Raynaud’s phenomenon is a spasm of narrowing of the arteries supplying the extremities induced by cold temperatures or emotional stress, resulting in a lack of circulation at the extremities of the limbs, which may be accompanied by local pain, numbness, chills, and burning sensations that may last for several seconds to several decades. The symptoms may return to normal after warmth or emotional recovery.
The symptoms are most common in the fall and winter and affect mostly females between the ages of 20 and 40. The affected areas are mostly the fingers, but the toes, ears, and tongue may also be affected.
Raynaud’s phenomenon is most often secondary to other clearly diagnosed diseases, most often rheumatologic diseases, but can also be found in such diseases as tuberculosis and neurologic diseases, when it is often referred to as “Raynaud’s syndrome” or “secondary Raynaud’s phenomenon. If a patient presents with only an isolated Raynaud’s phenomenon and no evidence of a specific disease causing Raynaud’s phenomenon can be found after a thorough search for possible disease factors, the patient is said to have a “primary Raynaud’s phenomenon” and is also often referred to as “Raynaud’s disease” or “Raynaud’s disease. “Raynaud’s disease”.
Types
A typical Raynaud’s phenomenon attack is divided into three phases: the hypoxic, anoxic, and congestive phases.
- The hypochondriac phase: Early in the disease, the skin on the tips of the fingers or toes is suddenly cold and pale, and the patient feels pain or numbness, often in symmetrical episodes, starting at the ends of the fingers and progressing to the palms, usually no further than the wrists.
- Hypoxic phase: Continued lack of oxygen at the site of the attack causes dilated and stagnant colored colored wolves, making the skin purplish and painful and lowering the skin temperature, but the symptoms are usually mild.
- In the long term, if the patient is warm, he or she will experience flushing of the skin, a return to temperature, and a self-induced burning and swelling pain.
- Sympathetic Raynaud’s phenomenon: associated with abnormal sympathetic nervous system function, often accompanied by autonomic nervous system symptoms, such as excessive sweating, insomnia, headache, and palpitations.
- limited scleroderma-type Raynaud’s phenomenon: this type is often accompanied by skin sclerosis, skin atrophy and other symptoms, mostly seen in patients with systemic sclerosis.
- Idiopathic Raynaud’s phenomenon: It refers to Raynaud’s phenomenon of unknown cause, without other disease manifestations, but the symptoms during the attack are similar to those of typical Raynaud’s phenomenon.
- Alcoholic Raynaud’s phenomenon: This is a Raynaud’s phenomenon caused by alcohol consumption or cold after alcohol consumption and is related to the sympathetic nervous system.
- What are the signs of Raynaud’s phenomenon?
- Who is prone to Raynaud’s phenomenon?
- Is there a way to prevent Raynaud’s phenomenon?
- Does Raynaud’s phenomenon have long-term effects on the body? In some cases, prolonged untreated or poorly controlled Raynaud’s phenomenon can lead to complications such as skin ulcers, infections and even tissue necrosis (gangrene). However, with proper treatment and management, these complications can be avoided.
- Is there a link between Raynaud’s phenomenon and other diseases? Raynaud’s phenomenon is usually associated with certain connective tissue diseases, such as systemic sclerosis (scleroderma) and lupus, as well as other autoimmune diseases. It may also be associated with other diseases, such as carpal tunnel syndrome and thyroid disease. It is important to discuss any underlying conditions or potential risk factors with your healthcare professional.
- Disease factors
- Connective tissue diseases: Most commonly, these include systemic sclerosis, systemic lupus erythematosus, dry spell syndrome, and cold-spherical whiteheadedness maladaptive wolframy, especially in patients with systemic sclerosis of the New Year disease, where the incidence of Raynaud’s phenomenon can be as high as 90% or more.
- Circulatory diseases: These include acute arterial obstruction, atherosclerosis, and thrombotic vasculitis, as well as primary pulmonary arterial hypertension.
- Diseases of the nervous system: including spinal cord diseases such as poliomyelitis, spinal cord cavernosum, spinal cord tumors, as well as carpal tunnel syndrome and some intervertebral disc diseases.
- Diseases of the electrical system, including increased condensate in the electrical fluid, macroglobulin, cold fibrinogen conservancy, and myeloproliferative diseases
- Smoking and certain medications: Regular smoking and certain medications, such as beta-blockers for hypertension, may also increase the risk of Raynaud’s phenomenon.
- Drug Factors
- Environmental Factors
- Modes of life
- Repetitive vibratory motion: Engaging in repetitive vibratory tasks, such as typing, playing the piano, and operating a hammer, can cause shock damage to the peripheral armature, limiting the supply of nonexistent oxygen to the extremities by limiting their supply, thereby triggering Raynaud’s phenomenon.
- Smoking: Smoking increases the risk of Reynaud’s phenomenon by causing constriction of the heart valves.
- Departments for consultation
- Rheumatology and Immunology: If you have sudden onset of pale, colorful, or flushed skin on the fingertips or other peripheral parts of the body, with pain and lowered skin temperature, you should go to the Rheumatology and Immunology Department.
- Surgery of the heart: When a patient is not responding well to medications and requires manual therapy, he or she is recommended for referral to surgery of the heart. Rheumatology is usually the first choice for patients with Raynaud’s phenomenon, especially if the symptoms are severe or prolonged. A rheumatologist can perform a thorough evaluation and recommend an appropriate treatment plan. If surgery is required, the patient may be referred to surgery for further evaluation and treatment.
- Hematology: to check for circulatory problems
- Neurology: to check for neurological problems causing Raynaud’s phenomenon
- Dermatology: treats skin problems such as pain and ulcers caused by Raynaud’s phenomenon
- Rehabilitation: treats muscle and motor problems such as stiffness, pain, etc. caused by Raynaud’s phenomenon
- Related examinations
- Medical examination:
- Examination of the skin color of the affected fingers, the presence of ulcers, gangrene, etc., to help the physician diagnose and determine the severity of the disease.
- Examine the arterial pulsations and bilateral pressures in the affected limb to determine whether the patient has circulatory disturbances and arterial disease.
- Examination of the skin of the extremities and torso for tightness, loss of wrinkles, and other skin changes such as dilated skin, skin erythema, and hair loss may help diagnose whether other diseases are responsible.
- Blood tests: Check indicators such as red blood cell count, hemoglobin and white blood cell count to assess the patient’s level of anemia.
- Hemodynamic examination: such as Doppler ultrasound, which allows observation of blood flow, determination of vasoconstriction and dilation, and exclusion of vascular stenosis, vascular obstruction, etc.
- Neurological function examination: such as neurophysiological examination, which can assess whether the nerve function is normal and thus determine the presence of neuropathy.
- Other imaging tests: such as X-rays, CT, MRI, etc., can help doctors understand the condition of blood vessels, nerves and other tissue structures to determine the cause and extent of the lesion.
- Laboratory Tests
- Routine wolves: Ruling out some of the diseases of the wolivine system as well as inflammatory diseases.
- Urine Routine: A urine routine + urine sediment test may need to be completed. If urine egg white or red blood cells are present, consideration needs to be given to whether this is a local manifestation of systemic disease.
- Erythrocyte sedimentation rate (ESR): Screen for the absence of systemic inflammation and autoimmune diseases.
- Multiple autoantibody tests: help behind the diagnosis of the true cause.
- Other tests
- Cold water test:Immersion of the patient’s hands in cold water at about 4°C for 1 minute may induce pale, purple, flushed, and painful fingers. While this method is simple and easy to use to help diagnose the condition and to assess the effectiveness of treatment, the cold water test should be used with caution in patients with high blood pressure and heart disease because cold water immersion may cause an increase in blood pressure and may exacerbate these conditions. Therefore, it is important to consider the patient’s overall health and medical history before performing the test.
- Microcirculation examination of the nailfold: Normal mythical collaterals are clear, well aligned, uniform in size, with a red-red base and smooth flow.
- Finger temperature recovery time measurement: The temperature of the fingers at room temperature is first recorded, then the hands are immersed in ice water for 20 seconds, and then the time for the eyes of the fingers to recover to normal temperature is recorded. The recovery time for normal finger temperature is less than 15 minutes, while the recovery time for Raynaud’s phenomenon is more than 20 minutes. This test can be used to help diagnose the condition and to assess the effectiveness of treatment.
- Fist clenching test: When both hands are clenched for 90 seconds and the fingers are pale, purple, flushed and painful after releasing the fingers, it can help in diagnosis.
- Finger artery pressure measurement: A finger artery pressure greater than 40 mmHg indicates arterial obstruction and is useful in the diagnosis of this condition.
- Finger arteriography and hypothermia (after immersion in ice water) finger arteriography: This is useful in the diagnosis of Raynaud’s phenomenon by providing a picture of the arteries in the fingers, and also shows whether there is an organic lesion in the artery.
- The first step is to confirm whether the patient is experiencing Raynaud’s phenomenon.
- Disease Diagnosis
- Systemic sclerosis: An autoimmune disease in which patients often have visual impairment, limb weakness, sensory abnormalities, and incoordination of limb movements. The diagnosis is made when the patient meets the following four criteria: two or more lesions in the white matter of the central system; the patient is 10 to 50 years of age; the patient alternates between remission and relapse with episodes lasting more than 24 hours, or the disease progresses slowly and gradually for more than one year; and other causes are excluded.
- Systemic lupus erythematosus: An autoimmune connective tissue disease that often involves multiple tissues and organs throughout the body and presents with a wide range of symptoms, typically including butterfly erythema, fever, malaise, and arthralgia.
- Also known as thromboembolic vasculitis, Buerger’s disease is a rare inflammatory disease involving small and medium-sized blood vessels in the extremities. It is commonly seen in young people who smoke and can cause pain in the fingers and toes, skin ulcers and gangrene. The diagnosis is based on clinical presentation and angiography, which shows narrowing and occlusion of small and medium-sized arteries in the extremities. It is important to rule out other causes of peripheral arterial disease (such as atherosclerosis) before diagnosing Buerger’s disease.
- Arterial embolism and thrombosis Arterial embolism and thrombosis are complications in which a blood clot or other substance blocks blood flow in an artery, leading to tissue damage and potentially life-threatening conditions. Symptoms may include sudden onset of pain, numbness and discoloration in the affected limb. Diagnosis is based on imaging tests such as Doppler ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA), which show the presence of a clot or other obstruction in the affected artery. Blood tests may also be performed to check for potential clotting disorders.
- Peripheral artery disease Peripheral artery disease (PAD) is a common condition in which the arteries supplying blood to the legs and feet become narrowed or blocked, resulting in pain, spasm, and weakness in the affected limb. Diagnosis is based on physical examination, ankle-brachial index (ABI) testing and imaging studies (such as ultrasound or angiography) showing narrowing or blockage of the affected artery. Other tests, such as blood tests or exercise tests, may also be performed to assess the severity and extent of the disease.
- The grid-shaped metallic spots: the disease may appear on the head, neck, extremities and trunk, mostly on the lower extremities, and in severe cases on the entire extremities, but less frequently on the hands alone. In primary cases, the only symptoms are chills and unpleasant sensations due to the disease; in secondary cases, the clinical manifestations of the primary disease are present. It can usually be distinguished from Raynaud’s phenomenon by its location and morphology.
- Erythromelalgia: The clinical picture is often one of symmetrical, paroxysmal redness, swelling, heat, and pain in the hands. The hands may be adequately affected, but both sufficiencies are common and pronounced. Patients often feel burning pain when the temperature of the area becomes elevated. This condition can be differentiated from Raynaud’s phenomenon by whether the patient is sensitive to warmth or cold.
- Peripheral arterial disease (PAD)
- Primary Raynaud’s disease: similar to Raynaud’s phenomenon but without an obvious primary cause, patients may have a family history of the disease, mostly seen in females.
- Extra-fascial fat necrosis: Mostly seen in obese women, pain is mainly in the lower extremities, the skin surface is purplish or red, there may be pressure pain, easily confused with Raynaud’s phenomenon.
- Thrombo-occlusive vasculitis: Patients present with cold, painful, numb extremities with skin color changes and ulcers on the extremities.
- Vasculitis: autoimmune diseases such as systemic lupus erythematosus and scleroderma may present with Raynaud’s phenomenon.
- Atrophic osteoarthritis: Patients present with atrophy and deformation of the fingers or toes, which may be accompanied by Raynaud’s phenomenon.
- Lifestyle changes: Patients should avoid exposure to cold temperatures and wear protective clothing, such as gloves, socks and scarves. They should also avoid smoking, as smoking constricts blood vessels.
- medications: calcium channel blockers such as nifedipine can relax blood vessels and improve blood flow. alpha-blockers such as prazosin can also help relax blood vessels. Topical nitroglycerin can be used to dilate the blood vessels in the affected area. In severe cases, intravenous prostaglandins may be used to increase blood flow.
- sympathectomy: In rare cases, surgical sympathectomy may be performed to sever the sympathetic nerves that control vasoconstriction.
- Biofeedback: Biofeedback techniques can be used to help patients learn to control their body’s response to stress and reduce symptoms.
- drug therapy: mainly use vasodilators, such as calcium channel blockers, alpha-blockers, phosphodiesterase inhibitors, etc., to increase the blood flow of peripheral blood vessels and reduce the degree of arterial spasm.
- Physical therapy: such as heat therapy, electrotherapy, physiotherapy, etc., which can promote blood circulation and relieve symptoms such as muscle tension and pain.
- Biofeedback therapy: Through computerized monitoring and correction of the patient’s physiological response, vascular tone and blood flow are regulated, thus relieving symptoms.
- Surgical treatment: For patients with severe Raynaud’s phenomenon, such as necrosis and ulceration, surgical treatment, such as arterial stenting and sympathectomy, may be required.
- Home treatment
- Temperature care: You should leave the cold environment as much as possible and warm areas such as fingers or toes with a gentle method such as exercise, massage, wrapping the affected area or soaking the affected area in warm water to relieve symptoms. Try not to move immediately from a hot environment to an air-conditioned room and avoid exposure to frozen food areas.
- Moderate Exercise: Exercise increases circulation and provides general health benefits, so patients should maintain moderate exercise. However, it is important to consult a physician and keep warm before exercising outdoors in cold environments.
- Managing stress: If caused by emotionally stressful stimuli, patients should try to regain calm while learning to recognize and avoid stressful situations, which may help control the number of attacks.
- Smoking cessation: Cigarette smoking or second-hand smoke can constrict the heart and trigger Raynaud’s phenomenon, so patients should quit smoking immediately.
- Wear warm clothing: It is recommended to wear extra layers, warm gloves, socks and shoes when going out in cold weather.
- Avoid caffeine and certain medications: Caffeine and certain medications (e.g., decongestants and beta-blockers) can cause vasoconstriction and worsen Raynaud’s phenomenon. If needed, patients should consult their physician to adjust their medication regimen.
- Practice relaxation techniques: Stress can trigger Raynaud’s attacks, so practicing relaxation techniques (such as deep breathing, meditation, or yoga) may help control stress and reduce the number of attacks.
- Use hand warmers: Hand warmers, such as heated gloves or disposable hand warmers, can provide additional warmth to the hands and help prevent attacks.
- Maintain a healthy lifestyle: A balanced diet, adequate sleep, and management of other underlying medical conditions can also help improve overall health and reduce the frequency and severity of Raynaud’s attacks.
- Avoid wearing tight-fitting clothing or clothing that tightly binds the affected area, as this may interfere with blood circulation.
- Avoid using heating devices such as overheated water bottles or electric blankets, as this may cause burns.
- Sufficient water and calorie intake should be maintained, and more foods rich in vitamin B and C should be eaten to promote blood circulation and keep the body healthy.
- Pay attention to maintain sufficient sleep and rest time to avoid overexertion and physical weakness.
- Professional treatment (symptomatic treatment)
- Drug therapy.
- Calcium channel blockers: For those who do not yet have atrophy of the fingertips, which causes dilation of the motorized lymphatic vessels, such as nifedipine.
- Drugs affecting sympathetic nerve activity: In those with atrophy of the fingertips but no open ulcers, these drugs, such as guanethidine and prolotherapy, should be used in addition to calcium channel blockers.
- Prostaglandins: Used for severe deficiency, colorful skin, open finger (toe) ulcers or necrosis, this drug can be given intravenously for 3 to 5 days to dilate the heart, and many other forms are available.
- Surgical treatment
- Sympathetic ganglionectomy: By making a small incision in the hand or foot, sympathetic nerves are removed from around the skinned tubes, blocking their control over opening and narrowing of the skinned tubes and reducing the frequency and duration of symptomatic episodes.
- Sympathetic Nerve Closure: Sympathetic nerves are blocked by injections of anesthetic or gonadotoxin type A, which may be repeated depending on the condition. Postoperative care of the incision is necessary to avoid serious complications due to secondary infection.
- Treatment of the cause
- Systemic sclerosis: Treatment mainly includes the acute and remission phases, in addition to symptomatic treatment.
- Systemic lupus erythematosus: immunosuppression is the main drug treatment option for this disease. High-dose adrenal corticosteroids and other options are available in cases of severe disease and treatment difficulties. Treatment of concomitant diseases, such as high blood pressure, diabetes, and osteoporosis, should also be emphasized.
- Rheumatoid arthritis: Treatment consists mainly of medications such as non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and biologics. Lifestyle changes, such as exercise, healthy eating and stress management, can also help improve symptoms.
- Daily life
- Drinking
- Lifestyle Habits
- Smoking cessation: Smoking triggers Raynaud’s phenomenon by constricting the lungs, so strict cessation and avoidance of second-hand smoke is warranted.
- Warmth: Keep the torso and extremities warm and dry. For example, avoid entering cold areas such as air-conditioned rooms from places with high temperatures; stay away from frozen food areas; wrap knitted gloves around cold hands; wear gloves or thicker socks if necessary; and prevent sudden contraction of the peripheral consciousness to trigger Reynolds’ phenomenon.
- Regular exercise: Moderate exercise dilates the lungs and improves circulation, so patients should maintain regular, but gradual, exercise in a measured manner.
- Emotional management: Emotional stress may trigger Raynaud’s phenomenon, so patients should train to be as calm as possible.