Raynaud's disease

Introduction to Raynaud's disease Raynaud syndrome refers to paroxysmal spasm of the extremity artery. It is often caused by factors such as cold irritation or emotional agitation, which is characterized by intermittent pale, purpura and flushing changes in the skin color of the extremities. Generally, the upper limbs are heavier and occasionally seen in the lower limbs. basic knowledge The proportion of illness: the incidence rate is about 0.02% - 0.07% Susceptible people: no specific population Mode of infection: non-infectious Complications: osteomyelitis sepsis

Cause of Raynaud's disease

1, the central nervous system dysfunction, so that sympathetic nerve function.

2. The levels of adrenaline and norepinephrine in the blood circulation are increased.

3, the condition is often aggravated in the menstrual period, the gestation period is reduced, so some people think that it is related to endocrine.

4, the defects of the limb arteriole itself, caused by excessive reaction to normal physiological phenomena.

5. Some people think that the early stage is that the aortic arterioles have an overreaction to the cold. Later, due to long-term vasospasm, the intima of the arteries is proliferated and the blood flow is not smooth. If there is any reduction in the blood flow of the aortic arterioles, A physiological factor can act on the diseased artery to cause an attack.

6, patients often have a family history, suggesting that may be related to heredity.

7, immune and connective tissue diseases, such as systemic lupus erythematosus, scleroderma, nodular polyarteritis, dermatomyositis, rheumatoid arthritis, polymyositis, mixed connective tissue disease, hepatitis B antigen Vasculitis, vasculitis caused by drugs, and Sjogren syndrome.

8, obstructive arterial disease, such as occlusive arteriosclerosis, thromboembolic vasculitis.

9, physical factors, such as shock damage, direct arterial trauma, cold damage.

10, caused by certain drugs, such as ergot, lead, bismuth, arsenic and other poisoning, polyvinyl chloride, -blockers, cytotoxic drugs, contraceptives and so on.

11. Factors affecting neurovascular mechanisms such as cervical ribs, anterior scalene muscle syndrome, thoracic, exit syndrome, improper use of crutches, compression of the ankle, tumor compression of the brachial plexus and subclavian vessels, cervical spondylitis or nucleus pulposus rupture, peripheral nerves Inflammation, syringomyelia or spinal cord spasm.

12, increased blood agglutinin or cryoglobulinemia, polycythemia vera, paroxysmal hemoglobinuria and so on.

13. Some are associated with migraine and varicose angina.

Reynolds disease prevention

Avoid cold irritations and emotional excitement; avoid smoking; avoid the use of ergotamine, beta-blockers and birth control pills; those who are obviously caused by occupational reasons (long-term use of vibrating tools, work at low temperatures) should be changed as much as possible, careful Protect your fingers from trauma, and cause fingertip ulcers or other nutritional diseases due to minor injuries. Drinking a small amount of alcoholic beverages in daily life can improve symptoms. If conditions permit, people can move to a mild climate, dry areas, and reduce symptoms. Relieving the patient's mental concerns and maintaining optimism are all important measures in prevention.

Raynaud's disease complications Complications osteomyelitis sepsis

Reynolds disease can occlude small blood vessels, resulting in ischemic necrosis of the fingertips. In severe cases, the fingertips may flatten and the gangrene may be necrotic due to ischemia, absorbed, dissolved, shortened or Intercept finger phenomenon, in some patients with low resistance, ulceration of fingertips may cause osteomyelitis, sepsis and other diseases, which is the most serious complication of this disease, the correct and timely application of anti-infective drugs can help Prevent these complications from occurring.

Symptoms of Raynaud's disease Common symptoms Skin pale skin Blue-purple change Hand skin Purple skin pain Hand back skin redness and swelling Nail highlights skin of blue-purple limbs... After sleeping, fingers appear hemp... Finger cyanosis or necrotic nail bed bun

Patients often suffer from cold or finger contact with hypothermia, but also because of emotional excitement and mental stress. The characteristic of the attack is that the skin color of the (toe) part suddenly turns white, then turns into cyanosis, and then turns into flushing, which is intermittent. It is rare to see the fingers and the toes are rare. The seizure often starts from the little finger and the ring fingertips, and gradually spreads to the entire finger or even the palm as the lesion progresses, but the thumb is less ill, accompanied by local chills, numbness, tingling and soreness discomfort or other abnormal sensations. There was a decrease in systemic and local temperature, but the radial or dorsal artery pulsation was normal. At the time of initial onset, the onset time is usually a few minutes to half an hour or so. When the skin turns into flushing, it is often accompanied by a burning tingling sensation and then turns into a normal color. If the topic is warmed during the attack, rubbing the affected limb, swinging the limb, etc., the attack can be suspended. When the disease progresses, the symptoms are aggravated and the attacks are frequent. Each episode lasts for more than one hour. Sometimes it is necessary to immerse the hands and feet in warm water to stop the attack.

Examination of Raynaud's disease

(1) Laboratory inspection

Antinuclear antibodies, rheumatoid factor immunoglobulin electrophoresis, complement values, anti-natural DNA antibodies, condensed globulin, and Combs tests suggesting systemic connective tissue disease should be routinely examined.

(2) Special inspection

Cold excitation test

After the finger is cooled by the cold, the time required for the finger circulation to return to normal is traced by photoplethysmography (PPG). As a simple and reliable, non-invasive method for estimating the fingertip circulation, the patient should sit quietly during the test. After indoors (room temperature 26 ± 2 ° C) for 30 minutes, use PPG to trace the finger end cycle waveform, immerse both hands in ice water for 1 minute, wipe dry immediately, then trace the finger cycle every minute for 5 minutes, the normal person's finger end cycle Recovering to baseline within 0 to 2 minutes, in patients with Raynaud's syndrome, the time required for the fingertip circulation to return to normal is significantly prolonged (more than 5 minutes). The normal human fingertip arterial wave is bidirectional, that is, it has a main peak wave and a heavy wave. However, in patients with Raynaud's syndrome, the arterial wave is unidirectional, the peak is low, blunt and flat, and even disappears. This test method can also be used to evaluate the therapeutic effect. If the patient's symptoms improve after administration, the fingertip cycle recovery time will be shortened.

2. Finger humidity recovery time measurement

After the finger is cooled down, the thermistor probe is used to measure the time required to return to normal temperature. It is used to estimate the blood flow of the finger. It provides an objective argument for the diagnosis of Renault. 95% of normal people's finger temperature recovers within 15 minutes. By baseline, and in most patients with Raynaud's syndrome, it takes more than 20 minutes for the finger temperature to return to normal. This test can also be used to estimate treatment outcome.

3. Finger angiography

If necessary, upper extremity angiography to understand the condition of the finger artery can help to determine the diagnosis of Raynaud's syndrome, and also to show whether the artery has organic lesions. Arteriography is not only a method of injury, but also complicated. Therefore, it is not suitable for routine inspection.

In a special examination, the nerve conduction velocity of the upper limbs was measured to find possible carpal tunnel syndrome, and the hand X-ray film was helpful for finding rheumatoid arthritis and finger calcification.

Diagnosis and diagnosis of Raynaud's disease

1, good hair in the 20 to 40 years old character introverted.

2, cold or emotional can induce the occurrence of Raynaud's phenomenon.

3. Both sides are involved.

4. The arterial pulsation in the affected area is normal.

5, generally no tissue necrosis, or only minimally referred to subcutaneous necrosis in the late stage, usually only limited to the fingertips.

6. No other system can explain.

7, the course of disease is more than 2 years.

Care should be taken to distinguish from other vascular dysfunction diseases characterized by skin color changes.

(a) hand and foot cyanosis

It is a vasospasm disease caused by autonomic dysfunction. It is more common in young women. The skin of the hands and feet is symmetric and uniform, and the cold can make the symptoms worse. It is often accompanied by skin scars or autonomic dysfunction such as sweating of hands and feet. The pathological changes are persistent iliac arteries and capillary and varicose veins, which need to be differentiated from Raynaud's syndrome. There is no typical skin color change in patients with hand and foot carbuncle. The range of sputum purple is wide, involving the entire hand and foot, and even Involving the entire limb, purpura lasts for a long time, although the cold can make the symptoms worse, but in the warm environment often can not immediately relieve the symptoms, or disappear, emotional hormones and mental stress generally do not induce the disease.

(two) reticular bluish

Mostly female, due to small arterial spasm, capillary and venous tension-free expansion, the skin is persistent reticular or spotted purpura, lesions occur in the lower limbs, occasionally involving the upper limbs, trunk and face, often with cold limbs , numbness and paresthesia, blemishes in cold or sagging limbs, in the warm environment or after raising the limbs, the markings are reduced or disappeared, clinically can be divided into marble-like skin spots, idiopathic reticular leukoplakia and symptomatic Three types of reticular bluish.

(three) erythema limb pain

The etiology is still unclear. The pathological changes are symmetry of the extremities, and the vasodilatation of the aging is more common in young women. The onset is rapid, the two feet are at the same time, and even the hands can be involved. Symmetrical paroxysmal severe burning, foot. When the temperature exceeds the critical temperature (about 33 ~ 34 ° C), if the foot is in the warm bedding, the pain can occur, mostly burning, but also tingling or pain, limbs drooping, standing, exercising It can induce pain episodes, raise the affected limbs, rest or expose the feet to the outside of the bedding. The pain can be relieved. When the symptoms appear, the skin color of the feet is flushed with red blood, the skin temperature rises with sweating, and the dorsal and posterior tibial artery Stroke enhancement, according to the present characteristics, easy to be similar to Raynaud's syndrome, a small number of erythematous limb pain can be secondary to polycythemia or diabetes.

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