Raynaud's syndrome symptoms and. Raynaud's disease - treatment with folk remedies. Ask your doctor about your situation

The French physician Maurice Raynaud first described the symptoms of the disease, which later became known as Raynaud's disease, more than 150 years ago. Since then, the physiopathology of the syndrome and the disease has not been fully studied. At timely handling to the doctor, the prognosis of treatment for the patient is favorable.

Raynaud's syndrome - what is it

In short, Raynaud's syndrome is an unusual form of manifestation of angiodystonia, manifested in a number of diseases. It is characterized by local three-stage peripheral ischemia of the fingers, less often the legs, auricles and the tip of the nose. In a severe and neglected case, this can lead to ischemic tissue necrosis, leading to the occurrence of trophic ulcers, subsequent gangrene with amputation and disability. What is Raynaud's disease is an independent disease with symptoms similar to the syndrome.

The reasons

There is Raynaud's disease, called Raynaud's phenomenon, at present, the factors of its occurrence have not been reliably established. Presumably, they include a hereditary predisposition for a special response of blood vessels to adverse external influences. The secondary phenomenon (Raynaud's syndrome) is the symptomatology resulting from the complication of diseases such as systemic lupus erythematosus, scleroderma. Other causes of Raynaud's syndrome are lesions in the neck of the vertebrae, trauma, rheumatoid arthritis.

Among women

In most cases, examinations diagnose the presence of Raynaud's syndrome in asthenic women aged thirty and older. Interestingly, the first Raynaud's disease was also described in a woman, and in the photo of the hands with angiospasm, women are more often. Practically it is important to distinguish between the syndrome and the disease. Ignoring the manifestations of the sign of the syndrome on early stages, you can miss the clinical manifestation of atherosclerosis and other beginning serious diseases, the successful treatment of which depends on the timely diagnosis.

In children

Among children, the disease is more common in girls in puberty. The manifestation of Raynaud's syndrome in children must be distinguished from vascular neurosis and youthful acrocyanosis. It is manifested by the symmetrical appearance of stable cyanosis on the feet and hands, but there are no trophic disorders on the skin and discomfort. Such a violation in color is a consequence of atony of the capillaries, and if you raise your hand up, the skin will immediately turn pale due to the outflow of blood. Vascular reactions are not paroxysmal in nature, there are no paresthesias.

Treatment for easy course comes down to simple prevention: the exclusion of hypothermia, the mandatory wearing of gloves and a hat. To exclude emotional overstrain in a child, the use of drugs is indicated. sedative effect. All children and adolescents who are diagnosed with Raynaud's syndrome are registered in the dispensary, observation is long-term. Recommendations are given on professional selection, professions associated with vibration, temperature changes, and great nervous stress are excluded.

Raynaud's Syndrome - Diagnosis

Because the this pathology is one of the manifestations of autoimmune or rheumatic diseases, the diagnosis of Raynaud's syndrome begins with laboratory methods research. General analysis blood shows thrombocytosis and excess ESR. Such a violation of erythrocyte sedimentation is given by rheumatic diseases and connective tissue, also the manifestation is characteristic of systemic lupus erythematosus.

The condition of the capillaries on the nail bed is being studied by the method of capillaroscopy, the doctor carefully examines the fingers under a microscope. To study the effect of low temperature on the vascular response to simulate an attack, and then to follow the dynamics of the change in color, the patient's hand is placed in cold water for a couple of minutes.

Symptoms

The symptoms of Raynaud's syndrome are manifested by a violation of the microcirculation of blood in the fingers, but less often they can be affected lower limbs, nose tip, chin, ears. The emerging symptoms are conditionally divided into three phases. The first (initial) phase or vasoconstrictor is characterized by blanching of skin areas, they begin to turn white. Its duration reaches a quarter of an hour, numbness and tingling are felt, pain appears.

The next phase is called cyanotic, when the arteries spasm and a bluish color comes to replace it, it remains on the skin for up to a couple of minutes. The final phase is reactive hyperemia, the skin becomes red, cooling is replaced by warming, capillary spasm disappears. The manifestation of phase transitions depends on the stage of the underlying disease.

Treatment

Treatment of Rein's syndrome must begin with the disease that provoked the appearance of the symptom complex. You will have to say goodbye to smoking, avoid the effects of vibration on the entire body and fingers, limit contact with cold (air, water), eliminate psychological stress. In the complex of treatment, in addition to medicines, physiotherapy is necessarily included, but the conservative method does not always help, therefore surgical intervention becomes inevitable.

Folk remedies

Additional assistance in the treatment can be provided by herbal remedies from the arsenal of alternative traditional medicine. It is impossible to prescribe the intake of certain herbs on your own, and even more so to replace the medicines prescribed by the doctor. How to treat Raynaud's disease - similar to the syndrome. The main differences of the disease are in the absence of provoking ailments and in the symmetry of the damage to the limbs.

Reyn's syndrome treatment folk remedies aimed at strengthening immune system and slowing down the pathological process:

It is useful to massage the hands and feet.
Take a shower or bath to train and strengthen blood vessels, changing the temperature of the water several times from hot to cold.
Prepare a 1:1 solution of glycerin with water, lubricate your hands before going outside in cold weather.
Pour 40 g strawberry leaves boiling water, let stand, drink all 300 ml in two doses per day.
It is recommended to eat a berry for 2 weeks Chinese magnolia vine three times a day.

Medical

In the treatment of the disease, doctors prescribe medications that promote vasodilation and prevent platelets from sticking together, and as a result, the occurrence of vascular thrombosis. When prescribing drug treatment for Rein's syndrome, the following drugs are prescribed:

Nicardipine;
Amlodipine;
Vasaprostan;
Nifedipine;
Dipyridamole;
Agapurin;
Diltiazem;
Pentoxifylline;
Verapamil.

Modern equipment and diagnostic methods make it possible to identify the disease at an early stage. If a visit to the doctor for a long time postponed, you will have to be patient and tune in to a long treatment. The quality of life as a result of the treatment will depend on the course of the underlying disease that has become the root cause of the syndrome.

Check out the ways.

Video

Raynaud's disease is leading place among the group of vegetative-vascular diseases of the distal extremities.

Data on the prevalence of Raynaud's disease are conflicting. One of the largest population-based studies showed that Raynaud's disease occurs in 21% of women and 16% of men. Among professions where the risk of contracting vibration disease is increased, this percentage is twice as high.

ICD-10 code

I73.0 Raynaud's syndrome

What causes Raynaud's disease?

Raynaud's disease occurs in a variety of climates. It is most rare in countries with a hot, constant climate. Infrequent reports of this disease among northerners. Raynaud's disease is most common in the middle latitudes, in places with a humid temperate climate.

The hereditary predisposition for Raynaud's disease is small - about 4%.

In the classical form, Raynaud's symptom complex proceeds in the form of seizures, consisting of three phases:

blanching and coldness of the fingers and toes, accompanied by pain;
accession of cyanosis and increased pain;
redness of the extremities and subsidence of pain. Such a symptom complex is commonly referred to as Raynaud's phenomenon. All cases of pathognomonic combination of symptoms of the primary disease with physical features FRs are referred to as Raynaud's syndrome (SR).

As clinical observations have shown, the symptom complex described by M. Raynaud is not always independent disease(idiopathic): it can also occur in a number of diseases that differ in etiology, pathogenesis and clinical manifestations. The disease described by M. Raynaud began to be regarded as an idiopathic form, i.e. Raynaud's disease (BR).

Among the many attempts to classify various forms of Raynaud's syndromes, the most complete is the etiopathogenetic classification created by L. and P. Langeron, L. Croccel in 1959, which in modern interpretation is as follows:

Local origin of Raynaud's disease (digital arteritis, arteriovenous aneurysms of the vessels of the fingers and toes, occupational and other trauma).
Regional origin of Raynaud's disease (cervical ribs, anterior scalene muscle, syndrome of sharp abduction of the arm, damage to the intervertebral disc).
Segmental origin of Raynaud's disease (arterial segmental obliteration that can cause vasomotor disorders in distal parts limbs).
Raynaud's disease in combination with a systemic disease (arteritis, arterial hypertension, primary pulmonary hypertension).
Raynaud's disease with insufficient blood circulation (thrombophlebitis, vein injuries, heart failure, cerebral angiospasm, retinal vasospasm).
Damage to the nervous system (constitutional acrodynia, syringomyelia, multiple sclerosis).
The combination of Raynaud's disease with digestive disorders (functional and organic diseases of the digestive tract, stomach ulcers, colitis).
Raynaud's disease in combination with endocrine disorders (diencephalic-pituitary disorders, adrenal tumors, hyperparathyroidism, Graves' disease, climacteric menopause, as well as menopause as a result of radiotherapy and surgery).
Raynaud's disease in violation of hematopoiesis (congenital splenomegaly).
Raynaud's disease in cryoglobulinemia.
Raynaud's disease in scleroderma.
True Raynaud's disease.

In the future, this classification was supplemented by some selected clinical forms with rheumatic lesions, hormonal dysfunction (hyperthyroidism, postmenopausal period, uterine and ovarian dysplasia, etc.), with some forms of occupational pathology (vibration disease), complications after taking peripherally acting vasoconstrictor drugs, such as ergotamine, beta-blockers, widely used for the treatment arterial hypertension, angina pectoris and other diseases that can cause attacks of Raynaud's disease symptom in individuals with a corresponding predisposition.

The pathogenesis of Raynaud's disease

The pathophysiological mechanisms underlying the onset of attacks of Raynaud's disease are not fully understood. M. Raynaud considered the cause of the disease described by him to be "hyperreactivity of the sympathetic nervous system." It is also assumed that this is the result of a local defect (local fault) peripheral vessels of the fingers. There is no direct evidence for the correctness of one of these points of view. The latter assumption has certain grounds in light of contemporary ideas on the vascular effects of prostaglandins. It has been shown that in Raynaud's disease there is a decrease in the synthesis of endothelial prostacyclin, the vasodilating effect of which is beyond doubt in the treatment of patients with Raynaud's disease of various etiologies.

It is currently established that the change rheological properties blood in patients suffering from Raynaud's disease, especially during an attack. The immediate cause of the increase in blood viscosity in these cases has not been elucidated: this may be due to both a change in the concentration of plasma fibrinogen and a deformation of the red blood cells. Similar states occur with cryoglobulinemia, in which the relationship between a violation of protein precipitation in the cold, an increase in blood viscosity and clinical manifestations of acrocyanosis is undeniable.

At the same time, there is an assumption about the presence of angiospasms of the cerebral, coronary and muscle vessels in Raynaud's disease, the manifestation of which are frequent headaches, angina attacks, and muscular asthenia. Connection clinical manifestations peripheral circulatory disorders with the occurrence and course emotional disorders confirmed by changes in digital blood flow in response to emotional stress, the influence of anxious emotional states on skin temperature in both patients with Raynaud's disease and healthy people. In this case, the state of nonspecific systems of the brain is of great importance, which has been shown by numerous EEG studies in various functional states.

In general, the mere presence clinical signs such as paroxysmality, symmetry, dependence of clinical manifestations on various functional states, the role emotional factor in the provocation of attacks of Raynaud's disease, some biorhythmological dependence, pharmacodynamic analysis of the disease, allows us with sufficient reason to imply the participation of cerebral mechanisms in the pathogenesis of this suffering.

In Raynaud's disease, a violation of the integrative activity of the brain is shown (using the study of infraslow, as well as evoked brain activity), manifested by a mismatch of specific and nonspecific processes of somatic afferentation, various levels information processing processes, mechanisms of nonspecific activation).

An analysis of the state of the autonomic nervous system in Raynaud's disease using special methods that allow selective analysis of its segmental mechanisms revealed, only in the idiopathic form of the disease, facts indicating the insufficiency of the mechanisms of sympathetic segmental regulation of cardiovascular and sudomotor activity. The presence of insufficiency of sympathetic influences in conditions of vasospastic disorders suggests that the existing symptom complex is a consequence of vasospasm, as a phenomenon of post-denervation hypersensitivity. The latter, obviously, has a compensatory and protective value for ensuring a sufficient level of peripheral blood flow and, as a result, the preservation of vegetative-trophic functions in Raynaud's disease. The significance of this compensatory factor is especially evident when compared with patients with systemic scleroderma, where the percentage of vegetative-trophic disorders is so high.

Raynaud's disease symptoms

The average age of onset of Raynaud's disease is the second decade of life. Cases of Raynaud's disease in children 10-14 years old are described, about half of which had a hereditary condition. In some cases, Raynaud's disease occurs following emotional stress. The onset of Raynaud's disease after age 25, especially in individuals with no previous evidence of peripheral circulatory disorders, increases the likelihood of any underlying disease. Rarely, usually after severe mental shocks, endocrine changes, the disease can occur in people 50 years of age and older. Raynaud's disease occurs in 5-10% of patients in the population.

Among patients suffering from Raynaud's disease, women predominate significantly (the ratio of women and men is 5:1).

Among the factors provoking the occurrence of attacks of Raynaud's disease, the main one is exposure to cold. Some people with individual characteristics peripheral circulation, even short-term episodic exposure to cold and humidity can cause Raynaud's disease. Emotional distress is a common cause of Raynaud's disease. There is evidence that in about 1/2 of patients, Raynaud's disease has a psychogenic nature. Sometimes this disease occurs as a result of exposure to a whole range of factors (cold exposure, chronic emotional stress, endocrine and metabolic disorders). Constitutional-hereditary and acquired features of the autonomic-endocrine system are the background that contributes to more easy onset Raynaud's disease. Direct hereditary conditionality is low - 4.2%.

The earliest symptom of the disease is increased chilliness of the fingers - more often than the hands, which is then joined by blanching of the terminal phalanges and pain in them with elements of paresthesia. These disorders are paroxysmal in nature and disappear completely at the end of the attack. The distribution of peripheral vascular disorders does not have a strict pattern, but more often it is the II-III fingers of the hands and the first 2-3 toes. More than others, the distal parts of the arms and legs are involved in the process, much less often other parts of the body - earlobes, the tip of the nose.

The duration of the attacks is different: more often - a few minutes, less often - a few hours.

These symptoms are typical for the so-called stage I Raynaud's disease. In the next stage, there are complaints about attacks of asphyxia, after which trophic disorders in the tissues may develop: swelling, increased vulnerability of the skin of the fingers. Characteristic features trophic disorders in Raynaud's disease are their locality, relapsing course, regular development from the terminal phalanges. The last, trophoparalytic, stage is characterized by the aggravation of the listed symptoms and the predominance of dystrophic processes on fingers, face and toes.

The course of the disease is slowly progressive, however, regardless of the stage of the disease, there may be cases of reverse development of the process - upon the onset menopause, pregnancy, after childbirth, changes in climatic conditions.

The described stages of the development of the disease are characteristic of secondary Raynaud's disease, where the rate of progression is determined by clinical picture primary suffering (more often it systemic diseases connective tissue). The course of primary Raynaud's disease is usually stationary.

The frequency of disorders of the nervous system in patients with Raynaud's disease is high, in the idiopathic form it reaches 60%. As a rule, a significant number of neurotic complaints are revealed: headache, feeling of heaviness in the head, pain in the back, limbs, frequent violations sleep. Along with psychogenic headache, paroxysmal vascular headache is characteristic. Migraine attacks occur in 14-24% of patients.

Arterial hypertension is noted in 9% of cases.

Paroxysmal pain in the region of the heart is functional in nature and is not accompanied by changes in the ECG (cardialgia).

Despite a significant number of complaints about the increased sensitivity of the forearms, fingers and feet to cold, the frequency of itching, burning sensations and other paresthesias, objective sensitivity disorders in patients with the idiopathic form of the disease are extremely rare.

Numerous studies of the idiopathic form of Raynaud's disease have shown complete patency of the great vessels, and therefore the severity and frequency of convulsive crises of arteriolocapillaries in the distal parts of the extremities remain difficult to explain. Oscillography only demonstrates an increase in vascular tone, mainly in the hands and feet.

Longitudinal segmental rheography of the extremities reveals two types of changes:

in the stage of compensation - a noticeable increase in vascular tone;
in the stage of decompensation - most often a significant decrease in the tone of small arteries and veins. Pulse blood filling decreases in the fingers and toes during an ischemic attack with symptoms of obstruction of venous outflow.

Diagnosis of Raynaud's disease

In the study of patients with Raynaud's disease, it should first of all be established whether the phenomenon is not a constitutional feature of the peripheral circulation, that is, a normal physiological reaction under the influence of cold of varying intensity. In many people, it includes single-phase blanching of the fingers or toes. This reaction is reversed on rewarming and almost never progresses to cyanosis. Meanwhile, in patients with true Raynaud's disease, the regression of vasospasm is difficult and often lasts longer than the application of an influencing stimulus.

The greatest difficulty is the differential diagnosis between the idiopathic form of the disease and secondary Raynaud's syndrome.

Diagnosis of the idiopathic form of the disease is based on five main criteria formulated by E.Ellen, W.strongrown in 1932:

the duration of the disease is at least 2 years;
absence of diseases, secondary causing the syndrome Raynaud;
strict symmetry of vascular and trophoparalytic symptoms;
absence of gangrenous changes in the skin of the fingers;
episodic occurrence of attacks of ischemia of the fingers under the influence of cooling and emotional experiences.

However, further, with a disease duration of more than 2 years, it is necessary to exclude systemic diseases connective tissue, as well as other most common causes secondary Raynaud's disease. That's why Special attention should be involved in identifying symptoms such as thinning of the terminal phalanges, multiple long-term non-healing wounds on them, difficulty opening the mouth and swallowing. In the presence of such a symptom complex, one should first of all think about the possible diagnosis of systemic scleroderma. Systemic lupus erythematosus is characterized by butterfly-like erythema on the face, hypersensitivity to sunlight, hair loss, symptoms of pericarditis. The combination of Raynaud's disease with dryness of the mucous membranes of the eyes and oral cavity is characteristic of Sjögren's syndrome. In addition, patients should be interviewed to identify a history of data on the use of drugs such as ergotamine and long-term treatment beta-blockers. In men over 40 years of age with a decrease in peripheral pulse, it is necessary to find out if they smoke in order to establish a possible connection of Raynaud's disease with obliterating endarteritis. To exclude occupational pathology, anamnestic data on the possibility of working with vibrating instruments are required.

In almost all cases of the patient's primary visit to the doctor, it is necessary to make a differential diagnosis between its two most common forms - idiopathic and secondary in systemic scleroderma. The most reliable method along with detailed clinical analysis is the use of the method of evoked cutaneous sympathetic potentials (SCSP), which allows almost 100% to distinguish between these two conditions. In patients with systemic scleroderma, these indicators practically do not differ from normal ones. While in patients with Raynaud's disease there is a sharp elongation latent periods and a decrease in VCSP amplitudes in the limbs, more roughly represented in the arms.

Vascular-trophic phenomena in the extremities occur in various clinical variants. The phenomenon of acroparesthesia in a milder form (Schulze form) and more severe, widespread, with edema (Notnagel form) is limited to subjective sensitivity disorders (crawling, tingling, numbness). Conditions of permanent acrocyanosis (Cassirer's acroasphyxia, local sympathetic asphyxia) can be aggravated and occur with edema and mild hypesthesia. Numerous clinical descriptions Raynaud's disease depending on the localization and prevalence of angiospastic disorders (the phenomenon of "dead finger", "dead hand", "miner's foot", etc.). Most of these syndromes are grouped together common features(paroxysmism, occurrence under the influence of cold, emotional stress, similar nature of the course), which suggests that they have a single pathophysiological mechanism and consider them within the framework of a single Raynaud's disease.

Special tactics of management and treatment should be followed in patients with occupational and domestic hazards, while first of all, the factor causing these disorders (vibration, cold, etc.) is eliminated.

In cases of the idiopathic form of the disease, when primary Raynaud's disease is caused only by cold, humidity and emotional stress, the elimination of these factors can lead to relief of Raynaud's disease attacks. Analysis of clinical observations results long-term use different groups of vasodilators indicates their insufficient effectiveness and short-term clinical improvement.

It is possible to use defibrinating therapy as a variety pathogenetic treatment, but its short-term effect should be borne in mind; similar action also possesses plasmapheresis, used in the most severe cases.

In some forms of the disease, accompanied by the formation of irreversible trophic disorders and a pronounced pain syndrome, significant relief is brought surgery- sympathectomy. Observations of operated patients show that the return of almost all symptoms of the disease is observed after a few weeks. The rate of increase in symptoms coincides with the development of hypersensitivity of denervated structures. From these positions, it becomes clear that the use of sympathectomy is not justified at all.

Recently, the range of peripheral vasodilation agents used has expanded. Successful is the use of calcium blockers (nifedipine) in primary and secondary Raynaud's disease due to their effect on microcirculation. Long-term use of calcium blockers is accompanied by a sufficient clinical effect.

Of particular interest from a pathogenetic point of view is the use of large doses of cyclooxide inhibitors (indomethacin, vitamin C) to correct peripheral circulation disorders.

Given the frequency and severity of psychovegetative disorders in Raynaud's disease, psychotropic therapy occupies a special place in the treatment of these patients. Among the drugs in this group, tranquilizers with anxiolytic action (tazepam), tricyclic antidepressants (amitriptyline) and selective serotonin antidepressants (methanserin) are shown.

To date, some new aspects of the treatment of patients with Raynaud's disease have also developed. With the help of biological feedback patients manage to control and maintain skin temperature at a certain level. special effect in patients with idiopathic Raynaud's disease give autogenic training and hypnosis.

- a vasospastic disease characterized by a paroxysmal disorder of arterial circulation in the vessels of the extremities (feet and hands) under the influence of cold or emotional excitement. Raynaud's syndrome develops against the background of collagenosis, rheumatoid arthritis, vasculitis, endocrine, neurological pathology, blood diseases, occupational diseases. Clinically, Raynaud's syndrome is manifested by seizures, including sequential blanching, cyanosis, and hyperemia of the fingers or toes, chin, and tip of the nose. Raynaud's syndrome leads to gradual trophic tissue changes. Conservative measures include the use of vasodilators, surgical treatment consists of sympathectomy.

ICD-10

I73.0

General information

Raynaud's syndrome is a secondary condition that develops against a background of a number of diseases: diffuse pathology of the connective tissue (scleroderma, systemic lupus erythematosus), systemic vasculitis, rheumatoid arthritis, diseases of the sympathetic ganglia, endocrine and hematological disorders, diencephalic disorders, compression of the neurovascular bundles. In addition, Raynaud's syndrome can be triggered by exposure to occupational hazards(cooling, vibration).

In the pathogenesis of Raynaud's syndrome, the leading role is played by endogenous vasoconstrictors - catecholamines, endothelin, thromboxane A2. In the development of Raynaud's syndrome, three successive phases are distinguished: ischemic, cyanotic and hyperemic. The ischemia phase develops due to spasm of peripheral arterioles and complete emptying of capillaries; manifested by local blanching skin. In the second phase, due to blood retention in the venules and arteriovenular anastomoses, blanching of the skin is replaced by cyanosis (cyanosis). In the last phase - reactive-hyperemic, reddening of the skin is noted.

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

Raynaud's syndrome symptoms

The symptomatology of Raynaud's syndrome is due to paroxysmal vasospasm and resulting tissue damage. In typical cases, with Raynaud's syndrome, IV and II fingers of the feet and hands are affected, sometimes the chin, ears and nose. Attacks of ischemia in the beginning are short-term, rare; arise under the influence of cold agents, as a result of excitement, smoking, etc. Paresthesia suddenly develops, coldness of the fingers, the skin becomes alabaster-white. Numbness is replaced by burning, bursting pain, a feeling of fullness. The attack ends with a sharp hyperemia of the skin and a feeling of heat.

The progression of Raynaud's syndrome leads to a lengthening of the time of attacks up to 1 hour, their increase, spontaneous occurrence without visible provocations. After the height of the paroxysm, a cyanotic phase begins, a slight swelling of the tissues appears. In the intervals between attacks, the feet and hands remain cold, cyanotic, wet. Paroxysms of ischemia in Raynaud's syndrome are characterized by a symmetrical and consistent development of manifestations: first on the fingers of the hands, then on the feet. The consequences of tissue ischemia in the case of prolonged and severe course Raynaud's syndrome can become trophic changes in the form of poorly healing trophic ulcers, areas of necrosis, degenerative lesions of the nail plates, osteolysis and deformation of the phalanges, gangrene.

Diagnosis of Raynaud's syndrome

A patient with Raynaud's syndrome is referred for a consultation with a rheumatologist and a vascular surgeon. In Raynaud's syndrome, angiography of the peripheral vascular bed allows revealing changes in the distal parts of the arteries, in which areas of uneven stenosis and total obstruction of the vessels, the absence of capillary networks and collaterals are determined. With capillaroscopy nail bed and the anterior surface of the eye, morphological changes in the microvascular pattern are detected, indicating a violation of perfusion.

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

Raynaud's syndrome treatment

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

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

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

Forecast and prevention of Raynaud's syndrome

The prognosis of Raynaud's syndrome depends on the progression of the underlying pathology. The course of the syndrome is relatively favorable, attacks of ischemia may spontaneously stop after a change in habits, climate, profession, sanatorium treatment etc.

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

ICD-10 code

Raynaud's disease is an angiotrophoneurosis with predominant lesion small arteries and arterioles (most often the upper limbs, less often the feet, and even more rarely its manifestations occur on protruding skin areas on the nose, ears and chin).

As a result, some part of the affected limb stops feeding due to sharp decline the amount of incoming blood. The disease occurs in women 5 times more often than in men, mainly in young and middle age.

What is Raynaud's syndrome and disease?

Raynaud's syndrome is a phenomenon in which reversible spasm of the vessels of the fingers and toes occurs periodically in response to stress or cold.

Raynaud's disease (ICD 10 - code I73.0) is a similar ailment, which, however, developed against the background of some systemic disease.

Maurice Reynaud is a French doctor who first described this disease, was of the opinion that this is nothing more than a neurosis resulting from excessive excitability relevant to the vasomotor spinal centers.

What is the difference and difference between them? With the disease and with Raynaud's syndrome, there are identical changes in blood circulation at the level of the limbs, which is manifested by absolutely the same signs. However, they differ in the cause that prompted their occurrence, and sometimes in localization.

The reasons

The hereditary predisposition for Raynaud's disease is small - about 4%. Among patients suffering from Raynaud's disease, women predominate significantly (the ratio of women and men is 5:1).

It is noteworthy that Raynaud's disease is a disease that pianists and typists are particularly susceptible to.

The most common localization of the disease is the peripheral parts of the limbs, that is, the feet and hands. The lesions of the extremities in most cases occur symmetrically.

Main reasons:

Among the factors provoking the occurrence of attacks of Raynaud's disease, the main one is exposure to cold. In some people with individual characteristics of the peripheral circulation, even short-term episodic exposure to cold and humidity can cause illness.
Injuries. Physical injuries are also dangerous, which include excessive squeezing of the limbs, excessive and intense loading, and injuries associated with exposure to chemicals.
Rheumatic diseases - periarthritis nodosa (inflammation of the tendons), (inflammatory disease of the joints), systemic lupus erythematosus, systemic scleroderma.
Emotional distress is a common cause of Raynaud's disease. There is evidence that in about 1/2 of patients the syndrome is psychogenic in nature.
Functional disturbances endocrine organs, as well as endocrine disorders (pheochromocytoma, hypothyroidism) and

Taking certain medications can also trigger the onset of the syndrome. This applies to medicines that have vasoconstrictor action. Most often, these are drugs that are used to treat migraines or.

Raynaud's disease symptoms

The disease proceeds paroxysmal. Each of the attacks consists of three phases:

Spasm of the vessels of the extremities. Fingers become pale and cold, pain appears here.
The pain sharply increases and comes to the fore. The skin of the hands and / or feet turns blue, cold sweat enters.
The spasm abruptly disappears, the skin becomes red and warm. The pain subsides. Limb function is restored.

Skin color symptoms develop gradually. First, pallor appears, the severity of which depends on the degree of vascular spasm. Most often, this phase is accompanied by a sensation of pain. The pain syndrome is present in all phases, but is most pronounced in the first, when the fingers are pale.

Pay attention to the photo, Raynaud's disease is accompanied not only pain attacks, but also pallor or cyanosis of the skin, and it happens that its swelling.

Some patients may have seizures several times a day, others - at intervals of several months. The progression of Raynaud's syndrome leads to a lengthening of the time of attacks up to 1 hour, their increase, spontaneous occurrence without visible provocations. In the intervals between attacks, the feet and hands remain cold, cyanotic, wet.

The frequency of disorders in the functioning of the nervous system in Raynaud's disease reaches 60% of cases. Patients complain about:

constant headache,
feeling of heaviness in the temples,
pain in the lower back and limbs
there are difficulties with the coordination of limb movements.

Syndrome stages and characteristic features

As we have already noted, Raynaud's disease is more common in women (about five times) than, respectively, in men. Basically, the incidence is observed among women from 20 to 40 years old, a combination of the course of the disease with migraine is possible.

The course of the disease is divided into three stages:

angiospathic;
angioparalytic;
atrophoparalytic.

1 stage

The occurrence of short-term rare, lasting about a few minutes, attacks of numbness of the skin, a pronounced decrease in temperature in the affected area and blanching of the skin, followed by the development of pain of a bursting nature. After the end of the attack, visual changes in the areas are not observed.

stage 2 Raynaud's disease

The second stage is characterized by the addition of other symptoms of the disease to the listed signs:

The skin color at this stage is no longer just pale, but with a bluish tint, the skin color becomes “marble”.
Puffiness may appear on the affected limbs, especially in areas that are affected by the disease.
The pain during an attack becomes stronger and more intense.

The duration of the first and second stages averages from 3 to 5 years. With the development of the process on the feet or hands, it is quite often possible to observe the symptoms of all three stages, at the same time.

3 stage

At this stage of Raynaud's disease, there is a tendency to develop panaritiums and ulcers, up to the destruction and necrosis of the skin on soft tissues terminal phalanges.

What is contraindicated in patients with this syndrome?

It is very important to quickly and reliably eliminate the factors that contribute to the onset of the disease. If this is a professional activity, change it or adjust it. If this is a specific habitat, change the place of residence.

Patients are contraindicated for work related to:

with hypothermia of the extremities,
with subtle and complex movements of the fingers (playing on musical instruments, typing on a computer, typewriter),
in contact with various chemicals.

Due to the impossibility of performing work in the main profession, depending on the degree of the disease, 3 or very rare cases 2 group of disability.

Diagnostics

Which doctor should I contact if I suspect this disease? If Raynaud's disease is suspected, it is necessary to contact an angiologist, and if it is impossible to do this, a rheumatologist should be consulted. Additionally, consultation with a cardiologist and vascular surgeon.

The first diagnostic criterion for Raynaud's disease is a persistent vasospasm of the skin: when warmed, blood circulation is not restored, the extremities remain cold and pale.

Laboratory studies are required:

general blood analysis;
to general and C-reactive protein, albumin and globulin fractions;
detailed coagulogram, fibrinogen level, properties of platelets and erythrocytes.

Recently, experts have noted the high efficiency of a new method for diagnosing Raynaud's disease - wide-field capillaroscopy of the nail bed. This method has a high accuracy of diagnosing the disease.

The final diagnosis of Raynaud's disease can only be established as a result of a thorough examination. If no other diseases are identified that caused the occurrence of the symptom complex, the diagnosis of "Raynaud's disease" is established.

Raynaud's disease treatment

Treatment of patients with Raynaud's disease presents certain difficulties associated with the need to establish a specific cause that caused the syndrome, so the question of how to treat Raynaud's disease, or rather how to do it correctly, with the greatest efficiency, is discussed from different points of view.

In cases where a primary disease is identified, management should include treatment of the underlying disease and observation by an appropriate specialist.

As a rule, the treatment of Raynaud's disease is symptomatic and includes the use of:

fortifying drugs,
antispasmodics,
analgesics,
medicines that normalize hormonal levels.

In the first and second stages of the disease drug therapy includes drugs that reduce blood viscosity, such as Curantyl, Dipyridamole.

Of the physiotherapeutic methods in the first two stages of the disease, the following are used:

electrosleep;
electrical stimulation of the frontotemporal areas of the brain;
diadynamic currents or ultrasound on the cervical and lumbar sympathetic nodes in the paravertebral zone;
electrophoresis with sedatives and antispasmodics;
magnetotherapy.

At the stage of appearance of ulcers and tissue necrosis, the patient is prescribed local wound healing therapy. Medical treatment Raynaud's disease can last for several years, until the period when attacks of angiospasm of the extremities become insensitive to vasodilators.

An important component of the treatment of Raynaud's disease is to limit the patient's contact with provoking factors. With a high negative emotional stress sedatives should be taken. If necessary, contact with cold and damp environment you should dress warmer than usual, especially carefully insulate your hands and feet.

Surgical treatment of Raynaud's disease consists in sympathectomy (when the flow of pathological impulses is interrupted by surgery, leading to vasospasm in certain areas of the autonomic nervous system, which is responsible for the state of the tone of blood vessels).

Proper nutrition

The diet for Raynaud's syndrome coincides with the anti-cholesterol diet of patients with. In Raynaud's disease, it is necessary to exclude as much as possible fatty foods- smoked sausages, fatty meat, chicken legs, mayonnaise, fatty sour cream.

Food must be kept enough vitamin C and routine. It is recommended to use more vegetables in any form. Besides the fact that they are good source vitamins, vegetables, like fruits, are rich in fiber, which serves as a source of nutrition for the intestinal microflora. In this case, a lot of heat is generated, which warms the body.

The patient should eat about 400 g of vegetables and fruits daily.

Folk remedies for Raynaud's disease

Take fir baths. You need to mix 5-6 drops fir oil with base oil (olive, peach, corn) and pour them into a prepared bath with water at a temperature of 37 ° C. Bath time - 15 minutes. It is necessary to do 15-20 baths for 1 course.
Siberian recipe: eat a piece of bread with drops of fir oil in the morning.
Cut two or three bottom leaves of a three-year-old aloe plant and chop them. Squeeze out the gruel and soak gauze bandages with aloe juice. Apply dressings to the affected areas of the body and leave for several hours. A pre-made massage of the limbs will help to increase the effectiveness of the procedure.
Take fresh onion juice and honey (mix 1:1). Take 1 teaspoon 3-4 times daily.

It is easier to endure severe attacks will help:

warming the affected limb in warm water or woolen cloth;
soft massage;
warming drink.

Prevention

Conduct preventive examinations with a vascular surgeon and a neurologist once a year.
Smoking should be avoided to prevent spontaneous peripheral vasoconstriction. Even passive smoking leads to negative changes in vascular walls so you should avoid places where smoking is allowed.
To prevent Raynaud's disease, doctors recommend training the vessels of the hands, tempering the hands. Contrasting baths are well suited for this.
Dress for the weather and don't forget gloves.
Most important factors that affect the appearance of seizures - nervous shaking and overwork. Therefore, it is necessary to avoid these factors and strive for peace and peace of mind.

If you have the first signs of the syndrome, it is better to immediately consult a doctor. Treatment of the syndrome is a complex task, the solution of which depends on the possibility of eliminating causal factors and effective impact on the leading mechanisms of development of vascular disorders.

Raynaud's syndrome refers to vasospastic paroxysmal disorders of the blood supply to the hands and feet. Vasospasm manifests itself in three stages:

Ischemia - whitening of the fingers;
Cyanosis - their blueness;
Hyperemia - redness of the limb.

Symptoms

Raynaud's disease is accompanied by a feeling of sharp cold, numbness, then tingling and pain in the extremities. less often similar symptoms can appear on the earlobes, tip of the nose, tongue. On the limbs they are always symmetrical. The attack lasts from several minutes to an hour. It occurs mainly under the influence of even a slight cold or strong nervous tension. In the zone increased risk there are women from 20 to 40 years old, less often men after fifty.

Causes of the disease

The origin of the disease is still unclear. It can be either independent or one of the first symptoms of a cardiovascular or nervous disease. Therefore, it is important to consult a doctor to find out the causes of the disease. The syndrome develops with the following diseases:

Rheumatoid arthritis
Systemic scleroderma
Disorders of the endocrine system
Diencephalic disorders
Vascular diseases
Blood diseases
Nervous disorders

The syndrome can develop against the background of taking some medicines- antineoplastic, adrenergic receptor blockers or ergot alkaloids. In such cases, after the end of the course of medication, the syndrome usually disappears.

Studies indicate that Raynaud's syndrome hereditary disease. In this case, it is often enough to push - hypothermia, nervous shock or injury to the fingers, so that the disease turns from a prodromal state into an actively progressive one. This should especially be paid attention to people who already had a similar disease in the family.

Those at risk are those whose work is associated with constant hypothermia of the limbs, vibration or contact with polyvinyl chloride. Typists and pianists also suffer from it.

Stages of the disease

There are 3 stages of the syndrome:

angiospastic
angioparalytic
trophoparalytic

The first stage is characterized by slight spasms of blood vessels at the tips of two to three fingers. The spasm quickly passes, the vessels dilate sharply, leaving a feeling of heat and tingling.

The second stage is characterized by a blue hand and fingers, swelling appears subcutaneous tissue, the contours of the bones and muscles are smoothed out, when pressed with a finger, a visible hole does not form.

In the third stage, acute purulent inflammation tissues, as well as ulcers on the upper phalanges of the fingers. Then soft tissue necrosis begins, leading to non-healing wounds.

Medical treatment

Drug treatment is aimed at the use of drugs that improve peripheral circulation and blood thinning. Can be used:

Vasodilator drugs (calcium antagonists): Nifedipine (up to 60 mg per day), Verapamil, Diltiazem.
ACE inhibitors: Captopril (dosage is selected individually), the duration of admission is up to 1 year.
In the treatment of elderly patients, selective serotonin receptor blockers are used: Ketanserin.
Drugs that improve the properties of blood and reduce its viscosity: Dipyridamole, Pentoxifylline (orally and intravenously), Reopoliglyuktn (intravenous drip infusion, 10 procedures per course of treatment).

With the progression of the disease, vasoprastan is used for intradrop administration (20-40 mcg). The course of therapy is carried out twice a year, a positive therapeutic effect is observed after 2-3 infusion procedures. The pharmacological effect of vasoprastan persists for 4 months - six months.

Drug treatment must necessarily be combined with physiotherapy, reflexology, psychotherapy and hyperbaric oxygen therapy.

Symptomatic treatment

Raynaud's syndrome serious illness, but since the causes of its appearance are often not known, treatment is mainly symptomatic.

As symptomatic treatment Raynaud's syndrome are recommended vasodilators. It is important to remember that such treatment will not eliminate the disease completely, but will stop the rapid progression of the disease. The following are recommended:

Collection of herbs, including creeping thyme, lemon balm and garden rue in equal proportions. One teaspoon is poured into 200 ml of boiling water and allowed to brew for several hours. Take 50 ml per day.
You can prepare a collection of other vasodilating herbs - mint, motherwort, yarrow, dill and anise. One tablespoon of the mixture or one of the herbs is poured with a glass of boiling water. An hour later, the infusion can be taken orally. You can also make a similar oil infusion for massaging the limbs.
Recommended for Raynaud's syndrome vegetarian diet and products rich in vitamins PP and C.
Common harmala. A plant that dilates peripheral vessels. Brew 1 teaspoon per 200 ml of water. Take one tablespoon of herbal decoction three times a day.
strawberries. peripheral vessels also expands the decoction of wild strawberry leaves, for this, brew a tablespoon of the leaves in a glass of boiling water. Take a glass in the morning and evening.
Leuzea roots. To prepare a decoction, take one teaspoon of chopped roots and pour a liter of boiling water, cook for 15 minutes. Take a glass 3 times a day, a course of 2 weeks, a break between courses of at least 2 weeks.
Schisandra chinensis fruits. Consume one berry three times a day for two weeks. Break 2 weeks. Lemongrass fruits also effectively dilate peripheral vessels.

Important remember that Raynaud's syndrome can be a sign of a more serious condition, so before you begin to treat the symptoms, be sure to full examination see a doctor, and only after that you can start treatment with herbs. If you are taking medication, check with your doctor if there are any contraindications for any of the herbs.

Prevention

For people prone to this syndrome, the following procedures can be advised as a preventive measure:

Cold and hot shower. With reduced vascular tone, this procedure is necessary, it restores the process of thermoregulation, strengthens the walls of blood vessels, and also strengthens the overall immunity of the body and resistance to colds.
Walking barefoot. A very useful habit that strengthens the vessels of the legs. In winter, walk without slippers around the house, and in summer do not wear shoes in nature.
Massage. Do a daily massage of the feet and fingers, you can use olive oil, sea buckthorn oil or oil infusions of vasodilating herbs for this purpose.
Warm. In the cold season, to avoid aggravation, dress warmer. In winter, wear warm mittens and shoes with an airy layer. When leaving the house in cold weather, drink hot tea or eat, so you will freeze less.
Cigarettes and alcohol. You should definitely quit smoking, do not drink alcoholic beverages. Nicotine and alcohol sharply constrict blood vessels, which adversely affects the blood supply to the small terminal capillaries of the fingers and toes.
Glycerol. To make your hands less chilly, before going outside, lubricate them with glycerin and water, mixed in a one-to-one ratio.
Fish fat. Capsules are good for prevention. fish oil. Take the course for at least three months.