Raynaud's disease

Introduction to Raynaud's disease Raynaud syndrome refers to the paroxysmal spasm of the extremity artery, which is often affected by factors such as cold stimulation or emotional agitation. It is characterized by intermittent pale, purpura and flushing of the skin color of the extremities. Occasionally seen in the lower limbs. Reynolds syndrome is not uncommon in clinical practice. It is more common in women. The proportion of males and females is about 1:10. The age of onset is between 20 and 30 years old, and rarely exceeds 40 years old. Most of them are found in cold regions, which are good for the cold season. basic knowledge Sickness ratio: 0.0001% Susceptible people: good for people between 20 and 30 years old Mode of infection: non-infectious Complications: osteomyelitis sepsis

Cause of Raynaud's disease

Cold stimulation (20%):

Patients are particularly sensitive to cold stimuli. Most patients with winter morbidity or cold stimuli can induce symptoms, and symptoms can be relieved spontaneously in summer. Critically ill patients are particularly sensitive to changes in temperature, even in summer. The disease has a high incidence rate in northern China.

Immunity and connective tissue disease (15%):

In most patients with Raynaud's syndrome, abnormal serum immunological tests suggest that there is an antigen-antibody complex in the serum of the patient, which can directly or indirectly act on the sympathetic nerve to cause vasospasm. In addition to autoimmune diseases, patients with connective tissue diseases often also have Raynaud's syndrome.

Endocrine disorders (15%):

The disease is more common in women, accounting for 70% to 90%, and the symptoms are aggravated during menstruation and the symptoms during pregnancy are alleviated. When the drug adjusts the endocrine disorder, the symptoms of the patient can be significantly alleviated.

Arterial obstructive disease (15%):

Such as arteriosclerosis, thromboangiitis obliterans, thoracic outlet syndrome and hypercoagulable state, polycythemia vera, paroxysmal hemoglobinuria, chronic renal failure, central or peripheral nervous system diseases, etc., may lead to or accompany Raynaud's syndrome.

Special living and working environment (10%):

Workers of some types of work, the small arteries of the fingers have chronic shock wounds. In addition, Raynaud's syndrome can occur in direct arterial wounds, frostbite, chronic low temperature injury, and the like.

Drug-induced factors (10%):

Such as ergot, beta adrenal blockers, oral contraceptives, etc. can cause or aggravate Raynaud's syndrome.

Nerve excitation (10%):

The incidence of many patients is related to mood swings and mental stress. The levels of adrenaline and norepinephrine in the blood of patients were significantly increased at the time of onset.

Raynaud's disease prevention

(1) Identify the cause of the disease, and the secondary should control the primary disease as much as possible.

(2) General control measures: cold and warm, try to avoid exposure to cold air or cold water and cold objects; avoid all kinds of damage; drink a small amount of alcohol to increase blood circulation, do not smoke to prevent nicotine from stimulating vasoconstriction; easy to excite or easy Impulsive patients should be more comforted to relieve their ideological concerns or to properly apply sedative and tranquil drugs.

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 be flattened and gangrene, and the distal phalanx may be necrotic, absorbed, dissolved, and shortened or intercepted due to ischemia. In some patients with low resistance, ulceration of fingertips may lead to diseases such as osteomyelitis and sepsis. This is also the most serious complication of this disease. Correct and timely application of anti-infective drugs can help prevent these complications. happened.

Symptoms of Raynaud's disease Common symptoms After the yellow skin of the toe skin, the purple and black hands and feet are numb fingers or arm thorns...

After the patient is often cold or emotional, the color of the finger skin suddenly turns pale, and then purple, the attack often starts from the fingertips, and then spreads to the entire finger, even the palm, accompanied by local chills, numbness, acupuncture And the feeling subsided, after a few minutes, gradually turned into flushing, the skin turned warmer, and before the burning sensation, the skin color returned to normal, hot drink or drinking, after warming the limbs, often relieve the attack, generally, after the cold stimulation The skin color from the pale, cyan, flushing stage to the time of return to normal is as large as 15 to 30 minutes. A few patients begin to appear cyanotic without pale phase, or after pallor, they turn into flushing, no bruising, and the brachial artery during attack The pulsation is not weakened, and there is no other symptom except for the finger skin temperature is slightly cold and the skin color is slightly pale.

The onset of the disease is generally seen in the fingers, but also in the toes, even involving the ears and nose. Symptoms of the symptoms are another important feature of Raynaud's syndrome. For example, the little finger and ring finger on both sides are often the first to be affected, and then extend to the index finger and middle finger. The thumb is rarely affected by the blood supply. The extent of the color change of the skin on both sides of the finger is the same. A small number of patients are initially unilaterally and later turned to both sides.

The course of the disease generally progresses slowly. A small number of patients progress faster, have frequent episodes, have severe symptoms, and have swelling of the fingers. Each episode lasts for more than 1 hour, the ambient temperature is slightly lowered, and the emotion is slightly excited, which can be induced even if it is warm. The seasonal symptoms did not disappear, and nutrient changes occurred at the fingertips. For example, the nail deformity was brittle, the pad was atrophied, the skin was thin, the wrinkles disappeared, and the nail tip ulcer or gangrene was absent, but the radial artery was not weakened.

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

1. Cold-excitation test: After the finger is cold-cooled, the time required for the finger circulation to return to normal is traced by photoplethysmography (PPG), which is a simple, reliable and non-invasive method for estimating the finger-end circulation. The patient should sit quietly indoors (room temperature 26±2°C) for 30 minutes, use PPG to trace the fingertip cycle waveform, immerse both hands in ice water for 1 minute, dry immediately, and then trace the finger cycle every minute for 5 minutes. The normal fingertip cycle returns to the 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), and the normal human arterial wave is bidirectional, ie With main peak wave and heavy wave, the arterial wave of Renault syndrome 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 improves the symptoms after taking the drug, the fingertip cycle recovery time See shortening.

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

The diagnosis of Raynaud's disease (Raynaud's syndrome) is based on typical clinical manifestations:

1 seizure is induced by cold or emotional agitation;

2 bilateral symmetry attacks;

3 no necrosis or only a small finger (toe) end skin necrosis, combined with provocation test and finger arterial pressure measurement can identify sputum type and obstruction type; through special blood test, some patients can find the cause of the disease, the main sign and the hand and foot Hair palsy, reticular bluish, erythematous limb pain, and normal human exposure to cold air in the surface of the surface of the blood vessels are identified.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.