RAYNAUD’S PHENOMENON AND DISEASE

HAMAD EMAD H. DHUHAYR

RAYNAUDS DISEASE

•Raynauds disease is the intermittent arteriolar vasoconstriction that results in coldness,pain and pallor of finger tips or toes.

• The term raynauds phenomenon is used to refer to localized intermittent episodes of vasoconstriction of small arteries of the feet and hands that cause color and temperature changes.Generally unilateral. Aggressive.

INCIDENCE

• Most common among patients between 16 and 40 years of age and it occurs more frequently in cold climates and during the winter.

TYPES

• Primary :

Without any underlying disease or medical problem

• Secondary :

Caused by underlying problem

ETIOLOGY• Immunologic disorders

• Scleroderma

• Systemic lupus erythematosus

• Rheumatoid arthritis

• Obstructive arterial disease

• Trauma

• Certain medicines (BETA BLOCKERS)

• Sjogrens syndrome

• Carpel tunnel syndrome

• Diseases of arteries

• Chemical exposure

• Thyroid gland disorders (HYPOTHYROIDISM)

• Stress

RISK FACTORS

• Primary

• Age

• Gender

• Family history

• Climate

• Secondary

• Associated diseases

• Certain occupations

• Exposure to certain substances

PATHOPHYSIOLOGY• Due to etiological factors

• Vasospasm and spastic constriction of arteries and arterioles

Retarted blood flow to capillaries and venules

• Cyanosis

• After a period of minutes and hours local ruber occurs

• Throbbing pain accompanies with recovery

CLINICAL FEATURES OR RAYNAUD’S• Primarily affects fingers

• Can affect toes, thumbs, nipples, nose, earlobes

• Episodes precipitated by cold exposure and emotional stress

• Episodes accompanied by pain +/- numbness

• Pulses present

• Necrosis / tissue damage suggestive of secondary cause

Initial ischaemia

Pallor

Cyanotic phase

Blue

Hyperaemic phase

Red / purple

MEDICAL MANAGEMENT

•Avoiding trigerring factors like cold and tobacco etc is a primary in controlling raynauds disease

•Calcium channel blockers (nifedipine)

•Sympathectomy

• Interrupting the sympathetic nerves by removing sympathetic ganglia or dividing their branches may help some patients.

• You teaches patients to avoid situations that may be stressful or unsafe. Stress management classes may be helpful.

• Exposure to cold must be minimized, and in areas where the fall and winter months are cold, the patient should remain indoors as much as possible and wear layers of clothing when outdoors.

• Hats and mittens or gloves should be worn at all times when outside. Fabrics specially designed for cold climates (eg, thinsulate) are recommended.

• Patients should warm up their vehicles before getting in so that they can avoid touching a cold steering wheel or door handle, which could elicit an attack. During summer, a sweater should be available when entering air-conditioned rooms.

• Concerns about serious complications, such as gangrene and amputation, are common among patients that should be informed

• Patients should avoid all forms of nicotine; the nicotine gum or patches used to help people quit smoking may induce attacks.

• Patients should be careful about safety.

• Sharp objects should be handled carefully to avoid injuring the fingers.

• Patients should be informed about the postural hypotension that may result from medications, such as calcium channel blockers, used to treat raynaud’s disease.