaud's syndrome. Manifested against the background of another disease. Usually occurs when connective tissue is damaged in autoimmune processes. But some drugs or pathologies (vibration disease, intoxication, etc.) can act as the cause. In contrast to the primary syndrome, in this case, in the later stages, irreversible changes in the limbs can occur with the formation of ulcers or tissue death.

  To date, the exact cause of the pathology has not been established. But scientists put forward several theories about the mechanism of development of this disease. This does not exclude the possibility of other causes of Raynaud's syndrome.

  Main proposed mechanisms:

  1. 1. Vascular disorders. With a lack of biological active substances required for normal physiological response to stressful situations, spasm or insufficient relaxation of blood vessels may occur.
  2. 2. Intravascular pathologies. When the surface or structure of the vessel changes in conjunction with the impaired function of the endothelial cells that form its wall, circulatory disorders may occur, aggravated by arterial spasm.
  3. 3. Neurological disorders. In neurology, it is assumed that with Raynaud's syndrome and disease, there is a violation of the nervous regulation of the motor activity of the vessels, as a result of which an inadequate response to certain factors of the internal or external environment is observed.

  Raynaud's syndrome and disease manifest themselves in most cases against the background of certain provoking factors that have a varying degree of influence on the condition of the vessels of the extremities and blood circulation:

  • exposure to cold water;
  • hypothermia;
  • vibration;
  • psycho-emotional stress;
  • taking vasoconstrictor drugs;
  • contact with heavy metals and PVC;
  • smoking.

  In the later stages of Raynaud's syndrome, vasospasms can occur spontaneously, even in the absence of any provoking factor.

  Raynaud's disease is most often observed in the following systemic diseases:

  • systemic lupus erythematosus;
  • vibration disease;
  • vascular disease;
  • cryoglobulinemia;
  • scleroderma;
  • intoxication with polyvinyl chloride.

  Raynaud's phenomenon in itself is not dangerous, therefore, with proper treatment, the prognosis for patients is favorable. But in some cases, with prolonged vasospasm or a combination with another disease, Raynaud's syndrome can lead to a complete cessation of blood circulation in the fingers or even a limb, followed by tissue death. This is most often observed in stage 3 of the disease.

  

  Symptoms

  With Raynaud's syndrome, characteristic lesions mainly of the fingers appear. Moreover, more often blood circulation is disturbed in the index, middle and ring fingers, and less often in the little finger and thumb. In rare cases, other exposed areas of the body (chin, toes, tips of the nose and ears) are affected, despite the fact that they are also regularly exposed to cold and other precipitating factors. Clinical signs men and women do not differ.

  The severity of symptoms is determined by the stage of pathology.

  

  First stage

  The first stage is called angiospastic, because it is characterized by spasm, that is, narrowing of blood vessels. At this stage, the symptoms of the disease are of a short duration.

  The first manifestation of the disease is a change in the color of the skin. This symptom first occurs due to a violation of the nervous and hormonal regulation of vascular tone. With a sharp spasm of arterioles (small blood vessels), their blood supply decreases. Because of this, the fingers become pale.

  
  

  A characteristic feature of Raynaud's disease is a clear boundary between the affected and healthy tissue. At the first stage, the spasm lasts from 2 to 4 minutes, after which there is a compensatory expansion of the vessels, as a result of which they are filled with blood and the skin acquires its usual color.

  At this stage in the development of Raynaud's disease, edema may appear in the joints, which are caused by increased permeability of blood vessels and sweating of the liquid component of blood plasma into the surrounding tissues.

  Since a constant local temperature is maintained due to the microcirculation of blood, which heats up when passing through the internal organs, a decrease in temperature is observed in the affected areas. With spasm of blood vessels, the temperature difference can be from 2 to 4 degrees or more.

  In case of violation of blood circulation in the fingers, delivery is stopped nutrients to nerve fibers that are extremely sensitive to oxygen starvation. With hypoxia of the fingertips, the patient feels a slight tingling or “goosebumps”. After a few minutes, the sensitivity is significantly weakened until it disappears completely.

  Spasm of the vessels of the fingertips leads to the occurrence of pain. During normal functioning, the cells of the body constantly secrete lactic acid and other by-products of their vital activity, which depart along with the blood stream. With spasm of arterioles, these substances accumulate where they are formed, as a result of which pain sensations of a stabbing, burning or aching nature appear. After normalization of blood circulation, a large concentration of toxic substances is carried with the blood flow to nearby tissues, therefore, a short-term increase in pain during the period of reflex vasodilation is possible.

  

  Second stage

  The development of the second stage begins about six months after the onset of the first symptoms of Raynaud's disease. It is characterized by a greater severity of violations of the mechanisms of regulation of vascular tone. Therefore, there is a decrease in the frequency, but an increase in the duration of seizures that can occur under the influence of the factors described above or spontaneously.

  
  

  In the second stage of the disease, spasm of the vessels of the fingertips leads to the formation of severe cyanosis. Under normal conditions, the oxygen contained in red blood cells is transferred to the cells of various tissues and carbon dioxide is released in return. Arterial blood, rich in oxygen, has a red color, and venous blood, saturated with carbon dioxide, has a characteristic bluish tint. This explains the cyanosis of the fingers with impaired blood circulation. The released carbon dioxide does not have time to be carried away with the venous blood flow to the lungs.

  In the second stage of Raynaud's disease, a pathological expansion of the venous vessels is noted, as a result of which the manifestations of the pathology are further enhanced. The pain is longer and more intense than in the first stage of the disease.

  Third stage

  The third stage appears 1-3 years after the development of the disease. It is characterized by necrosis of the tissues of the fingers, associated with circulatory disorders. With insufficient supply of tissues with oxygen, the cells die and eventually are rejected, forming ulcers in their places that can reach several mm in depth.

  Their bleeding is noted in rare cases, while they are painless. Ulcers heal for a long time (from several days to weeks), form dense scars.

  
  

  If there is a violation of local blood circulation, the risk of developing infectious diseases as the local immune defense weakens. This is facilitated by local ischemia and necrosis.

  The disease is able to stop on its own even at the first stage after several attacks. If this does not happen, then it proceeds for a very long time, and pain attacks that increase in frequency and duration lead to the need to consult a doctor.

  The first two stages of Raynaud's syndrome are not dangerous. Damage to the vessels at these stages is noted in rare cases. The 3rd stage is dangerous, which poses a threat of the appearance of ulcers on the skin, necrosis of tissues and even loss of a limb. However, it appears only in advanced cases and in people who have Raynaud's disease provoked by another serious illness.

  Manifestations on the toes

  A case with a primary lesion of the lower extremities is possible. Signs of pathology are the same as on the hands. First, there is a painful vasospasm, leading to blanching of the fingers and a change in temperature. Attacks last from 10 to 30 minutes. In the later stages, spasms become longer, blue extremities are possible.

  
  

  When the legs are affected, their motor function. Patients begin to suffer from lameness, severe pain during attacks when standing or walking.

  Features of the disease in children

  Raynaud's syndrome in children, as a rule, first manifests itself at 11-12 years old, but in some cases it can develop at an earlier age. Clinical signs differ only slightly from those seen in adults and include blanching of the fingertips, localized fever, and pain.

  But when a disease is detected in children, special attention is paid to other signs that can indicate the onset of the development of autoimmune diseases. Secondary Raynaud's syndrome can be combined with the following clinical manifestations:

  • nail plates in the form of watch glasses;
  • nodules when feeling fingers;
  • sores on the fingertips;
  • swelling of the skin;
  • soreness and stiffness in the joints;
  • general weakness;
  • persistent redness of the face;
  • ulcers at the corners of the mouth.

  These and other symptoms do not indicate an autoimmune pathology, but they often accompany it, therefore, if Raynaud's disease is suspected, a thorough diagnosis should be made to early detection potentially dangerous diseases.

  Diagnostics

  The doctor makes a diagnosis, relying on the patient's complaints and objective data obtained during additional studies. One of these is capillaroscopy of the nail bed. It allows you to identify functional and structural changes in the vessels of the extremities. Another technique is cold tests, the essence of which is to assess the condition of the hands and feet after they are immersed for 2-3 minutes in water with a temperature of 10 degrees.

  In Raynaud's disease, diagnosis consists in assessing the following criteria:

  • symmetry of areas with angiospasms;
  • the level of impaired blood circulation in the extremities;
  • the presence of other venous diseases;
  • the duration of symptoms of the disease.

  Laboratory methods are also used to make a diagnosis:

  • general analysis of blood and urine;
  • coagulogram - assessment of blood clotting;
  • blood chemistry;
  • immunological analyses.

  Treatment

  The treatment of Raynaud's disease is complex. Medical or surgical treatment is established only if the disease cannot be controlled by other means.

  Usually, the therapist deals with the treatment of the disease. But if there is a secondary Raynaud's syndrome, which developed against the background of systemic diseases of the connective tissue, then a rheumatologist who is a specialist in autoimmune pathologies is observed. The effectiveness of therapy depends entirely on the patient's consciousness, since, first of all, it is necessary to eliminate provoking factors (stress, cold, smoking, alcohol and vibration).

  Raynaud's syndrome is not able to have a significant impact on the course of pregnancy, therefore, in this case, its therapy also comes down to the prevention of vasospasm.

  Medicines

  In primary Raynaud's syndrome, drug therapy is carried out in the cold season to prevent vasospasm and complications. At secondary syndrome long-term and regular treatment with drugs is prescribed.

  To prevent vasospasm, several groups of drugs are used that have a vasodilating effect and improve blood rheology:

  1. 1. Calcium channel blockers (Cordaflex, Normpodipine, Corinfar, Amlodipine, Tenox, Plendil, Felodipine, Nifedipine, Felodipine). They reduce the frequency of attacks of vasospasm. Appointed by monthly courses in the cold season with a break for the same period. If a therapeutic effect from this group of drugs is insufficient, then they are combined with other drugs.

  Calcium channel blockers are contraindicated in the following cases:

  • minor age;
  • pregnancy and lactation;
  • top arterial pressure does not exceed 90 mm Hg. Art.;
  • no more than 4 weeks have passed since acute attack myocardial infarction;
  • stenosis (aortic and mitral);
  • tachycardia.
  1. 2. Vasodilators and antiplatelet agents (Dipyridamole, Trental, Pentoxifylline, Curantyl, Pentinyl, Papaverine hydrochloride). They help reduce blood viscosity, reduce platelet aggregation, increase oxygen saturation of tissues and have a vasodilating effect. Use drugs in courses of 1-2 months. From this group, nitroglycerin ointment 2% is isolated, which is applied topically to the fingers of the extremities 2-3 times a day. It is effective in both primary and secondary forms of the disease, in the healing of ulcers.
  2. 3. Alpha-blockers (Doxazosin, Prazosin). Their action is based on blocking norepinephrine, a hormone responsible for vasoconstriction. They help to eliminate the pathological link of the disease and stabilize blood circulation in the limbs. But their action may be insufficient under severe stress.

  Surgery

  Surgical methods are used extremely rarely in Raynaud's disease. They are necessary in cases of increased risk of soft tissue necrosis of the fingers and toes.

  There are the following types surgical treatment:

  • Stem sympathectomy. The bottom line is the intersection of the section of the sympathetic nerve on the limbs, which is responsible for the spasm of the vessels in them. This reduces the duration and frequency of attacks of the disease.
  • chemical injections. The action is based on the chemical blocking of the transmission of nerve impulses in the sympathetic nerves with the help of anesthetics or botulinum toxin type A.

  A significant disadvantage of surgical treatment is that the effect obtained can be short-lived.

  Physiotherapy

  Physiotherapeutic procedures can prevent vasospasm by improving the condition of their walls. With Raynaud's syndrome, the following methods are used:

  • Magnetotherapy. Inductors act on the cervical and thoracic region spine for 15 minutes. Sessions are held daily for two weeks.
  • Electrophoresis. It is carried out using sedatives (sodium bromide, Diazepam), antispasmodics (Dibazol, Eufillin, Papaverine). In this case, they act on the palms and feet for 10 minutes. A total of 10 sessions are carried out.
  • Paraffin and ozocerite applications. The area with spasmodic vessels is affected by a temperature of 38-40 degrees. The procedure lasts from 15 to 25 minutes. In total, up to 10-15 sessions are carried out.
  • Mud cure. Apply bromine-iodine, hydrogen sulfide and nitrogen-thermal baths. One procedure takes up to 20 minutes. The course of therapy includes 10 sessions.
  • Sulphide baths. The main component is hydrogen sulfide, which penetrates the skin, improving microcirculation in tissues and stimulating metabolism. The procedure takes from 10 to 15 minutes, in total, 5-10 sessions are performed.

  Folk methods

  Before resorting to methods traditional medicine, it is recommended to consult a doctor to rule out complications. Besides, folk remedies are effective only in the early stages of Raynaud's disease, therefore they are considered only as an additional measure to the main conservative therapy.

  The following popular recipes and methods are distinguished:

  • A decoction of pine needles and wild rose. Finely chopped needles of young pine needles are taken, mixed with half a glass of honey and the same amount of onion peel and 2-3 tablespoons of wild rose. The resulting mixture is seasoned with boiling water, after which it is boiled for 10 minutes and infused for 8-12 hours. The decoction is consumed 100 ml 3-5 times a day, preferably after a meal.