Raynaud's Disease - Symptoms And Treatment
One of several primary arteriospastic disorders, Raynaud's disease is characterized by episodic vasospasm in the small peripheral arteries and arterioles, precipitated by exposure to cold or stress. This condition occurs bilaterally and usually affects the hands or, less often, the feet. It is characterized by repeated episodes of color changes of the skin of digits on cold exposure or emotional stress .
Raynaud's disease is most prevalent in women, particularly between puberty and age 40. A benign condition, it requires no specific treatment and has no serious sequelae.
Raynaud's phenomenon, however, a condition often associated with several connective tissue disorders - such as scleroderma, systemic lupus erythematosus, and polymyositis-has a progressive course, leading to ischemia, gangrene, and amputation. Differentiating the two disorders is difficult because some patients who experience mild symptoms of Raynaud's disease for several years may later develop overt connective tissue disease-most commonly scleroderma.
Causes of Raynaud's Disease
Although the cause is unknown, several theories account for the reduced digital blood flow: intrinsic vascular wall hyperactivity to cold, increased vasomotor tone resulting from sympathetic stimulation, and antigen antibody immune response (the most probable theory, because abnormal immunologic test results accompany Raynaud's phenomenon.
Signs and symptoms of Raynaud's Disease
After exposure to cold or stress, the skin on the fingers typically blanches, then becomes cyanotic before changing to red and before changing from cold to normal temperature. Numbness and tingling may also occur. These symptoms are relieved by warmth.
In longstanding disease, trophic changes such as sclerodactyly, ulcerations, or chronic paronychia may result. Although it's extremely uncommon, minimal cutaneous gangrene necessitates amputation of one or more phalanges.
Diagnosis of Raynaud's Disease
Clinical criteria that establish Raynaud's disease include skin color changes induced by cold or stress; bilateral involvement; absence of gangrene or, if present, minimal cutaneous gangrene; normal arterial pulses; and a patient history of clinical symptoms of longer than 2 years' duration. The diagnosis must also rule out secondary disease processes, such as chronic arterial occlusive or connective tissue disease.
Treatment of Raynaud's Disease
Initially, treatment consists of avoidance of cold, mechanical, or chemical injury; cessation of smoking; and reassurance that symptoms are benign.
Because adverse drug effects, especially from vasodilators, may be more bothersome than the disease itself, drug therapy is reserved for unusually severe symptoms. Such therapy may include phenoxybenzamine or reserpine.
CLINICAL TIP Low doses (30 mg) of sustained-release nifedipine may be given.When conservative treatment fails to prevent ischemic ulcers, sympathectomy may be helpful; fewer than a quarter of patients require this procedure.
The prognosis for most people with Raynaud's disease is very good. In general, primary Raynaud's disease has the best prognosis, with a relatively small chance (1%) of serious complications. Approximately half of all affected individuals do well by taking simple precautions, and never require medication. The prognosis for people with secondary Raynaud's disease (or phenomenon) is less predictable. This prognosis depends greatly on the severity of other associated conditions such as scleroderma, lupus, or Sjögren syndrome.
There is no way to prevent the development of Raynaud's disease. Once an individual realizes that he or she suffers from this disorder, however, steps can be taken to reduce the frequency and severity of episodes.
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