Raynaud syndrome

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Raynaud's syndrome , also known as Raynaud's Phenomenon , is a medical condition in which arterial spasms cause episodes of decreased blood flow. Usually the fingers, and less often the toes, are involved. Rarely, nose, ear, or lips are affected. The episode causes the affected part to turn white and then blue. Often, there is numbness or pain. When the blood flow returns, the area turns red and burns. Episodes are usually last minute, but can last up to several hours.

Episodes are often triggered by cold or emotional stress. There are two main types: Primary Raynaud, when the cause is unknown, and secondary Raynaud, which occurs as a result of other conditions. Secondary Raynaud can occur due to connective tissue disorders, such as scleroderma or lupus, hand injuries, prolonged vibrations, smoking, thyroid problems, and certain medications, such as birth control pills. Diagnosis is usually based on symptoms.

The main treatment is to avoid cold. Other measures include cessation of nicotine use or stimulants. Drugs for the treatment of cases that do not improve include calcium channel blockers and iloprost. Little evidence supports alternative medicine. Severe disease may be rarely complicated by skin injuries or gangrene.

About 4% of people experience the condition. The onset of the main form is usually between the ages of 15 and 30 and is more common in women. Secondary forms usually affect the elderly. Both forms are more common in cold climates. It's named after the French doctor Maurice Raynaud, who described the condition in 1862.

Video Raynaud syndrome

Signs and symptoms

This condition can cause pain in affected limbs, discoloration (pale), and cold and/or numb sensation. This can often be troublesome for those who are undiagnosed, and can sometimes become obstructive. If someone with Raynaud is placed in a cold climate, it could potentially be dangerous.

1. When exposed to cold temperatures, the blood supply to the fingers or toes, and in some cases the nose or ears, is greatly reduced; the skin becomes pale or white (called pale) and becomes cold and numb.

These events are episodic, and when the episode subsides or the area is warmed, the blood flow returns, and the first color of the skin turns red (rubor), and then returns to normal, often accompanied by swelling, tingling, and pain. and needle "sensation.

All three color changes were observed on the classic Raynaud. However, not all patients see all the color changes mentioned in all episodes, especially in milder cases of the condition. Symptoms are thought to be due to reactive hyperemia from areas lacking blood flow.

In pregnancy, these marks usually disappear due to increased surface blood flow. Raynaud's also occurs in nursing mothers, causing the nipples to become white and becoming very painful. Nifedipine, a calcium channel blocker and vasodilator, is recommended to increase blood flow to the extremities and to feel the pain lost in the breasts in a very small study group.

Maps Raynaud syndrome

Cause

Primary

Raynaud's disease, or "Raynaud's Primary", is diagnosed if the symptoms are idiopathic, ie, if they appear on their own and are unrelated to other diseases. Some refer to Primary Raynaud's disease as "allergic to cold". It often develops in young women in their early teens and early adulthood. Primary Raynaud is considered at least partly descendant, although certain genes have not been identified.

Smoking increases the frequency and intensity of attacks, and there are hormonal components. Caffeine, estrogen, and non-selective beta-blockers are often listed as an aggravating factor, but evidence that they should be avoided is not solid. People with this condition are more likely to experience migraine and angina.

Secondary

Raynaud's phenomenon, or "Secondary Raynaud", occurs secondary to various other conditions.

Raynaud's Secondary memiliki sejumlah asosiasi:

• Gangguan jaryan :
  • scleroderma
  • lupus erythematosus systemic
  • rheumatoid arthritis
  • Syndrome Sjögren
  • dermatomiositis
  • polymyositis
  • penyakit jaringan ikat campuran
  • penyakit aglutinine dingin
  • Ehlers-Danlos syndrome
• Gangguan makan :
  • anorexia nervosa
• Gangguan obstruktif :
  • atherosclerosis
  • Penyakit Buerger
  • Arteritis Takayasu
  • aneurysm subklavia
  • syndrome saluran keluar toraks
• Obat-obatan :
  • beta-blocker
  • obat sitotoxic - terutma chemotherapy dan terutma bleomisin
  • cyclosporin
  • bromocriptine
  • ergotamine
  • sulfasalazine
  • Vaccin anthrax yang bahan utamanya adalah Anthrax Protective Antigen
  • obat stimulant, seperti yang digunakan untuk mengobati ADHD (amphaethamine dan methylphenidate)
  • Obat pseudoephedrine OTC (Chlor-Trimeton, Sudafed, lacquered)
• Pekerjaan :
  • pekerjaan yang melibatkan getaran, terutama penggunaan dan penggunaan jangka panjang dari pemangkas String (pencil giling), menderita jari putih getaran
  • terpapar vinyl chloride, mercury
  • paparan dingin (misalnya, dengan bekerja sebagai pengemas makanan bless)
• Loan :
  • trauma fizik, seperti yang diderita dalam kecelakaan mobil atau kejadian traumatik lainnya
  • Penyakit Lyme
  • hypothyroidism
  • cryoglobulinemia
  • keganasan
  • syndrome kelelahan kronis
  • Reflects sympathetic sympathetic
  • syndrome terowongan karpal
  • kekurangan magnesium
  • multiple sclerosis
  • Erythromelalgia (secara klinis merupakan kebalikan dari Raynaud, dengan ekstremitas panas dan tigers) sering terjadi bersamaan pada pasien dengan Raynaud's)

Raynaud can persuade this disease over a period of more than twenty years in some cases, making it effectively their first symptom. This may be the case with CREST syndrome, which Raynaud is part of.

Patients with secondary Raynaud may also have symptoms related to the underlying disease. Raynaud's phenomenon is an early symptom that occurs in 70% of patients with scleroderma, skin and joint diseases.

When Raynaud's phenomenon is limited to one hand or one leg, it is called the Unilateral Raynaud. This is an unusual form, and is always secondary to local or regional vascular disease. It usually develops within a few years to affect other limbs as the development of vascular disease develops.

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Mechanism

Its pathophysiology includes hyperactivation of the sympathetic nervous system that causes extreme vasoconstriction in peripheral blood vessels, leading to tissue hypoxia.

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Diagnosis

It is important to distinguish Raynaud's (Raynaud's) disease from the phenomenon (secondary Raynaud). Look for signs of arthritis or vasculitis as well as a number of laboratory tests can separate it. If suspected to be secondary to systemic sclerosis, one tool that can be helpful in predicting systemic sclerosis is thermography.

A careful medical history will often reveal whether this condition is primary or secondary. Once this has been established, checks are mostly to identify or exclude the possibility of secondary causes.

• Digital arterial pressure: pressure is measured in the finger artery before and after the hand is cooled. A reduction of at least 15 mmHg is diagnostic (positive).
• Doppler ultrasound: to assess blood flow.
• Total blood count: this may reveal a normocytic anemia that indicates anemia of chronic disease or renal failure.
• Blood tests for urea and electrolytes: These can reveal kidney disorders.
• Thyroid function test: this may reveal hypothyroidism.
• Autoantibody screens, tests for rheumatoid factor, blood sedimentation rate, and C-reactive protein, which may reveal specific disease or general inflammatory processes.
• Nail fold vasculature: this can be checked under a microscope.

To assist in the diagnosis of Raynaud's phenomenon, several sets of diagnostic criteria have been proposed. Table 1 below provides a summary of these various diagnostic criteria.

More recently, the International Consensus Criteria was developed for the diagnosis of primary Raynaud's phenomenon by a panel of double experts in the fields of rheumatology and dermatology.

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Management

Secondary Raynaud is managed primarily by treating underlying causes and as the main Raynaud, avoiding triggers, such as cold, emotional and environmental stress, vibration and repetitive motion, and avoiding smoking (including passive smokers) and sympathomimetic drugs.

Drugs

Drugs can be useful for moderate or severe RP.

• Vasodilators - calcium channel blockers, such as dihydropyridines nifedipine or amlodipine, preferably slow release preparation - are often first-line treatment. They have common side effects of headache, redness, and ankle edema; but this is usually not hard enough to require treatment discontinuation. Available limited evidence suggests that calcium channel blockers are only slightly effective in reducing how often attacks occur. People whose RP is secondary to erythromelalgia often can not use a vasodilator for therapy because it triggers a 'flare' that causes the extremity to become red from too much blood.
• People with heavy RP who are prone to ulceration or major arterial thrombotic events may be prescribed aspirin.
• Sympatholytic agents, such as Prazosin alpha-adrenergic blockers, may provide temporary relief.
• Losartan can, and topical nitrates can, reduce the severity and frequency of attacks, and the phosphodiesterase sildenafil and tadalafil inhibitors may reduce their severity.
• Angiotensin receptor blockers or ACE inhibitors may help blood flow to the fingers, and there is some evidence that angiotensin receptor blockers (often losartan) reduce the frequency and severity of attacks, and may be better than nifedipine.
• Prostaglandin iloprost is used to manage critical ischemia and pulmonary hypertension in RP, and bosentan endothelin antagonist receptors are used to manage severe pulmonary hypertension and prevent finger ulcer on scleroderma.
• Statins have a protective effect on blood vessels, and SSRIs such as fluoxetine may help with RP symptoms but their data are weak.
• PDE5 inhibitors are used off-label to treat severe ischemia and ulcers on the fingers and toes for people with secondary Raynaud's phenomenon; in 2016 their role is more common in Raynaud is not clear.

Surgery

• In severe cases, endoscopic thoracic sympathectomy (ETS) procedures may be performed. Here, the nerve signifying the fingertip's blood vessels to narrow is cut through surgery. Microvascular surgery in the affected area is another possible therapy but this procedure should be regarded as a last resort.
• Infusion of prostaglandins, eg. prostacyclin, can be tried, with amputation in very severe cases.
• A newer treatment for severe Raynaud is the use of botulinum toxin. The 2009 article studied 19 patients aged 15 to 72 years with a severe Raynaud phenomenon in which 16 patients (84%) reported pain reduction at rest. 13 patients reported immediate pain, 3 more had a gradual reduction of pain for 1-2 months. All 13 patients with chronic finger ulcer cured within 60 days. Only 21% of patients require repeated injections. The 2007 article describes similar improvements in a series of 11 patients. All patients had significant pain relief.

Alternative medicine

The evidence does not support the use of alternative treatments, including acupuncture and laser therapy.

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Prognosis

The prognosis of primary Raynaud syndrome is often highly favorable, with no mortality and little morbidity. However, minorities develop gangrene. The prognosis of secondary Raynaud depends on the underlying disease, and how effective the blood flow recovery maneuver is.

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References

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External links

• Apa Penyakit Raynaud di National Heart, Lung, dan Blood Institute
• Pertanyaan dan Jawaban tentang Fenomena Raynaud di National Institutes of Health
• Bakst R, Merola JF, Franks AG, Sanchez M (Oktober 2008). "Fenomena Raynaud: patogenesis dan manajemen". Jurnal Akademi Dermatologi Amerika . 59 (4): 633-53. doi: 10.1016/j.jaad.2008.06.004. PMID 18656283.

Source of the article : Wikipedia