Raynaud's syndrome: symptoms and treatment, types of disease and stages of its development. Raynaud's syndrome. Causes, symptoms and signs, diagnosis and treatment of the disease The phenomenon of clinical signs of rhine syndrome

Raynaud's disease is classified as a vegetative-vascular disease. Ailments of this kind are associated with peripheral circulatory disorders for various reasons. Raynaud's syndrome differs from other types of diseases in that its mechanism is associated with increased excitability of the nervous system, which leads to an inadequate response of the body to minor stimuli.

What is Raynaud's disease

The starting point for the formation of the disease is the body’s reflex reaction to cold. Normally, the lumen of small vessels decreases in order to reduce the flow of blood into the skin, thereby reducing heat loss. In this case, the main part of the blood is directed to the core of the body, which allows it to continue functioning in conditions of low temperature without loss.

They resort to a number of different studies to separate idiopathic and secondary disease.

• – before an attack and immediately after it, an increased level of fibrin is detected in the blood. The blood composition deteriorates significantly.
• VCSP – evoked cutaneous sympathetic potentials. With scleroderma, for example, the amplitude of the impulses remains normal, but with primary Raynaud's disease, the amplitude in the arms or legs is noticeably reduced, and the latent periods are lengthened.
• or rheovasography - allows you to assess the patency and fullness of blood vessels. In this way, it is possible to identify pathologies that have not yet manifested themselves clinically.
• Thermal imaging - determines the difference in temperature in different areas. Particularly indicative during an attack. At stages 2 and 3 of the disease, the method is used to assess soft tissue damage.

Treatment methods

Since the etiology of the disease remains unclear, the treatment undertaken is symptomatic. If Raynaud's syndrome accompanies a primary disease, then the course is primarily aimed at eliminating the main disease.

Symptoms and treatment of the disease are described in the video below:

Medication

Treatment medications are aimed at improving microcirculation. Complete healing is not given, since the issue is not poor blood supply, but an excessive vegetative reaction.

• Vasodilators - trental, platiphylline, nicotinic acid. Ganglioblockers such as pachycarpine and benzohexonium may also be prescribed. However, long-term observation of patients shows that the effect of their use is short-lived. Recently, calcium blockers have been used for treatment. The drug also improves microcirculation, but provides a more lasting clinical effect.
• Correction of peripheral circulation is also carried out using cycloaxial inhibitors - ascorbic acid, indomethacin. Impact doses of the drug prevent the occurrence of spasms.
• Psychotherapy is of great importance in the treatment of Raynaud's disease. During treatment, tranquilizers are prescribed - tazepam, antidepressants, like methanesirin. No less effective are hypnosis and autogenic training, which allows the patient to regulate the temperature of her fingers using simple techniques.

Disease scheme

Physiotherapy

Treatment methods are aimed at relieving symptoms, and during remission, at stopping attacks. The methods are quite effective, especially in the initial stages of the disease, and are very diverse.

Lymph drainage:

• massage of the collar zone - this activates the regional blood supply and reflex zones. Massage increases microcirculation and improves lymphatic drainage, preventing swelling. The course includes at least 15 procedures;
• – a traveling magnetic field reduces the tone of the venules, which improves the outflow of blood and lymph. The procedure is carried out at different magnetic frequencies, at least 10 times;
• segmental vacuum therapy - the cervicothoracic region or collar area is affected using a vacuum applicator. At the same time, the hydrostatic pressure gradient increases, which leads to a decrease in arteriolar tone and active lymph outflow.

Vasodilator methods:

• – for example, with nicotinic acid, which quickly relieves swelling and reduces painful symptoms;
• ultratonotherapy is a combination of high voltage currents and supersonic frequencies. Strengthens the outflow of blood and lymph;
• barotherapy - exposure to high and low pressure, especially indicated for obliterating endarteritis;
• – stimulates capillary blood circulation and improves oxygen supply to soft tissues.

Hypocoagulating methods:

• low-frequency magnetic therapy - exposure to a low-frequency field. Improves blood supply to tissues and trophism;
• laser irradiation of blood - the effectiveness of the procedures is based on the absorption of a laser beam of a certain length by the molecular structures of the blood. This improves the rheological composition of the blood, which leads to a reduction in spasmodic phenomena.

They also resort to stimulating procedures: thalassotherapy, aerotherapy, contrast baths.

Operation

In case of severe pain and pronounced trophic changes, they resort to sympathectomy - the intersection of the nerve trunk in the cervical or lumbar spine, which leads to a decrease in the sensitivity of the upper or lower extremities.

The effect occurs very quickly, but alas, it is short-lived - no more than a few weeks. As soon as the sensitivity of the nerve trunks is restored, the disease manifests itself in full. Moreover, studies show that the operation leads to hypersensitivity of the innervated trunk.

Prevention

Raynaud's disease cannot be cured, since the etiology of the disease remains unknown. To prevent attacks and, if possible, reduce their intensity, it is necessary to follow certain recommendations:

• Smoking is prohibited - smoking leads to severe spasm of blood vessels, especially in people with circulatory problems;
• Vibration should be avoided - if this phenomenon is related to the profession, the job will have to be changed. In everyday life, you should avoid holding a mixer, for example, or an electric drill in your hands, since the devices create vibration. It is not advisable to use even a vacuum cleaner for a long time;
• Warm mittens and dry, warm shoes are a must-have item of clothing. You should always keep your hands and feet warm;
• It is forbidden to wash your hands with cold water so as not to cause a spasm. If there is no centralized supply of hot water, it is necessary to heat water on the stove for washing and washing hands;
• It is necessary to avoid stress and overwork, since even slight anxiety can cause vasospasm.

Raynaud's disease in a woman

Forecast

Raynaud's disease cannot be completely cured. A person suffering from this disease is forced to follow the recommendations described above throughout his life and periodically resort to physiotherapy methods. Depending on the severity of the disease, drug therapy can be either continuous or prescribed in courses.

If Raynaud's syndrome is diagnosed, and the underlying disease is curable, then it is quite possible to get rid of vascular spasms. As a rule, recovery leads to the disappearance of the factors that provoke the syndrome.

Among vegetative-vascular diseases of the distal extremities, Raynaud's disease occupies a leading position. Data about it are quite contradictory. As a rule, the disease is not life-threatening, but it limits opportunities and requires constant drug therapy.

You will find even more useful information about this disease in the video below:

In addition, it can be accompanied by various disorders of the adrenal glands. And unlike Raynaud's, it's one-sided.

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Symptoms and course of the disease

The clinical picture of Raynaud's phenomenon consists of three sequential stages:

• under the influence of cold or emotional overload, the lumen of the vessel narrows, blood flow to the finger is disrupted, the fingers turn pale, patients feel numbness, tingling or burning;
• as vascular spasm persists, the fingers become bluish and pain appears;
• when warmed up or spontaneously after 10-15 minutes, vascular spasm is eliminated, blood flow is restored, the hand turns red and warms up.

These changes are usually bilateral and symmetrical. Some patients may experience not the typical three-phase change in skin color (1-pallor, 2-bluishness, 3-redness), but two-phase or single-phase. Much less often, similar changes can be observed in other areas of the skin (tip of the nose, lips, ears).

With long-term Raynaud's phenomenon (for several years), due to circulatory failure, trophic ulcers on the fingers may appear (tissue death occurs, dead areas are rejected with the formation of a long-term non-healing defect).

There are two forms of Raynaud's phenomenon. Their clinical manifestations are absolutely identical, the differences are only in the reasons for their appearance:

• Raynaud's syndrome - occurs against the background of various diseases, most often rheumatological (systemic lupus erythematosus, systemic scleroderma, poisoning, exposure to vibration, diseases of the blood system, blood vessels);
• Raynaud's disease develops as an independent disease.

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Treatment of the disease

Treatment of the syndrome is a complex task, the solution of which depends on the possibility of eliminating causative factors and effectively influencing the leading mechanisms of development of vascular disorders. Treatment of Raynaud's disease includes conservative and surgical methods.

The first principle of treatment for Raynaud's syndrome is the exclusion of provoking moments:

• Long stays in cold places should be avoided. It is recommended to wear heat-saving clothing (mittens, hat, warm underwear);
• quitting smoking and drinking caffeine-containing drinks is an essential component of successful treatment;
• it is necessary to avoid psycho-emotional stress, and also refrain from taking medications that have a stimulating effect on the nervous system (sympathomimetics, clonidine and others);
• avoid exposure to vibration (coffee grinder, blender, etc.); Place the refrigerator and washing machine on a rubber mat to soften the vibration.

The primary disease that caused the development of Raynaud's syndrome is identified and treated.

Among the vasodilators for Raynaud's syndrome, the prescription of calcium antagonists - nifedipine (Cordafen, Corinfar, etc.), vasaprostan, selective calcium channel blockers - verapamil, nicardipine diltiazem - is effective. If necessary, ACE inhibitors (captopril) and selective HS2-serotonin receptor blockers (ketanserin) are used. For Raynaud's syndrome, antiplatelet drugs are prescribed - dipyridamole, pentoxifylline (agapurine, trental), low molecular weight dextrans (reopolyglucin).

In the event of an ischemic attack, immediate measures include warming the limb in warm water, massaging it with woolen cloth, and offering the patient a hot drink. In case of a prolonged attack, injectable forms of antispasmodics (no-shpy, platiphylline), seduxen and other drugs are prescribed.

For Raynaud's syndrome, non-drug methods are used:

• psychotherapy;
• reflexology;
• physiotherapy;
• hyperbaric oxygen therapy;
• in case of Raynaud's syndrome caused by systemic collagenoses, sessions of extracorporeal hemocorrection are indicated.

A new word in the treatment of Raynaud's syndrome is therapy using stem cells, 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 paroxysms of vasoconstriction.

Surgery

Progression and resistance of Raynaud's syndrome to drug therapy is an indication for surgical sympathectomy or ganglionectomy. The essence of the surgical intervention is to free the vessels from the nerve trunks (several nerve trunks approaching the vessels are cut), which are responsible for narrowing their lumen. Sympathectomy involves stopping or removing the nerve fibers of the sympathetic trunk, which are the main cause of arterial spasms. Less trauma is observed 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. The surgical method is highly effective, but its effect does not last long, because just a few weeks after rehabilitation the disease recurs with full force. So doctors strongly doubt the need for surgical procedures.

Diagnosis of the disease

A patient with Raynaud's syndrome is referred for consultation with a rheumatologist and a vascular surgeon.

In diagnostic terms, it is very important to distinguish between Raynaud's syndrome and Raynaud's disease. The following diagnostic criteria have been identified for Raynaud's disease:

• symmetrical damage to the fingers;
• absence of other vascular disease;
• absence of persistent malnutrition of surrounding tissues (necrosis, ulcers, gangrene);
• absence of damage to the capillaries of the nail bed;
• absence of laboratory parameters specific for systemic diseases (antinuclear antibodies, accelerated ESR).

The diagnosis of Raynaud's disease or syndrome is reliable when a three-phase (pallor, bluishness, redness) change in the color of the skin of the last phalanges of the fingers is detected during attacks. In other cases, the diagnosis is presumptive. In the presence of certain connective tissue diseases (systemic scleroderma, systemic lupus erythematosus), the diagnosis of Raynaud's syndrome becomes most likely.

Capillaroscopy is used to determine the condition of the capillaries of the nail bed.

Using a microscope, the doctor evaluates the capillaries of the skin fold of the nail bed. The method is painless, no additional preparation for the study is required.

To simulate an attack and detect changes in skin color, a cold test is performed. The patient’s hand is immersed in water at a temperature of 10°C for 2-3 minutes and the condition of the skin is observed over time.

In addition, Doppler ultrasound is performed to determine the condition of the vessels. And with the help of thermal imaging and rheovasography, changes in blood vessels can be detected in the early stages.

Differential diagnosis is always difficult. Previously, Raynaud's disease was differentiated from Raynaud's syndrome of secondary origin and other diseases with vasomotor trophoparalytic disorders. It is always necessary to exclude diffuse connective tissue diseases and pathological conditions, diseases of the nervous system and blood vessels, the clinical course of which may be accompanied by similar secondary angiotrophoparalytic symptoms. With neurovascular diseases, Raynaud's syndrome is observed in angioneurotic diseases: “dead finger”, “dead hand”, acrocyanosis, erythromelalgia.

Prices

Since the pathologies are very different, their treatment methods also differ significantly from each other. Vascular surgery in Israel carries out a variety of operations by type, level of complexity, etc. which effectively help eliminate the problem and save a person’s life.

In Israel, the following operations can be performed depending on the type of disease.

For atherosclerosis of the coronary arteries and coronary heart disease, coronary angioplasty combined with stenting, as well as coronary artery bypass grafting, are performed. In case of atherosclerosis of the carotid arteries, they are stenated.

Aortic aneurysm is treated using standard prosthetics, graft stenting, aortic root reconstruction, aneurysm clipping, etc.

Endovasal surgery (obturation with special coils) helps to cure aneurysms and malformations of the cerebral arteries.

For varicose veins, effective methods are laser coagulation, foam sclerotherapy, stripping, etc.

Hemangiomas are treated by excision, sclerotherapy, cryosurgery, or laser surgery.

Prices for vascular surgery procedures in Israel are not very high, which is why treatment in clinics in this country is so popular. The cost will vary significantly depending on the treatment method, equipment and drugs used, doctor, clinic and many other factors. You can send a request to find out data for your specific case. The high level of professionalism of doctors and the use of advanced technologies guarantee a quick recovery.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is Raynaud's syndrome and Raynaud's disease?

With the disease and with Raynaud's syndrome, there are identical changes in blood circulation at the level of the extremities, which are manifested by absolutely identical signs. However, as mentioned earlier, Raynaud's disease occurs as one of the manifestations of a systemic (encompassing several organs or organ systems) disease, while Raynaud's syndrome is a primary phenomenon, the pathological substrate of which has not been identified or is unknown.

In most cases, Raynaud's disease develops against the background of an existing autoimmune disease (sometimes the syndrome may occur earlier). Almost 90% of people suffering from systemic scleroderma experience Raynaud's phenomenon to one degree or another. In other systemic connective tissue diseases, the incidence of this pathology is somewhat lower.

It is necessary to understand that Raynaud's phenomenon itself is not a dangerous pathology, and with proper treatment, the prognosis for patients is extremely favorable. However, in some cases, due to too long vascular spasm or due to association with another disease, this syndrome can lead to ischemia (lack of blood circulation) of the fingers or even a limb, followed by necrosis (death) of tissue, which most often occurs in the third stage of the disease .

Primary Raynaud's syndrome and secondary Raynaud's syndrome

The following forms of Raynaud's phenomenon are distinguished:

• Primary Raynaud's syndrome. Primary Raynaud's syndrome is a pathology, the exact cause of which is unknown. This disease develops independently and is characterized only by periodic spasms of blood vessels in the fingers. The course is usually mild, and with proper attention and monitoring there is no need to resort to drug treatment.

• Secondary Raynaud's syndrome. Secondary Raynaud's syndrome develops against the background of another disease. Most often, the disease occurs as a result of damage to connective tissue during autoimmune processes, but often the cause can be certain medications or other diseases (vibration disease and intoxication with heavy metal salts). Unlike the primary pathology, in the later stages of this form of the disease, irreversible changes may occur in the affected limbs with the formation of ulcers or even tissue death (due to severe circulatory disorders).

Causes of Raynaud's syndrome

• Vascular disorders. A lack of biologically active substances responsible for the normal physiological response to a stress factor can cause excessive spasm or insufficient relaxation of blood vessels.
• Neurological disorders. It is assumed that in case of Raynaud's syndrome and disease, the nervous regulation of vascular motor activity is somewhat impaired, resulting in an inadequate response to certain factors of the external or internal environment.
• Intravascular changes. Changes in the structure or surface of a blood vessel, combined with impaired endothelial cells (the cells that form the vessel wall), can lead to poor circulation, worsened by arterial spasm.

Raynaud's syndrome should be distinguished from the following pathologies:

• Thrombosis. Thrombosis is an extremely dangerous condition in which a blood clot (thrombus) is located in the lumen of a blood vessel, which blocks blood circulation. Typically, blood clots form in the veins, where the blood flow rate is much slower. In some cases, blood clots enter the arterial system, resulting in oxygen starvation of the tissues, followed by their death. Symptoms of thrombosis of an artery in the arm or leg are similar to Raynaud's phenomenon, but they are irreversible and much more severe. It is necessary to understand that without medical assistance, this condition poses a great danger not only to a person’s health, but also to his life.
• Vasculitis. With vasculitis, blood vessels become inflamed, resulting in significant disruption of their structure and function. There is a gradual decrease in blood circulation at the level of the extremities, which can provoke both thrombosis and other complications with the occurrence of irreversible cessation of blood flow.
• Vessel damage. If a vessel is damaged as a result of injury, blood circulation in the extremities may also decrease.

Raynaud's syndrome can be caused by the following factors:

• washing hands with cold water;
• psycho-emotional stress;
• vibration;
• use of vasoconstrictor drugs;
• contact with polyvinyl chloride, heavy metals.

It should be borne in mind that it is possible to establish the causes of only secondary Raynaud's syndrome, since it accompanies a number of systemic pathologies. The possible causes of primary Raynaud's syndrome still remain unclear, and at the moment only the mechanisms of occurrence of periodic arterial spasms are clear. Among the causes of secondary Raynaud's syndrome, the most important are autoimmune diseases and other diseases associated with damage to connective tissue and blood vessels.

The following pathologies most often act as causes of secondary Raynaud's syndrome:

• scleroderma (systemic sclerosis);
• systemic lupus erythematosus;
• vascular diseases;
• carpal tunnel syndrome;
• vibration disease;
• intoxication with polyvinyl chloride;
• cryoglobulinemia.

Raynaud's syndrome in systemic scleroderma

An autoimmune disease can develop for a number of different reasons, but the most common are genetic abnormalities, against the background of which the mechanism for regulating the intensity of the immune response changes. Often, an infection acts as a provoking factor, which triggers a cascade of immune reactions that attack both bacterial cells and one’s own tissues.

Systemic scleroderma is an autoimmune pathology, which in almost 90% of cases is combined with Raynaud's phenomenon. This occurs due to the proliferation of fibrous tissue in the structure of the vessel, which leads to a gradual narrowing of the lumen of the artery and its inadequate adaptation to temperature changes or other stress.

It should be noted that with scleroderma, there are five classic manifestations that usually accompany Raynaud's syndrome. These symptoms are combined under the general term CROSS syndrome, which is an acronym (abbreviation) for the identified pathologies.

CROSS syndrome includes the following diseases:

• Calcification. Calcinosis is the excessive accumulation of calcium salts in soft tissues or organs. Often, calcium crystals are deposited in the skin or subcutaneous tissue, deep in the muscles or in internal organs. In this case, the normal function of tissues is disrupted, their mobility changes and elasticity decreases.
• Raynaud's syndrome. Blood circulation is disrupted at the level of the fingers, and sometimes the toes, nose, ears, and tongue.
• Impaired mobility of the esophagus. Due to sclerosis, that is, the replacement of normal muscle tissue of the esophagus with non-functional connective tissue, the mobility of the esophagus decreases and the swallowing process is impaired.
• Sclerosis of the skin of the fingers. The skin of the fingers loses elasticity, becomes rougher, drier and colder.
• Telangiectasia. Telangiectasias (spider veins) form on the body, which develop due to dysfunction of skin vessels.

Raynaud's syndrome in systemic lupus erythematosus (and other autoimmune diseases)

Systemic lupus erythematosus is based on damage to the connective tissue, which is manifested by damage to the skin with the appearance of a classic rash on the face, baldness, and the development of ulcers. Often joints, kidneys, hematopoietic organs, and heart are affected. The vessels of the extremities are often affected with the development of spasm - secondary Raynaud's syndrome develops.

Raynaud's syndrome in vascular disease

With Raynaud's syndrome, there is a deficiency of nitric oxide, a substance that has a pronounced vasodilating effect. In addition, there is a slightly increased level of endothelin-1, which has a powerful constricting effect on blood vessels. Activation of this substance occurs under the influence of other factors that can develop against the background of genetic abnormalities or due to autoimmune processes.

It should be noted that in addition to changes in the structure and function of the vascular wall, Raynaud's syndrome can develop with intravascular anomalies, that is, with disorders the main consequence of which is changes directly in the lumen of the vessel.

Raynaud's syndrome can occur due to the following intravascular pathologies:

• Increased platelet activation and aggregation. Platelets are blood cells that take part in the formation of blood clots. This happens in several stages, among which the key ones are platelet activation and their aggregation (sticking together). When the functioning of these cells is disrupted, blood clots form in the lumen of the vessel, which impair blood circulation and provoke attacks of ischemia.
• Excessive production of thromboxanes. Thromboxanes are substances that have a pronounced vasoconstrictor effect, which is combined with platelet activation.
• Disturbed process of resorption of blood clots. In systemic scleroderma, as in some other pathologies, the function of the fibrinolytic system, which is responsible for the destruction of the fibrin protein, the main component of the blood clot, is impaired.

Raynaud's syndrome in carpal tunnel syndrome

Most often, carpal tunnel syndrome occurs due to excessive dynamic or static load on the wrist joint. This pathology usually affects people who work a lot at the computer (severe tension in the joints and ligaments when working with the keyboard and mouse). At the same time, this syndrome often develops in people who actively practice sports - bodybuilders, weightlifters, as well as in those who are engaged in physical labor with a high level of stress on the ligamentous apparatus of the hands.

Raynaud's syndrome due to vibration disease

The basis of this pathology is a disruption of the functioning of nerves and blood vessels at the level of the extremities, which are manifested by periodic disturbances of blood circulation, up to its almost complete stop; in other words, Raynaud's syndrome develops.

Raynaud's syndrome due to polyvinyl chloride intoxication

Typically, intoxication occurs as a result of prolonged contact with toxic substances. In most cases, the toxin enters the body through the respiratory tract (by inhaling vapors or small particles), but the food route cannot be ruled out.

Common signs of poisoning include nausea, vomiting, diarrhea, abdominal pain, headaches, and fever. Raynaud's syndrome develops quite rarely, but in some cases it may be the first sign of the disease.

Raynaud's syndrome with cryoglobulinemia

Cryoglobulinemia in most cases is a secondary pathology, that is, it develops against the background of other diseases. It is usually triggered by autoimmune processes, but it can be triggered by bacterial or viral infections, as well as many other ailments.

Chronic arterial insufficiency (CAI) and Raynaud's syndrome

HAN most often occurs due to atherosclerotic changes in blood vessels. This process develops against the background of impaired fat (cholesterol) metabolism, which is deposited in the vascular wall and, thereby, causes a narrowing of the lumen of the arteries.

It should be noted that atherosclerosis of the vessels of the lower extremities is a serious risk factor for the development of thrombosis of the lower extremities. This is due to the fact that when an atherosclerotic plaque is exposed, platelets, fibrin, and red blood cells begin to attach to it, as a result of which in a short time the lumen of the artery becomes completely closed. Ischemia develops followed by necrosis.

Symptoms of Raynaud's syndrome

• first stage;
• second stage;
• third stage.

First stage of Raynaud's syndrome

The first stage of Raynaud's syndrome can manifest itself:

• Change in skin color. It is the first manifestation of the disease. The first occurrence of this symptom is associated with a violation of the nervous and hormonal regulation of vascular tone, which is always caused by the action of provoking or predisposing factors. As a result of a sharp spasm of small blood vessels (arterioles), the blood supply to the vessels decreases. Since the pinkish color of the skin is due to the presence of blood in the capillaries, with vasospasm the skin of the affected area becomes pale in color. A characteristic feature of Raynaud's syndrome is a clear limitation of damage to unaffected areas (a person may feel as if his fingers were dipped in paint). Vascular spasm lasts for a fairly short period of time (2 - 4 minutes), after which their reflex expansion occurs, the vessels overflow with blood and the skin becomes bright red. At this stage, swelling may appear in the joint area, which is due to increased permeability of the vascular walls and the leakage of the liquid part of the blood into the surrounding tissues. Within 10 to 30 minutes, vascular tone is normalized, the skin acquires its normal color and all clinical manifestations disappear.
• Decrease in tissue temperature in the affected area. A constant body temperature is maintained by blood circulation, which heats up as it passes through internal organs (liver, muscles) and cools in the area of ​​the skin and other peripheral tissues. When the blood vessels spasm, blood stops flowing to the area of ​​the fingers, as a result of which the skin quickly cools down (the local temperature can drop by 2 - 4 degrees or more).
• Numbness of fingers. Numbness in the affected area occurs as a result of impaired delivery of blood and nutrients to nerve fibers, which are extremely sensitive to hypoxia (lack of oxygen). At the beginning of the attack, the patient may feel a slight tingling sensation or “crawling on the skin” (these symptoms are characteristic of the initial stage of nerve damage), but after a few minutes the sensitivity decreases significantly until it disappears completely.
• Pain. The occurrence of pain is also due to impaired blood circulation in the fingers. The fact is that under normal conditions, the cells of the body constantly release by-products of their vital activity (lactic acid and others), which are carried away with the bloodstream to the place of neutralization in other organs. When arterioles spasm, blood circulation is disrupted, as a result of which metabolic by-products accumulate in the area of ​​formation and lead to pain (pain in this case can be burning, stabbing, aching). After normalization of blood circulation, toxic substances accumulated in large concentrations are carried through the bloodstream into nearby tissues, which can lead to a short-term increase in pain in the phase of reflex vasodilation.

Second stage of Raynaud's syndrome

A distinctive feature of this stage of the disease is the pronounced cyanosis of the fingertips, which occurs after vasospasm. This is explained by the fact that under normal conditions, the oxygen contained in blood cells (erythrocytes) is transferred to the cells of various tissues, which in return release carbon dioxide (a by-product of cellular respiration). Oxygen-rich blood (arterial) is red in color, while venous blood (saturated with carbon dioxide) is bluish. Normally, the carbon dioxide released by the cells is carried rather quickly through the bloodstream into the lungs, where it is released with exhaled air. However, under conditions of impaired blood circulation, the concentration of carbon dioxide in the blood increases significantly, as a result of which the skin acquires a bluish tint.

It is also worth noting that the second stage of Raynaud’s disease is characterized by pathological dilation of the venous vessels, which further enhances the manifestations of the disease. After a prolonged spasm of blood vessels, the pain is usually more intense and lasting than in the first stage.

Third stage of Raynaud's syndrome

The third stage of Raynaud's disease is characterized by the following complications:

• Necrosis (necrosis) of soft tissues. Due to insufficient blood supply to tissues, cell death occurs in the most affected areas (skin of the fingertips). Dead tissue is rejected over time, and ulcers appear in their place. They can reach several millimeters in depth, rarely bleed, and are painless. Healing of ulcers occurs over a long period of time (days, weeks) and leads to the formation of dense scars.
• Infectious complications. Circulating blood contains immune cells that protect the body from infection. If local circulation is impaired, the risk of developing infectious diseases of the skin and soft tissues of the fingers increases, which is also facilitated by local ischemia and necrosis.

Raynaud's syndrome of the lower extremities

It should be noted that with Raynaud's syndrome affecting the lower extremities, their function is significantly impaired, which is manifested by lameness and severe pain during attacks when walking or standing.

Manifestations of Raynaud's syndrome in women and men

Raynaud's syndrome in children

However, when identifying Raynaud's syndrome in children, special attention is paid to the presence of other pathological symptoms that may indicate the onset of an autoimmune process.

Secondary Raynaud's syndrome in children can be combined with the following symptoms:

• nail plastics in the form of watch glasses;
• sores on fingertips;
• nodules on palpation of the fingers;
• persistent redness of the face;
• pain and stiffness in the joints;
• swelling of the skin;
• general weakness not associated with other health problems;
• sores in the corners of the mouth.

Diagnosis of Raynaud's syndrome

The following diagnostic criteria for primary Raynaud's syndrome are distinguished:

• attacks develop in stressful situations or during hypothermia;
• both limbs are involved (symmetrically);
• absence of necrotic changes;
• absence of an obvious cause of impaired blood circulation;
• absence of inflammatory markers in the tests.

Laboratory tests are used to rule out other conditions similar to Raynaud's syndrome, as well as to identify possible causes of the disease.

When diagnosing Raynaud's syndrome, the following laboratory tests are used:

• General blood analysis. Allows you to identify disorders of the hematopoietic system, excess red blood cells, and suggest an autoimmune process.
• Blood chemistry. A biochemical blood test allows you to measure the level of many substances in the blood plasma, thereby allowing you to identify disorders in a particular organ. In Raynaud's syndrome, markers of renal and hepatic function are informative, elevated levels of which may indicate the presence of another pathology.
• Determination of the level of autoimmune antibodies. During an autoimmune process, the body produces antibodies to its own tissues, which can be detected using a number of laboratory tests.

Treatment of Raynaud's syndrome

Which doctor treats Raynaud's syndrome?

Regardless of which specialist diagnosed this pathology, the effectiveness of therapy depends entirely on the behavior and consciousness of the patient, since the main method of treatment is changing lifestyle with the elimination of possible provoking factors (cold, stress, vibration, smoking, alcohol).

Drug treatment of Raynaud's syndrome

In case of primary Raynaud's syndrome, it is advisable to treat with medications in the cold season to prevent attacks of the disease and complications. For secondary Raynaud's syndrome, treatment should be long-term and regular.

To treat the symptoms of vasospasm, several groups of drugs are used, the mechanism of which is vasodilation (vasodilation) and improvement of the rheological properties of blood.

For the drug treatment of Raynaud's syndrome, the following groups of drugs are used:

• calcium channel blockers;
• vasodilators and antiplatelet agents;
• alpha-blockers.

Calcium channel blockers

Prescribed in the cold season in courses of 4 weeks followed by a break for a month. In cases where the therapeutic effect is insufficient, calcium channel blockers are combined with other groups of drugs.

Calcium channel blockers are contraindicated in the following cases:

• lactation period (breastfeeding);
• age under 18 years;
• arterial systolic pressure below 90;
• aortic and mitral stenosis;
• less than four weeks after myocardial infarction;
• tachycardia (heart rate greater than 80 - 90).

Vasodilators and antiplatelet agents used to treat Raynaud's syndrome

The next group of drugs, alpha-blockers, blocks the action of norepinephrine, a hormone that is responsible for vasoconstriction. Thus, the main pathological link of the disease is eliminated and blood circulation at the level of the extremities is stabilized. However, under conditions of severe stress, this action may not be enough.

Alpha blockers used to treat Raynaud's syndrome

Surgical treatment of Raynaud's syndrome

Several types of surgery are used:

• Truncal sympathectomy. With this intervention, a section of the sympathetic nerve in the arms and legs, which is responsible for vascular spasm in the extremities, is crossed. The frequency and duration of attacks of the disease are reduced.
• Chemical injections. Surgical injections of medications (anesthetics or botulinum toxin type A) can block the transmission of nerve impulses in the sympathetic nerves responsible for narrowing the blood vessels of the arms and legs.

Pregnancy and Raynaud's syndrome

Physiotherapeutic treatment of Raynaud's syndrome

Physiotherapeutic treatment of Raynaud's syndrome includes the following procedures:

• Magnetotherapy. Inductors are placed on the cervical and thoracic spine. Duration of exposure is 15 minutes. Daily, 15 sessions per course.
• Electrophoresis. It is carried out with sedatives (diazepam, sodium bromide), with antispasmodic drugs (papaverine, aminophylline, dibazol). The impact is on the feet and palms. Lasting 10 minutes, sessions daily, course of 10 procedures.
• Ozokerite, paraffin applications. The exposure temperature is 38 - 40 degrees in the form of “stockings”, “socks”, “collar”. The duration of the procedure is 15 - 25 minutes. Sessions every day, for 10 - 15 days.
• Mud therapy (hydrogen sulfide, bromine-iodine, nitrogen-thermal mud). Procedures are prescribed lasting 20 minutes, in courses of 10 sessions daily.
• Sulfide baths. The main component of sulfide baths is hydrogen sulfide, which penetrates the skin, thereby improving microcirculation in tissues and stimulating metabolism. The procedures are carried out for 10 - 15 minutes, in courses of 5 - 10 sessions every day.

Traditional methods of treating Raynaud's syndrome

It should be understood that traditional treatment is not an effective means of controlling Raynaud's disease in the later stages, when proven medications are needed to stop the background autoimmune process. That is why in case of Raynaud's disease (that is, with secondary Raynaud's syndrome), traditional medicine methods should be considered only as an addition to the main treatment.

The following traditional medicine methods can be used to treat Raynaud's syndrome:

• A decoction of pine needles and rose hips. Finely chopped young pine needles must be mixed with half a glass of honey, half a glass of onion peel and 2 - 3 tablespoons of rose hips. The resulting mixture should be poured with boiling water, then boiled for 10 minutes and left for 8 to 12 hours. This decoction can be taken half a glass 3 to 5 times a day, preferably after meals.
• Baths with fir oil. You need to add a few drops (usually 4-7 drops) of fir oil to a warm bath, and then take it for at least 20-25 minutes.
• Bee honey with onion juice. One hundred milliliters of fresh onion juice must be mixed with the same amount of bee honey. The resulting mass can be consumed three times a day before meals, one tablespoon.
• An infusion of mint, motherwort, yarrow and dill. A mixture of mint, motherwort, yarrow and dill in equal proportions must be poured into 200 ml of boiling water, then left for one hour. The resulting infusion must be filtered and drunk throughout the day.

Consequences of Raynaud's syndrome

The most noticeable consequence of uncomplicated Raynaud's syndrome is the need for some limitation of daily activities with the elimination of the influence of provoking factors (cold, stress, vibration).

Disability in Raynaud's syndrome

It is necessary to understand that if all preventive measures are followed and the necessary medications are taken in a timely manner, the risks associated with irreversible tissue changes are minimal.

Raynaud's syndrome and military service

Prevention of Raynaud's syndrome

Prevention of Raynaud's syndrome includes the following measures:

• wellness massage of hands and feet;
• to give up smoking;
• timely diagnosis of autoimmune diseases;

• eating large amounts of plant foods;
• taking enough vitamins and minerals;
• thorough treatment of background pathology in secondary Raynaud's syndrome.

What should you not do if you have Raynaud's syndrome?

If you have Raynaud's syndrome, you must adhere to the following rules:

• You should not stay outside for a long time at low temperatures, in a cold room or in conditions of high humidity;
• You cannot go outside in the cold season without gloves or mittens, a hat, and warm socks;
• you should not smoke, you should avoid coffee and drinks that contain caffeine (including limiting your tea consumption);
• you cannot use medications that contain pseudoephedrine, ergotamine, beta-blockers, as these drugs can provoke vasospasm;
• you should avoid choosing professions associated with vibration, exposure to cold, working with heavy metals (lead), silicon, plastic (polyvinyl chloride);
• You should not be exposed to psycho-emotional stress.

Raynaud's syndrome is a circulatory disorder that leads to a sharp narrowing of blood vessels in the skin due to stress or cold. The disease occurs in children and adults, more often in women after 35 years of age and girls during puberty. About 3–5% of the population are susceptible to the disease.

Causes

Raynaud's syndrome refers to connective tissue pathologies and is paroxysmal, paroxysmal in nature. In medicine, there is the concept of “Raynaud’s phenomenon,” which includes not only the syndrome of the same name, but also Raynaud’s disease. The difference between the pathologies is significant: if the syndrome appears against the background of other diseases, the disease is primary in nature.

With Raynaud's disease (angiotrophoneurosis), there is a symmetrical decrease in blood flow in the lower extremities and hands. The exact reasons for the development of the pathology are unknown, but more often the anomaly occurs after exposure to the following risk factors:

• suffered stress;
• nervous tension;
• severe hypothermia;
• taking vasoconstrictor drugs;
• caffeine abuse.

The disease often develops in people living in cold climates. There is a clear connection between psychosomatics and Raynaud's disease - disturbances in arterial blood flow appear in those suffering from neuroses and depressive states. Heredity plays an important role in the mechanism of occurrence of the disease - 30% of close relatives of patients are diagnosed with Raynaud's disease.

Raynaud's syndrome is a secondary pathology that occurs against the background of existing diseases. Typically, the causes of the syndrome are very serious and represent systemic connective tissue diseases:

• systemic scleroderma;
• systemic lupus erythematosus;
• dermatomyositis;
• periarteritis nodosa.

The cause may be rheumatism, ganglionitis, aneurysms of the vascular system, thyrotoxicosis, arteritis, cryoglobulinemia, compression of nerves in the neck, atherosclerosis of the upper or lower extremities. There is occupational Raynaud's syndrome, when attacks occur due to the influence of occupational hazards (hypothermia, vibration, polyvinyl chloride poisoning).

Classification and stages of the disease

According to the classification, there is a primary form of pathology (Raynaud's disease) and a secondary form (Raynaud's syndrome). There are different stages of pathology as they develop:

1. First (angiospastic) stage. A person periodically experiences short-term vascular spasms that last several minutes. After the attack is over, no consequences are observed. Usually the violations concern the first - third fingers of the hand, and a little less often - the first - second toes.
2. Second (angioparalytic) stage. The disease begins to progress, so attacks become more frequent and may occur for no reason. Their duration increases to an hour or more.
3. Third (atrophoparalytic) stage. Due to regular attacks, the skin undergoes serious trophic disorders, and the blood supply to tissues is disrupted. There is a risk of complications, including gangrene.

Symptoms of pathology

The most initial symptoms in children, women or men are a periodic feeling of chilly fingers, which may occur even before the onset of real attacks.

• short-term numbness of the skin;
• fingers become white and cold;
• aches and pain appear;
• There are elements of paresthesia - impaired sensitivity of the fingers.

An attack in the first stage can be triggered by washing your hands with cold water, smoking, washing your face or body, or stress. Upon completion of the paroxysm, all signs disappear without a trace. In rare cases, the process involves the earlobes and the tip of the nose.

Later, the frequency of attacks becomes higher and the severity is stronger. Pain in the fingers and toes increases. According to the description of the second stage, a prolonged spasm of blood vessels is recorded - the skin gradually acquires a red-violet hue, and as the attacks end, a vascular pattern is clearly visible on it.

Symptoms at the last stage:

• dystrophy of the skin and nails;
• the appearance of scars;
• swelling, cyanosis of the skin after attacks;
• the appearance of blisters with bloody contents;
• the formation of ulcers and areas of dead skin.

The duration of the disease for the first - second stages usually does not exceed 5 years. With Raynaud's syndrome, the pathology reaches severe consequences less often than with Raynaud's disease.

Complications

The consequences of prolonged vascular spasm are always unpleasant. In addition to the fact that symptoms always intensify over time, severe pain appears, there is a risk of developing trophic disorders:

• scarring;
• nail dystrophy;
• finger deformities;
• the appearance of gangrene;
• muscle damage;
• bone resorption.

In some cases, Raynaud's disease reverses its progression. It can go away spontaneously after pregnancy and childbirth, during menopause, and generally for no apparent reason. Stages 1–2 of the disease do not pose a threat to life and health, but stage 3 can already cause the loss of a limb. The patient’s quality of life suffers greatly, the person cannot occupy certain positions, perform work related to fine motor skills, or exposure to the cold.

Diagnosis of pathology

To prescribe the correct treatment, it is important to make a differential diagnosis between the syndrome and Raynaud's disease. Elimination of risk factors and impact on systemic diseases in Raynaud's syndrome lead to regression of the pathology, so diagnosis will include a search for causes.

Examination methods prescribed by a rheumatologist may be as follows:

1. General blood analysis. An elevated ESR is detected, which most often means the presence of systemic rheumatic diseases. Anemia may be observed (a drop in hemoglobin and red blood cells); in some cases, leukocytes and platelets drop.
2. Biochemistry. Total protein increases, and with lupus erythematosus the level of fibrinogen increases. AST, ALT, aldolase, and creatine phosphokinase are often elevated.
3. Coagulogram. Due to a decrease in the number of platelets, blood clotting decreases.
4. Immunoglobulins. Specific indicators increase in autoimmune diseases - rheumatoid arthritis, lupus erythematosus and others.
5. Antibodies. With autoimmune causes of Raynaud's syndrome, special antibodies appear in the blood - antinuclear and anticentromere.

Treatment

At an early stage, conservative measures are indicated - medications, limiting contact with provoking factors. Later only surgery will help. If attacks become insensitive to pills and injections, a sympathectomy is performed - part of the nerves of the sympathetic trunk, which are responsible for vascular spasms, are removed.

The operation is usually performed endoscopically in the chest area. New treatment methods use stem cells, which help create new blood flow paths, bypassing damaged ones.

Emergency help for spasms:

1. It is necessary to calm the person down and be sure to protect him from disease provocateurs.
2. Warm up, rub the skin of your feet and hands, give a hot drink.
3. Give an antispasmodic tablet or give an injection (“No-shpa”, “Revalgin”).

Drug therapy

Drug treatment must necessarily affect the underlying disease and, if possible, stop it. The following remedies can be used against attacks of Raynaud's disease or Raynaud's syndrome:

1. Vasodilators. Reduce the strength of vascular spasm, increase blood flow - general and local (Nifedipine, Vazaprostan, Nicotinic acid, Trental).
2. Non-steroidal anti-inflammatory drugs. Eliminate inflammation in blood vessels, relieve pain (Ibuprofen, Diclofenac, Indomethacin).

In some situations, clinical recommendations include taking hormonal drugs (Prednisolone, Dexamethasone). The drugs are indicated for systemic autoimmune pathologies, reducing their progression and having a positive effect on the course of Raynaud's syndrome. In the most acute and severe cases, chemotherapy drugs (cytostatics) are prescribed.

Traditional treatment

Therapy with folk remedies is often carried out by patients at home. It has a symptomatic effect, helping to relieve painful spasms, acts proactively and improves blood circulation:

1. Brew 100 g of pine needles with boiling water (liter), leave for 15 minutes. Pour the infusion into warm water, add a tablespoon of salt, and make hand baths.
2. Before going to bed, grate the pumpkin on a fine grater, squeeze the mixture a little, and tie it to the limbs as a compress. Wrap the compress with a woolen cloth on top.
3. Squeeze the juice from aloe and make night compresses for the skin of your hands and feet.
4. Bake onion (1 piece) in the oven, chop it into a paste, mix with 2 tablespoons of kefir, a teaspoon of honey. Make compresses in the same way.

Daily regime

The therapy process is usually long, so it is better for the patient to adapt to new living conditions and follow a number of tips:

1. Stop smoking so as not to provoke vascular spasms.
2. Avoid caffeine.
3. Be careful when using the keyboard - this may cause an exacerbation of Raynaud's disease.
4. Strictly avoid hypothermia - always wear warm shoes, socks, and gloves.
5. Avoid exposure to stress.

If Raynaud's syndrome develops as a result of occupational hazards, you will have to change jobs. In severe cases, a person is given a disability of 2–3 groups, which is determined by the commission. Moving to a warmer climate and stopping the hobby of ice fishing often helps.

Diet food

Nutrition plays an important role. If the menu is complete, the blood supply to the extremities will improve. Food should contain more vitamins and minerals, so you need to eat more fruits, vegetables, cereals, and dairy foods.

• exclude harmful semi-finished products, fried foods, marinades, fatty foods;
• do not eat food with preservatives, dyes, flavors;
• do not forget about natural vegetable oils - season salads and other dishes with them;
• consume more foods with magnesium (cereals, greens), add it in the form of medications (Magnerot, Magne B6).

You need to drink more water - up to 2 liters per day, if there are no contraindications.

Raynaud's disease and the army

Each conscript undergoes an examination before joining the army, where the question of suitability for service is decided on an individual basis. A general examination in the early stages usually does not reveal any abnormalities, because without the action of provoking factors there are no complaints. The conscript will be assigned laboratory tests that will help identify a number of health abnormalities.

If a person develops characteristic signs, but the guy is unaware of his diagnosis, doctors should be notified of the symptoms in advance. The examination will help make a diagnosis.

Since in the army it is not possible to eliminate all provoking factors, the disease may begin to progress. They definitely do not accept into the army men with stage 2 - 3 pathology, with frequent attacks, or in need of constant drug treatment. At the first stage of the pathology, a man can join the army, but if his health condition worsens, he is expelled early.

Prognosis and prevention

If the causes of the disease are eliminated or controlled, the prognosis will be favorable. With primary Raynaud's disease, the prognosis depends on the rate of progression of the pathology and is often unfavorable - a person may lose a limb.

For prevention, it is important not to smoke, eat well, and avoid coffee and energy drinks. It is advisable not to work where the body is exposed to constant stress and occupational hazards. Any hypothermia should be avoided - in this case, the risk of exacerbation of the disease will be minimized.

Raynaud's disease is a paroxysmal pathological condition of small blood vessels, which is manifested by vasospasm and disruption of the arterial blood supply to the extremities ( feet and/or hands), nose, chin, ears. Occurs against a background of prolonged stress, under the influence of low temperatures and other factors. This vascular disease predominantly affects the fingers ( more often 2nd – 4th fingers, much less often the thumb) and stop. Much less common is the nose, chin or ears. When exposed to one of the factors, a spasm occurs ( narrowing) small vessels, which can cause pain, numbness, a feeling of pulsation and tingling, and changes in skin color.

This pathology was first described by the French therapist Maurice Raynaud and was named after him. In 1862, he published a report about a young woman whose fingers changed color when exposed to cold or stress.

Worldwide, Raynaud's disease affects between 5% and 10%, which is between 15 and 30 million people. In different countries, the prevalence of the disease ranges from 2% to 16% of the population. The disease is most common in France and Great Britain, less often in Italy and Spain. This suggests that this disease is rare in countries with warm climates. Among patients suffering from Raynaud's disease, women predominate, often of childbearing age. According to some reports, the ratio of women to men with Raynaud's disease ranges from 2:1 to 8:1. In women, the disease manifests itself at an earlier age than in men. So, up to 50 years of age, the male/female ratio is 1:5.2. With increasing age of patients, this ratio levels out and is 1:1.1 ( men/women).

Skin anatomy and regulation of small vessel tone

There are numerous grooves on the surface of the skin ( more and less pronounced), folds, indentations. To expressed ( rude) grooves include folds on the palms, facial wrinkles and others.

The main functions of the skin are:

• protective function – protection from mechanical, chemical and biological influences ( microorganisms) factors;
• perception of environmental stimuli- pressure, heat, temperature and other stimuli are perceived through various receptors ( sensory nerve endings or specialized cells that convert perceived stimulation into a nerve impulse);
• thermoregulation – controlled by blood vessels and sweat glands by constricting blood vessels at low temperatures to conserve heat, dilating blood vessels at high temperatures to increase heat transfer, sweating, which ensures cooling of the body by evaporating moisture from the surface of the skin;
• breathing ( gas exchange) – oxygen enters the body through the skin and carbon dioxide is released;
• depositing function ( cumulative) – under certain conditions, dilated skin vessels can hold up to 1 liter of blood;
• excretory ( excretory) function – through the sweat and sebaceous glands, toxins and an excess of various substances are released ( salt, water).

The main layers of the skin are:

• epidermis;
• dermis;
• hypodermis ( subcutaneous fat tissue).

Epidermis

The epidermis consists of:

• Basal layer ( internal). The basal layer is the deepest. Regeneration occurs in this layer ( recovery) epidermis. The inner layer contains cells containing melanin, the chemical that gives color to skin and hair.
• Layer spinosum. The spinous layer is the thickest. Located above the basal layer. The basal and spinous layers are called germinal layers, since cell division occurs in them and physiological and regenerative processes occur ( if the integrity of the skin is damaged) skin regeneration.
• Granular layer. The granular layer consists of 1 – 2 rows of spindle-shaped cells.
• Shiny layer. The stratum lucidum is located above the granular layer and consists of 1–2 rows of flat, anucleate cells.
• Stratum corneum ( outdoor). The stratum corneum is the surface layer of the epidermis in contact with the external environment. Its main function is barrier and protective against environmental factors. This layer contains only horny scales. Its thickness can vary depending on the impact of mechanical stress - so in the area of ​​​​the feet and palms the skin is rougher than in other parts of the body. Physiological peeling occurs in this layer - the falling off of dead cells.

Dermis

The main functions of the dermis are:

• thermoregulation – occurs due to an increase or decrease in blood flow in the vessels, sweating by the sweat glands ( Sweating causes moisture to evaporate from the surface of the skin, causing it to cool.);
• ensuring skin sensitivity – basically all nerve fibers and skin receptors are located in the dermis;
• ensuring skin firmness and elasticity - The dermis contains collagen ( 70 – 80% ) and elastin fibers ( 1 – 3% ), which give the skin firmness, strength and elasticity.

• papillary layer ( located directly below the epidermis) – formed by loose fibrous connective tissue;
• mesh layer ( deeper) – formed by dense fibrous connective tissue.

Hypodermis ( subcutaneous fat)

Innervation of the skin

The nervous system is divided into:

• Central nervous system. The central nervous system includes the brain and spinal cord. The main function of the central nervous system is to receive information from afferent ( centripetal) nerve fibers from the periphery, analysis of the information received, as well as generating a response and transmitting it back to the organs and systems via efferent ( centrifugal propulsion) nerve fibers to organs and systems.
• Peripheral nervous system. The peripheral nervous system includes all nerves, ganglia and plexuses outside the central nervous system. The main function is to receive information from the external environment, internal organs and systems and transmit it to the central nervous system and back to the organs.

• Somatic nervous system. The somatic nervous system innervates muscles, joints and skin. It regulates all conscious muscle movements and the transmission of information coming from the external environment ( received by the senses through special receptors) along afferent fibers to the central nervous system and back to the muscles along efferent nerve fibers.
• Autonomic nervous system. The autonomic nervous system is a section of the nervous system that regulates the activity of internal organs, glands, lymphatic and blood vessels. If the activity of the somatic nervous system can be controlled by a person ( conscious muscle movements), then the activity of the autonomic nervous system is not subject to the will of a person - it is autonomous ( independent). That is, a person cannot control his heartbeat, the diameter of his pupils, the functioning of internal organs and many other functions of the body.

• Sympathetic nervous system. Responsible for mobilizing the body's forces, increases tissue excitability, and improves metabolism. Sympathetic centers ( nerve plexuses) are located in the thoracic and lumbar regions of the spinal cord. Nerve fibers from these centers are directed to the nodes ( thickenings) nerve trunk. The nerve trunk is a chain of nodes on the right and left along the spinal column. Nerve fibers from the nodes are sent directly to the organs and vessels. In the sympathetic nervous system, the transmission of nerve impulses is carried out thanks to a special chemical - norepinephrine. Impulse transmission pathways and receptors ( nerve endings that convert external stimuli into nerve impulses), with which norepinephrine interacts, are called adrenergic. In the wall of arterioles ( small blood vessels) there are α 1 - adrenergic receptors. Their stimulation leads to a narrowing of the lumen of blood vessels.
• Parasympathetic nervous system. Responsible for restoring the body’s energy, regulates many processes during sleep. The parasympathetic center is located in the brain stem and sacral spinal cord. Nerve processes go from the centers directly to the organs. The parasympathetic nervous system does not innervate the vessels of the extremities.

Depending on the function performed, there are:

• sensory nerve fibers ( cold is perceived by special receptors - Krause flasks);
• secretory nerve fibers;
• vasomotor nerve fibers;
• motor nerve fibers.

Blood supply to the skin and regulation of blood supply

A feature of skin vessels is a large number of arteriovenous anastomoses ( messages). The largest number of such anastomoses are located in the skin of the fingers, the tip of the nose, and the ears, where more intense blood flow is observed.

Nervous regulation of blood supply to the skin is provided by sympathetic adrenergic nerve fibers. This especially applies to anastomoses of veins and arteries. An increase in the tone of adrenergic sympathetic fibers leads to a narrowing of the lumen of blood vessels, and inhibition of the activity of these fibers leads to an increase in the lumen of blood vessels.

The main factor in regulating blood flow to the skin is body temperature. When the temperature drops, the lumen of the skin vessels decreases and blood flow decreases, which allows you to retain heat. As the temperature rises, the lumen of the blood vessels increases and blood flow improves. In this case, heat transfer and cooling of the body occurs.

The mechanism of development of Raynaud's disease

The course of Raynaud's disease is favorable. Extremely rarely, this disease leads to superficial ulcerations on the fingers and toes, but is never complicated by gangrene - tissue death due to impaired blood flow. Raynaud's disease is not associated with other concomitant diseases, but can sometimes be accompanied by headaches due to spasm ( narrowing) vessels. Microscopic examination does not reveal changes in the structure of the blood vessels, but sometimes minor changes may occur.

The main mechanisms of development of Raynaud's disease are:

• Increased activation of sympathetic nerves in response to cold or stress. The skin is innervated by sympathetic adrenergic nerve fibers that cause spasm ( reduction) blood vessels. Therefore, one of the hypotheses for the development of Raynaud's disease is the hypersensitivity of the sympathetic nervous system.
• Impaired adaptation of the cardiovascular system to stress. When stressed, the sympatho-adrenal system is activated. Activation of this system leads to vasospasm, increased heart rate, increased blood pressure and other changes. Thanks to these changes, the body adapts to stress. But with prolonged exposure to stress factors, adaptation ( device) becomes damaging.
• Local violation. Local disturbance is manifested by functional damage to blood vessels. In this case, the structure of the blood vessels is not affected. Local impairment may be caused by hypersensitivity to cold in the adrenergic receptors of the smooth muscle arteries supplying the fingers. Hypersensitivity of the autonomic adrenergic system leads to vasospasm and impaired blood flow in the extremities.
• The influence of chemically active vasoconstrictors. The cause of vascular spasm and impaired blood flow in the extremities can be chemically active vasoconstrictor substances circulating in the blood - endothelin, thromboxane, 5-hydroxytryptamine. Also, a deficiency of nitric oxide or its increased degradation can cause vasospasm. Normally, nitric oxide leads to relaxation of vascular smooth muscles, increasing their lumen and improving blood flow.

Risk factors for Raynaud's disease are:

• floor - Raynaud's disease is more common in females;
• age - the disease can manifest at any age, but is more common between 15 and 30 years;
• climate – pathology is much more common in people living in cold climates;
• heredity – the presence of pathology in family members increases the risk of Raynaud's disease ( 1/3 of patients had close relatives who also suffered from Raynaud's disease).

Secondary prevention of Raynaud's disease includes:

• avoiding hypothermia and exposure to low temperatures – You should not hold cold objects in your hands ( cold drinks, ice cream), swim in cool water;
• exclusion of strong tea and coffee from the diet - caffeine causes vasospasm and worsens the course of the disease;
• avoiding taking vasoconstrictor medications – oral contraceptives, beta-blockers;
• avoiding exposure to vibration – prolonged exposure to vibration ( working with an electric drill, electric saw) disrupts normal blood circulation in the capillaries;
• to give up smoking - nicotine promotes vasospasm, contributing to the progression of the disease ( Smoking one cigarette can reduce the temperature of your fingertips by 2 - 3°C);
• warming the extremities - in cold weather, you should wear warm gloves and socks, high-soled shoes, and you can use heating pads and heaters at home;
• regular exercise – physical activity helps improve blood circulation in the extremities;
• avoiding stress and emotional overstrain – Various relaxation techniques will have a beneficial effect;
• elimination of factors that impair blood circulation in the fingers - wearing small rings, bags in hands.

Classification of Raynaud's disease

Depending on the cause of the development of Raynaud's phenomenon, there are:

• primary Raynaud's phenomenon ( Raynaud's disease) – primary Raynaud phenomenon ( or Raynaud's disease) is an independent pathology not caused by other diseases ( accounts for 90% of all cases);
• secondary Raynaud phenomenon ( Raynaud's syndrome) – is a consequence of concomitant diseases, in which blood flow in the extremities is also disrupted and symptoms characteristic of Raynaud’s disease appear.

The development of Raynaud's disease is based on changes in the vascular wall, leading to persistent vasospasm and poor circulation. To correct disorders, a new group of medicinal substances has been created - cytamins. Cytamines are special proteins (peptides) that regulate intracellular processes and ensure the normal functioning of organs and tissues. A specific set of peptides is suitable for each organ. Prevention and treatment of vascular pathologies, in particular Raynaud's disease and syndrome, is the area of ​​responsibility of the vascular bioregulator – Vasalamine.

1. It has a selective effect on vascular tissue, normalizes blood microcirculation in organs and tissues in various diseases and exposure to extreme factors on the body.
2. Improves the condition of the vascular wall during endothelial dysfunction, improves vascular permeability, and increases the strength of capillary walls.
3. Indicated for the initial stages of Raynaud's disease, arterial hypertension, as well as for elderly people to maintain the functions of the vascular system.

How is Raynaud's disease different from Raynaud's syndrome?

If the disease develops for an unknown reason and is not a consequence of other concomitant diseases, then this pathology is Raynaud's disease. Raynaud's disease ( or Raynaud's phenomenon) is a primary disease manifested by vasospasm under the influence of stress or cold and a decrease in blood flow to the extremities.

Currently, doctors cannot explain the reasons for the development of Raynaud's disease.
The most obvious causes are increased sensitivity to cold and a severe reaction to stress. In some cases, the influence of one factor on the development of Raynaud's disease predominates over the other.

Raynaud's syndrome is a secondary pathology resulting from concomitant diseases ( diseases of the blood, blood vessels, connective tissue and others). Many diseases affect blood vessels and nerves, which can impair blood flow in the extremities. This results in numbness, skin discoloration, tingling, burning, and other symptoms similar to those of Raynaud's disease. These manifestations were called Raynaud's syndrome ( syndrome - a set of symptoms). The causes and mechanism of development of Raynaud's syndrome differ from those of Raynaud's disease. Since Raynaud's syndrome is often caused by serious illnesses, it can lead to serious complications. With the syndrome, blood flow is disrupted, as a result of which tissues suffer from a lack of oxygen and nutrients, which leads to their death ( necrosis). The treatment in this case is amputation ( surgical removal) affected limb.

The main causes of Raynaud's syndrome are:

• Autoimmune diseases. In autoimmune diseases, the body's own cells are recognized as foreign and are attacked by the immune system. One example of such diseases is rheumatoid arthritis.
• Collagenoses ( systemic diseases of connective tissue and blood vessels). Collagen diseases include systemic scleroderma ( an autoimmune connective tissue disease in which there is thickening of the connective tissue with damage to blood vessels and internal organs), Sjögren's syndrome ( autoimmune connective tissue disease), systemic vasculitis ( a disease characterized by inflammation and destruction of the walls of blood vessels) and others. These diseases affect blood vessels and connective tissue. This leads to vasoconstriction, poor circulation ( in particular in the limbs with Raynaud's syndrome), ischemic damage to the skin ( damage caused by lack of oxygen and nutrients due to poor circulation).
• Arterial diseases. Various arterial diseases lead to disruption of the structure and function of blood vessels. Inflammatory processes ( Buerger's disease), obstruction of the lumen of blood vessels ( atherosclerosis) and other pathologies lead to circulatory disorders and the appearance of Raynaud's syndrome.
• Hormonal disorders and diseases of the endocrine glands. Menopause ( cessation of menstruation), diseases of the thyroid gland, ovaries, and diabetes can lead to disruption of the integrity and function of blood vessels and nerve fibers. As a result, blood circulation in the extremities is impaired, which will be manifested by changes in skin color, tingling, numbness and other symptoms characteristic of Raynaud's disease.
• Repetitive movements or vibration. Prolonged exposure to vibration ( work in production) or systematic repetitive rapid movements of the fingers ( ) can lead to circulatory problems in the extremities. This increases the risk of Raynaud's syndrome.
• Bad habits. Smoking is a provoking factor for Raynaud's syndrome, as it causes vasoconstriction of the limbs and face.
• Neurological disorders. With neurological lesions, the normal function of nerve fibers is disrupted. One example is carpal tunnel syndrome. Carpal tunnel syndrome is a pathology that occurs when the median nerve of the hand is compressed for a long time. This happens when typing on the keyboard. The syndrome manifests itself as a feeling of pain and numbness. Hands become more susceptible to cold.
• Taking certain medications. The appearance of Raynaud's syndrome can be triggered by taking certain medications. These medications include vasoconstrictors to treat high blood pressure ( beta blockers), drugs for the treatment of migraine ( neurological disease manifested by attacks of headaches), chemotherapy drugs ( used for oncological diseases) and others. To prevent the occurrence of Raynaud's syndrome, medications should only be taken under the supervision of a doctor.
• Bruises, previous surgeries. Injuries to the arms or legs, as well as surgical interventions, and hypothermia can lead to the appearance of Raynaud's syndrome.

Diagnostic criteria for primary and secondary Raynaud's phenomenon

Symptoms of Raynaud's disease

Raynaud's disease is characterized by:

• paroxysmal circulatory disorders in the extremities when exposed to cold or stress;
• strictly symmetrical damage to the limbs;
• the duration of the disease is at least two years.

Symptoms of Raynaud's disease are divided into local and general. Common symptoms of Raynaud's disease are irritability, lethargy, increased fatigue, trembling of the hands and eyelids, a tendency to rapid heartbeat, and others. Raynaud's disease is often combined with diseases of the gastrointestinal tract ( stomach ulcer), kidney ( nephrosclerosis – replacement of healthy kidney tissue with scar tissue), migraine ( attacks of severe headache). These symptoms appear due to the involvement of the autonomic nervous system in the pathological process.

Local symptoms of Raynaud's disease are manifested by a three-phase change in the color of the skin of the extremities. The stage of ischemia is distinguished ( white skin color), stage of cyanosis ( bluish color), stage of hyperemia ( Red color). Not always and not all patients may experience a three-phase change in skin color.

Local symptoms of Raynaud's disease

Symptoms	Development mechanism	How does it manifest?
Ischemia stage	When exposed to cold or stress, vasospasm occurs in the extremities. This leads to cessation of blood circulation in the microcirculatory system.	Ischemia stage ( ischemia – cessation of blood supply) is manifested by pronounced pallor of the fingers of the extremities ( dead finger symptom), the tip of the nose or chin due to the lack of blood flow in them. There is numbness, burning, and chilliness in these areas.
Stage of cyanosis	Cyanosis is a bluish coloration of the skin due to the high content of reduced hemoglobin ( gave oxygen to tissues) in blood. After blood circulation is restored, the fingers receive blood rich in carbon dioxide and poor in oxygen due to previous blockage.	The influx of blood saturated with carbon dioxide and poor in oxygen leads to a bluish color of the skin - cyanosis. The pain subsides and a tingling sensation may be felt.
Hyperemia stage	At the stage of hyperemia ( hyperemia - excessive overflow of blood vessels in any area of ​​the body) normal blood circulation is restored with an abundant flow of oxygen-rich blood.	When blood circulation is restored, the skin turns dark red. Pain, numbness and tingling go away. Feels warm.

• Stage I – angiospastic. The first stage is characterized by short-term attacks of vascular spasm under the influence of cold or stress. Manifested by pallor of the extremities, loss of sensation in the fingers ( dead finger symptom), the appearance of pain or a burning sensation. After warming up, the symptoms go away.
• Stage II – angioparalytic. The disease enters the second stage after six months. Characterized by an increase in the duration of attacks ( up to several hours), increased sensitivity to cold. During an attack, the pallor of the fingers is replaced by pronounced cyanosis. There may be some swelling. The attack is accompanied by intense, burning pain.
• Stage III – trophoparalytic. The trophoparalytic stage develops 1–3 years after the onset of the disease in a small percentage of patients. The third stage is characterized by more severe symptoms and ischemic tissue disorders caused by impaired blood circulation. This is expressed by the appearance of painful ulcers on the fingertips and absolute intolerance to low temperatures. The performance of patients is reduced.

• eliminate the effect of the provoking factor - go into a warm room; if you are stressed, you need to retire and relax;
• lightly rub the fingers of the limbs, put them in warm ( not hot!) water;
• wear warm socks and gloves;
• drink warm tea.

Diagnosis of Raynaud's disease

Diagnostics is extremely important for determining treatment tactics and an individual approach to the patient, which will affect the future prognosis and quality of life. The doctor is faced with the task of correctly making a diagnosis and making a differential diagnosis ( exclusion or confirmation of a disease with similar symptoms).

The main goals of diagnosis are:

• confirmation of the diagnosis of Raynaud's disease;
• determining the degree of clinical course of the disease;
• carrying out a differential diagnosis ( differences between two diseases with similar symptoms) Raynaud's disease and syndrome.

Anamnesis collection ( life history and present illness)

At the appointment, the doctor will ask in detail about the patient’s complaints, the time of onset of symptoms, their duration, nature, and the connection between symptoms and the influence of external factors ( cold, stress). Of no small importance are past and concomitant diseases, injuries, operations, which can also provoke Raynaud's disease. Particular attention is paid to the presence of diseases that can cause symptoms characteristic of Raynaud's disease. In this case, it is necessary to exclude the presence of Raynaud's syndrome. The doctor will also be interested in the nature of professional activity, working and living conditions, hobbies, lifestyle, and the presence of bad habits. Raynaud's disease can be inherited, so the presence of this pathology in close relatives increases the patient's risk of developing the disease. If one of your relatives has similar symptoms, then you need to tell your doctor about it.

At the appointment, the doctor may ask:

• What are the symptoms of the disease? change in color of fingers and/or toes, feeling of numbness in fingers)?
• When did symptoms first appear?
• Have these symptoms changed over time?
• Do you experience discoloration of your fingers, numbness, or pain during an attack of Raynaud's disease?
• Is cold or stress a trigger for the attack?
• Can other factors cause similar symptoms?
• Were the patient diagnosed with other comorbidities?
• What medications is the patient currently taking?
• Has anyone in your family been diagnosed with Raynaud's disease?
• Does the patient exercise, smoke, drink coffee or other caffeinated drinks?
• What is the patient’s profession and working conditions?
• How does the patient cope with stress?

Patient examination

During a general examination, the doctor pays attention to the symptoms that appear during attacks of Raynaud's disease. To examine the manifestation of symptoms, it is necessary to provoke an attack of the disease by exposure to cold. For this, a cold test is used. The cold test method involves immersing your hands in water at a temperature of 10°C for some time. There is a change in the color of the skin and its localization - with Raynaud's disease, the ears, tip of the nose, toes, and fingers are affected ( more often 2nd – 4th fingers). The disease is characterized by clearly demarcated areas of sequential three-phase changes in the color of the skin of the fingers - pale - blue - red. During the attack, the patient notes numbness and tingling in the area of ​​vascular spasm. In extremely rare cases, damage to the tongue is observed, which is manifested by numbness and slurred speech. Sometimes during an attack, livedo reticularis may occur, which disappears after the completion of vasospasm. Livedo reticularis is a motor disorder motor activity) vessels in the skin of the extremities, in which arterioles ( small vessels that carry oxygenated blood to cells) are spasmed, and venules ( small vessels carrying carbon dioxide-rich blood from cells) are expanding. Livedo is characterized by the appearance of a blue or blue-pink mosaic on the skin and is more a cosmetic defect than a pathology.

In 1932, doctors Alain and Brown developed diagnostic criteria for Raynaud's disease.

The Allen and Brown criteria include:

• change in skin color during an attack ( at least 2 or 3 colors), provoked by exposure to cold or stress ( connection with external stimulus);
• periodic episodes of Raynaud's disease for at least 2 years;
• strict symmetry of damage to the limbs during an attack with a clearly demarcated affected area;
• absence of necrosis, gangrene;
• absence of diseases that provoke similar symptoms;
• negative antinuclear antibody test ( A.N.A.);
• no signs of capillary damage during capillaroscopy of the nail bed.

Laboratory research

Laboratory tests include:

• General blood analysis. A general blood test will reveal the presence of inflammatory processes in the body. This will be manifested by an increase in the number of leukocytes ( white blood cells) – more than 9.0 x 10 9 /l and an increase in erythrocyte sedimentation rate ( ESR) – more than 10 mm/hour in men and more than 15 mm/hour in women. These changes are characteristic of systemic and rheumatological diseases.
• Blood chemistry. A biochemical blood test examines the glucose level ( Sahara) in the blood, the amount of total protein, cholesterol, urea and others. This will allow us to diagnose concomitant diseases that can cause the development of Raynaud's syndrome - diabetes mellitus, atherosclerosis, systemic diseases and others.
• C-reactive protein ( according to indications). C - reactive protein - a blood plasma protein, which belongs to the group of acute phase proteins and indicates an acute inflammatory process, the presence of diseases of bones and joints.
• Rheumatoid factor ( according to indications). Rheumatoid factor is an antibody ( protein compounds of blood plasma that are produced by the immune system when bacteria, viruses, and foreign particles enter the body), produced by the immune system against the body's own cells, which are mistakenly perceived as foreign. This test is prescribed for symptoms of rheumatoid arthritis ( pain, swelling of joints, limitation of their mobility), diagnosis of autoimmune diseases. Normally, the rheumatoid factor level should not exceed 14 IU/ml.
• Antinuclear antibodies ( A.N.A.). Antinuclear antibodies are proteins produced by the immune system against components of the cell nucleus. It is carried out to diagnose systemic connective tissue diseases. For Raynaud's disease, this test will be negative, and for Raynaud's syndrome, it will be positive. Some patients may have a positive ANA test for several years without developing connective tissue disease.

Instrumental studies

Instrumental examination methods

Drug treatment for Raynaud's disease

Treatment of Raynaud's disease begins with a combination of medications and physical therapy procedures. Drug treatment is carried out in courses - 1 - 2 times a year for several years. Basically, for primary Raynaud's phenomenon, treatment is carried out in the winter season.

The main principles of conservative treatment are:

• eliminating risk factors that provoke attacks of Raynaud's disease;
• cupping ( elimination) vascular spasm during an attack;
• sedative therapy ( taking sedative medications for increased anxiety);
• correction of immunity;
• improvement of microcirculation and blood circulation in tissues;
• strengthening the walls of blood vessels;
• elimination of pain;
• correction of rheological properties of blood ( properties that determine blood fluidity).

Medicines used to treat Raynaud's disease

Additional treatments for Raynaud's disease include:

• Hyperbaric oxygenation. Hyperbaric oxygen therapy ( from lat. oxygenum - oxygen) is a procedure for saturating the body with oxygen under pressure. For this, the patient is placed in a special apparatus - a pressure chamber. It looks like a sealed capsule. The pressure chamber supplies oxygen under high pressure conditions. In this case, active saturation of the blood with oxygen occurs. With the blood flow, oxygen enters all organs and tissues, all cells of the body are saturated with oxygen. Hyperbaric oxygenation helps improve blood circulation, nourish tissue, heal skin damage, and eliminate the effects of oxygen starvation. The duration of the procedures is 10 – 20 sessions of 20 – 60 minutes.
• Reflexology. Reflexology is a treatment method based on irritation of nerve endings through acupuncture. The needles should be located at biologically active points. The general effects of acupuncture are increased immunity, improved blood flow in capillaries, and a calming effect.
• Psychotherapy. If there is increased anxiety or irritability, the patient will benefit from working with a psychotherapist. The specialist will teach self-control and relaxation techniques. Psychotherapy will help the patient react more calmly to stressful situations, as well as get rid of fears, uncertainty, and irritability. Biofeedback ( body feedback) is a special technique for controlling your body that will help reduce the frequency of Raynaud's disease attacks. The basics of this technique can be found in the medical literature or seek the help of a specialist.
• Physiotherapy. Physiotherapy is a set of treatment methods using various physical factors ( heat, electric current, light and others). To treat Raynaud's disease, local or segmental ( cervical, lumbar) diathermy - deep heating of tissues with high-frequency currents. Warm paraffin baths ( 50°С), ozokerite ( 48°C) and mud applications ( 38°C) in the form of “stockings”, “gloves” and “collar”. Such applications promote deep warming of the extremities, improving blood flow and metabolic processes.
• Massage. Massage is a mechanical or reflex effect on human tissue by rubbing, pressure or vibration. The massage is performed with hands or special devices. To improve the result, use aromatic oils, medicinal ointments and gels. This helps improve blood supply to tissues.

Surgical treatment of Raynaud's disease

Indications for surgery are:

• ineffectiveness of conservative treatment;
• frequent attacks of Raynaud's disease;
• severity and duration of symptoms;
• significant deterioration in the patient’s quality of life;
• trophic changes ( skin damage due to lack of oxygen and nutrients, often manifests itself in the form of trophic ulcers).

• patient refusal to undergo surgery;
• acute infectious diseases;
• chronic diseases in the acute stage;
• purulent rashes on the skin;
• acute myocardial infarction and a previous heart attack less than 6 months ago.

The anesthesiologist will tell you about the types of anesthesia, contraindications, complications and offer the patient the optimal method. The patient has the right to choose the method of anesthesia himself. Surgical interventions for Raynaud's disease are performed under general anesthesia, during which the central nervous system is depressed, which is manifested by loss of consciousness, memory loss during anesthesia, and suppression of pain sensitivity.

Methods of general anesthesia are:

• intravenous anesthesia – General anesthesia is achieved by administering anesthetics ( medicines) intravenously ( thiopental, ketamine, etomidate, propofol);
• inhalation anesthesia – providing general anesthesia by inhaling vapors of anesthetic gases ( sevoflurane, isoflurane) through a mask.

Surgical treatment must begin with blockade of the sympathetic nodes. To do this, local anesthetics - novocaine, lidocaine - are injected into the tissue surrounding the node, which block the transmission of nerve impulses along sympathetic nerve fibers. A short-term “switching off” of sympathetic innervation allows one to evaluate the therapeutic effect and the need for surgery. If vascular spasm goes away, the symptoms of the disease disappear and blood circulation in the extremities improves, then surgical treatment will have a good and long-lasting effect.

Sympathectomy is the surgical removal of a portion of the sympathetic division of the autonomic nervous system. For Raynaud's disease, endoscopic ganglionectomy is often performed ( removal of the sympathetic ganglion) second or third thoracic sympathetic node. With the endoscopic method of surgery, the operation is performed through small incisions using a camera and special instruments with a diameter of 3–5 millimeters. The advantage of this method is the low degree of trauma and rapid postoperative recovery. In most cases there is a relapse ( reappearance) symptoms after surgery.

Which doctor should I see if I have Raynaud's disease?

If you experience a feeling of numbness, tingling, or discoloration of the skin of the extremities in response to low temperatures or stress, you should contact your local doctor ( family doctor). The local doctor will collect a history of the present disease and conduct an external examination. If the disease is mild and there is complete confidence in the diagnosis, the doctor can prescribe the necessary treatment to the patient and explain the need for lifestyle changes for this disease. In case of frequent attacks of Raynaud's disease, stage II or III of the disease, ischemic damage ( damage to soft tissues due to lack of oxygen and nutrients due to impaired blood circulation) an additional consultation with specialized specialists - phlebologist, rheumatologist, angiosurgeon - will be scheduled. Subspecialists will conduct the necessary additional examinations and prescribe appropriate medical or surgical treatment.

It is very important to make a differential diagnosis ( diagnostics to exclude or confirm a particular disease) Raynaud's syndrome and Raynaud's disease. To distinguish between these two pathologies, doctors use diagnostic criteria that include the patient’s age and gender, the presence of certain concomitant diseases ( diabetes mellitus, Sjögren's syndrome, systemic vasculitis, atherosclerosis), the nature of the attacks ( symmetry, pain, numbness), ischemic damage to the skin ( necrosis, ulcers). Raynaud's disease does not lead to dangerous complications, unlike Raynaud's syndrome. Therefore, a correct diagnosis and appropriate treatment will help to avoid serious complications with Raynaud's syndrome and possible amputation of a limb in the future.

If the patient has an increased reaction to emotional stress, accompanied by attacks of Raynaud's disease, consultations with a psychologist may be prescribed. The psychologist will help the patient correctly assess the situation, reduce anxiety and fear, and teach him to calmly react to stressful situations.

Why is Raynaud's disease dangerous? What are its consequences?

In the initial stages of the disease, it will be enough to change your lifestyle, eat right, exercise, and give up smoking and coffee. It is also necessary to monitor the quality of clothing, dress warmly, and not be in the cold for a long time. It is imperative to undergo periodic medical checks. If attacks of Raynaud's disease become more frequent, last longer, cause great discomfort and negatively affect the patient's quality of life, then drug or surgical treatment is prescribed.

Raynaud's disease does not lead to serious complications, unlike Raynaud's syndrome. In extremely rare cases, small ulcers may appear on the fingers due to impaired circulation and ischemic tissue damage. Raynaud's disease is never complicated by gangrene - death ( necrosis) tissues of the extremities due to impaired blood circulation ( ischemia).

What is the prognosis for Raynaud's disease?

The causes of the disease are still unknown. Symptoms of the disease ( change in skin color, numbness, tingling) appear when exposed to cold or stress and are caused by vasospasm. When these factors are excluded, the symptoms disappear. Therefore, to prevent possible complications and progression of the disease, it is enough to lead a certain lifestyle.

At the first appearance of symptoms, you should consult a doctor. This will help make the correct diagnosis in time and determine treatment tactics. In the first stages of the disease, it is enough to avoid hypothermia, emotional stress, constant exposure to vibration, quit smoking and exercise. In some cases, Raynaud's disease goes away on its own without treatment after a few episodes.

As the disease progresses, drug therapy may be prescribed, and in advanced cases, surgical treatment. In severe cases of the disease, the patient may become unable to work if the profession is associated with factors that provoke the disease. Living in cold climates and constant exposure to negative factors ( stress) will also worsen the course of the disease. This will be manifested by frequent attacks of Raynaud's disease and an increase in their duration and severity.

In severe cases, the patient will need to change his place of residence to a place with a warm climate, change his professional activity, and give up many activities that provoke attacks of Raynaud's disease. This can disrupt the usual way of life and negatively affect the patient’s psychological state.

The prognosis for life with Raynaud's disease depends on the stage of the disease, on timely diagnosis and treatment, and on the patient's strict adherence to the doctor's instructions. The sooner this pathology is diagnosed and treatment is started, the more favorable the prognosis for the patient.

How to treat Raynaud's disease with folk remedies?

The main goal and effect of folk remedies is aimed at dilating blood vessels and improving blood circulation.

To treat Raynaud's disease, use:

• Fir oil. For Raynaud's disease, fir baths are taken. To prepare such a bath, you need to add 5 – 6 drops of fir oil to the water. The water temperature should not exceed 37°C. The duration of the bath is 15 minutes.
• Onion juice and honey. Mix fresh onion juice with honey in equal proportions. Take 1 tablespoon before meals 2 times a day. The course of treatment is 21 days.
• Honey and garlic. Mix chopped garlic with honey in a 1:1 ratio. Leave the resulting mixture for a week, stirring occasionally. Take 1 tablespoon half an hour before meals, 2 times a day for 2 months.
• Chinese lemongrass. The fruits of this plant are very effective in treating Raynaud's disease. It is necessary to take 1 fruit three times a day for two weeks.
• Beaver stream ( castoreum). Beaver stream is an aromatic substance of animal origin. It is a jelly-like substance with a characteristic odor, which is secreted by the endocrine glands of the beaver. You can buy it at the pharmacy. Take 1 teaspoon or 1 tablespoon of alcohol tincture up to 3 times a day during or after meals, with plenty of liquid. The beaver stream has a general strengthening effect, increases immunity, strengthens the walls of blood vessels, improves microcirculation, and has a beneficial effect on the nervous system, protecting against the negative effects of stress.

• Rose hips, onion peels, crushed pine needles, honey. Mix 3 tablespoons of rose hips, 3 tablespoons of onion peels, 2 tablespoons of chopped pine needles ( needles of any coniferous tree are suitable), 5 tablespoons of honey. Pour the resulting mixture with a liter of water and boil for 10 minutes. Leave for 12 hours and strain. Take half a glass 3-4 times a day after meals. It is not recommended to take if you have stomach diseases.
• Rue, creeping thyme and lemon balm. Mix the crushed leaves of rue, creeping thyme and lemon balm in a ratio of 1:1:1.5. Pour one tablespoon of the resulting mixture into a glass of boiling water ( 200 milliliters) and leave for several hours. Take no more than 50 milliliters daily after meals.
• Chestnut flowers, red clover flowers, oregano grass, dandelion ( herbs with roots), rosehip ( fruits and roots), burdock roots. Grind this medicinal mixture. To prepare the tincture, you need to pour 1 tablespoon of the mixture into 900 ml of boiling water. Leave in a thermos for 12 hours. Take 100 - 150 milliliters 3 times a day after meals. The course of treatment is 8 weeks.

Does Raynaud's disease cause disability?

Raynaud's disease can lead to changes in your usual lifestyle. Living in cold climates, washing hands with cold water, swimming in cool waters, ice fishing and many other factors can lead to frequent attacks of Raynaud's disease and its progression. The patient should constantly avoid hypothermia and emotional stress. Many activities familiar to the patient may be contraindicated. This can also be considered a disability to some extent.

If you strictly follow the doctor's instructions ( changing work activities, avoiding hypothermia, quitting smoking) and lifestyle changes, the patient can minimize the manifestations of Raynaud's disease and significantly improve the quality of life.

Can Raynaud's disease be cured?

In some cases, Raynaud's disease can occur extremely rarely ( for example, with frostbite or severe emotional shock) without treatment or a specific regimen.
Also, by strictly following the doctor’s recommendations, the manifestation of the disease can be minimized and the patient can lead a full life. Moving to places with a warm climate has a beneficial effect. There are cases where pregnancy helped cure Raynaud's disease.

Although there is no complete cure for Raynaud's disease, there are many ways to control the disease. The patient will need to learn to live with this pathology.

The problem with treatment is that doctors still don't know the exact cause of Raynaud's disease. Some mechanisms of the manifestation of pathology have been studied, which doctors can influence with the help of drugs or surgery. That is, it is a symptomatic treatment aimed at reducing the severity of symptoms. But this only gives a temporary effect. Without eliminating the cause that caused the disease, it is impossible to cure it.

Can I join the military with Raynaud's disease?

Raynaud's disease manifests itself episodically under the influence of cold or stress. A general medical examination may not reveal this disease in a conscript, since at the time of the examination there will be no characteristic symptoms and complaints. Only a detailed collection of the patient’s life history and complaints will help suggest the presence of Raynaud’s disease. If a conscript knows about concomitant Raynaud's disease, then it is necessary to inform doctors about this. If test results or previous examinations are available, they must be provided to the commission. If necessary, doctors may prescribe additional or repeat examinations.

If a conscript has not been previously examined for Raynaud's disease, but has characteristic symptoms, they must be reported to doctors. Many patients are unaware of the presence of Raynaud's disease, and changes in skin color, numbness, tingling in response to cold or stress are considered individual hypersensitivity to these factors. During medical monitoring, it is very important to pay attention to all the features and unusual reactions of the body to external factors, since a detail that is insignificant, in the patient’s opinion, can be a very important criterion in diagnosing a serious disease.

Permission to join the army with concomitant Raynaud's disease depends on the stage, severity of the disease, frequency and nature of the disease's manifestations. It is worth remembering that patients with Raynaud's syndrome need to lead a healthy lifestyle, avoid emotional stress and prolonged stay in cold conditions, dress warmly, not smoke, and do physical exercise. An important condition for the treatment of Raynaud's disease is precisely the creation of optimal conditions necessary to minimize the attacks of the disease and prevent its progression. In the army, it is not always possible to comply with these conditions, since military exercises can be carried out in rain or low temperatures and be accompanied by emotional stress. This can have an extremely negative impact on your health if you have Raynaud's disease. The harsh conditions of the army can lead to progression of the disease and the need for long-term medical or, in extremely severe cases, surgical treatment.

Frequent attacks of Raynaud's disease, the need for long-term drug treatment, stages II or III of the disease, and previous surgical interventions for Raynaud's disease are contraindications to joining the army. If a patient's Raynaud's disease worsens while serving in the military, he may be excluded for health reasons.

Conscripts with Raynaud's disease are of limited fitness. They are classified as category "B". This means that the conscript is completely exempt from military service, but he still receives a military ID and is enlisted in the reserves. In the event of hostilities, such people may be drafted into the army.

Does Raynaud's disease occur in children?

When diagnosing, the doctor must confirm Raynaud's disease and make a differential diagnosis with other diseases. One of the diseases characteristic of adolescents with similar symptoms is juvenile acrocyanosis ( bluish discoloration of the skin).
This pathology manifests itself as pain and persistent bluish discoloration of the extremities ( hands and feet) when they are lowered down. When raising the arms and legs, the symptoms disappear. This is caused by the high content of reduced hemoglobin in the blood ( hemoglobin, which gives oxygen to tissues).

In children, Raynaud's disease occurs in the same way as in adults. When the first symptoms of the disease appear in a child, it is necessary to immediately consult a doctor to prevent the disease from progressing to stages II and III. Treatment is prescribed depending on the severity and severity of symptoms. Children are less likely to be prescribed medication. Treatment of the disease is carried out throughout life, which often leads to side effects from medications. Therefore, if possible, avoid taking medications. Instead, physiotherapy, vitamin therapy, and massage may be prescribed. The main task of the doctor is to minimize the manifestation of the disease and prevent the development of complications.

A child with Raynaud's disease should avoid hypothermia and emotional stress. He needs to be explained how to behave during an attack - go to a warm room, put his hands in a warm one ( not hot!) water, put them under the armpits, rub lightly. It is important to monitor your child's clothing. You need to dress him according to the weather in warm clothes. Clothes should be made of natural fabric.

When choosing a profession, high school students need to take into account contraindications for Raynaud's disease to professions that involve working at low temperatures, with local or general cooling, vibration, and nervous tension. Boys with this disease can be exempted from the army and enlisted in the reserve group.

Children and adolescents with Raynaud's disease should be closely monitored by their healthcare provider. The course of treatment is repeated periodically. In the warm season, sanatorium-resort treatment is indicated.

What diet should you eat if you have Raynaud's disease?

There are no specific nutritional rules for Raynaud's disease. The basic principles of nutrition are healthy food, rich in vitamins and microelements. Proper nutrition helps improve immunity, strengthen the walls of blood vessels and prevent the development of various diseases.

To reduce the symptoms of the disease, it is recommended:

• exclude from eating fatty and fried foods, semi-finished products - mayonnaise, sausages, fried meat;
• eat vegetable oils ( do not use for frying) – flaxseed, olive and others;
• consume foods containing magnesium ( magnesium contributes to the normal functioning of capillaries, strengthens the nervous system) – buckwheat, leafy vegetables, nuts, beans, spinach and others;
• use “warming” spices and herbs - red pepper, mustard powder, cinnamon, garlic, turmeric;
• eat enough vegetables and fruits in any form;
• exclude caffeine - coffee, tea, energy drinks, as caffeine promotes vasoconstriction;
• drink enough fluids (water) 1.5 – 2 liters per day), compotes, fruit drinks.