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Raynaud's Disease

What is Raynaud's Disease?

Raynaud's disease - also known as vasospastic arterial disease - is one of several primary arteriospastic disorders. These disorders are characterized by episodic vasospasm in the small peripheral arteries and arterioles precipitated by exposure to cold or stress.

Raynaud's disease occurs bilaterally and usually affects the hands or, less commonly, the feet and, rarely, the earlobes and the tip of the nose. The disease is five times more common in females than in males, particularly between late adolescence and age 40. The disorder is benign, requiring no specific treatment and with no serious sequelae.

Raynaud's phenomenon, however, is a condition commonly associated with several connective tissue disorders, such as scleroderma, systemic lupus erythematosus, and polymyositis. The concurrent disorders have a progressive course, leading to ischemia, gangrene, and amputation.

Causes of Raynaud's Disease

Although the cause is unknown, several conditions account for the reduced digital blood flow: intrinsic vascular wall hyperactivity to cold, ineffective basal heat production, increased vasomotor tone from sympathetic stimulation, stress, and an antigenantibody immune response (the most probable theory because abnormal immunologic test results accompany Raynaud's phenomenon).

Signs & Symptoms of Raynaud's Disease

Symptoms of Raynaud's disease depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration upon cold exposure. They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal. When the blood vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen, and can cause pain in the involved digit(s). Rarely, poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected. With continued lack of oxygen, gangrene of the digits can occur.

Diagnostic Tests

Diagnosis is based primarily on presenting symptoms. Before Raynaud's phenomenon can be diagnosed. secondary disease processes, such as chronic arterial occlusive disease and connective tissue disease. must be ruled out.

Arteriography and digital photoplethysmography may also help diagnose the presence of Raynaud's phenomenon.

Treatment

Initially, treatment consists of avoidance of cold, mechanical, or chemical injury; cessation of smoking and reassurance that symptoms are benign. Because adverse reactions to drugs, especially vasodilators may be more bothersome than the disease itself, drug therapy is reserved for unusually severe signs and symptoms. Such therapy may include phenoxybep. zamine, nifedipine, reserpine, or guanethidine Combined with prazosin. Biofeedback therapy may be useful if signs and symptoms are caused by stress.

CULTURAL TIP Members of some cultures routinely practice various stress reduction techniques Ask about your patient's preferred method for reducirg stress. For example, many find meditation and yoga helpful, especially with ongoing practice.

Sympathectomy may be helpful when conservative treatment fails to prevent ischemic ulcers (occurring in less than 25% of patients)

Prevention Tips

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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