Treatment of Raynaud's disease: drug therapy, lifestyle correction

• What is Raynaud's syndrome?
• Causes and risk factors
• Signs of Raynaud's disease
• Diagnostics
• Treatment of Raynaud's phenomenon
• Prevention
• Popular questions

Raynaud's disease (syndrome, phenomenon) is an episode of transient digital ischemia due to vasoconstriction of the digital arteries, precapillary arterioles and cutaneous arteriovenous shunts under the influence of cold temperature and emotional stress. With this pathology, the arterial blood supply to the hands and/or feet is disrupted.

The disease is paroxysmal in nature and usually affects symmetrical limbs. The peculiarity of the vascular reaction is that it is inadequate to the stimulus, and over time it clinically only worsens Source: Alekperov R.T. Sildenafil in the treatment of Raynaud's syndrome / R.T. Alekperov // Scientific and practical rheumatology. - 2009. - No. 48 (3). — P. 38-45. .

In different countries, the prevalence of SR ranges from 2.1 to 16.8%. In countries with relatively cold climates, the incidence of CP is significantly higher than in countries with warmer climates. The peak incidence occurs at the age of 20-30 years. Among the patients, women predominate Source: Alekperov R.T. Raynaud's syndrome in the practice of a rheumatologist / R.T. Alekperov // Modern rheumatology. - 2014. - No. 2. - P. 37-46. .

Danilova Olga Andreevna

neurologist

Raynaud's disease is manifested by episodes of ischemia (circulatory failure) of the final parts of the upper extremities, which develop as a result of vascular spasm. Attacks develop when exposed to cold or stress. The main group of patients are young women. The disease is treated with conservative (vasodilator drugs) and surgical methods (sympathectomy). The operation is performed only if attacks of Raynaud's disease are too frequent, reduce the patient's quality of life, and lead to the formation of trophic ulcers on the hands.

Raynaud's disease

Raynaud's disease (or phenomenon) is a rare disease of the arteries and arterioles of the extremities.
It occurs in approximately 5% of the world's population, mainly in women aged 25–35 years. It is characterized by vasospastic (spontaneous) contraction of the walls of blood vessels, which causes circulatory disorders and contributes to the formation of a bloodless area, i.e. ischemia. With prolonged vasospasm of the arteries, Raynaud's disease is manifested by a change in the color of the tissues of the arms and/or legs (less commonly, the ears, tip of the nose, chin) - this is the main symptom of the disease. The lesion is symmetrical and bilateral. Raynaud's syndrome should be highlighted separately.
Unlike the disease, it always occurs as a complication of other vascular, endocrine or autoimmune diseases, often against the background of chronic scleroderma. It is characterized by an asymmetric manifestation of vasospasm and late development of specific symptoms.

Amen's test

1) Amen's test to detect occlusion of the branches of the radial artery or ulnar artery distal to the wrist. The patient clenches his fist to force the blood out of the hand. The doctor clamps the ulnar and radial arteries. The patient unclenches his fist, the hand remains pale. The doctor stops compressing the radial artery while continuing to compress the ulnar artery. If the radial artery distal to the site of clamping is patent, the hand quickly turns pink. If the patency of the radial artery is impaired, the hand remains pale. The patency of the distal branches of the ulnar artery is examined in the same way.

Possible reasons

The etiology has not been reliably established. The basis is probably a genetic predisposition.

The onset of the disease is provoked by the following risk factors:

• frequent and prolonged cases of hypothermia;
• frequent limb injuries;
• severe emotional stress.

Occupational factors and meteorological influences are of particular importance in the pathogenesis of Raynaud's disease, therefore the risk group includes:

• people living in damp and cold climates;
• chemical production employees;
• representatives of working professions (exposure to vibration, intense physical activity): timber harvesters, miners, milkmaids, etc.;
• pianists, typists (chronic overstrain of hands and fingers), etc.

Symptoms of Raynaud's disease

There are three stages of Raynaud's disease:

1. The first stage is characterized by a significant increase in the tone of the vascular walls, which causes a short-term spasm of the arteries. In response to cold or stress, the skin turns pale and an acute attack of pain occurs. After the negative factor ceases, the signs of Raynaud's disease disappear, the color of the hands and/or feet acquires a natural shade.
2. The second stage is characterized by the addition to the symptoms described above of swelling and numbness of the extremities, cyanosis and marbled skin color. The pain in stage 2 Raynaud's disease is intense and burning. Increases sensitivity to exposure to cold.
3. At the third stage, pain and bluishness of the skin are observed constantly. Trophic disorders appear in the form of ulcers on the fingertips and the formation of necrotic areas. Such wounds are difficult to treat because blood circulation in the limbs is impaired. This is fraught with the development of secondary infection and even sepsis. There is intolerance to low temperatures.

Raynaud's syndrome in men

If the signs are ignored and there is no treatment, Raynaud's syndrome progresses. During attacks, men and women experience common symptoms:

• pain syndrome, the development of which is preceded by insufficient blood supply to tissues and metabolic disorders;
• blanching of the skin is noted in the first minutes after the action of the provoking factor. Pale skin is associated with a sharp spasm of blood vessels and impaired blood circulation;
• a feeling of numbness and tingling that disappears after normalization of blood circulation;
• cyanosis of the skin appears after a pale color, which is explained by stagnation and blood filling of the veins;
• redness of the skin is caused by blood flow to the vessels that have experienced spasm.

Raynaud's syndrome, symptoms and treatment are similar in women and men, can develop with autoimmune rheumatic diseases. Rheumatologists at the Yusupov Hospital Therapy Clinic are engaged in scientific activities and study world experience in the treatment of Raynaud's syndrome.

Diagnostics

A preliminary diagnosis is established based on the patient's complaints. To confirm it, the following criteria are assessed:

• degree of circulatory impairment;
• symmetry of vasospasms;
• duration of symptoms characteristic of Raynaud's disease.

The following diagnostic methods are carried out: cold tests to study the reaction of the extremities to low temperatures and capillaroscopy to assess the degree of changes in the arteries of the extremities.

With the final conclusion, the doctor’s main task is to differentiate Raynaud’s disease from Raynaud’s syndrome, which can be a symptom of more than 50 different diseases.

Prevention

To prevent Raynaud's disease, medical experts recommend using contrast baths to train blood vessels. It is also necessary to eat properly and nutritiously, and not to overuse coffee, as it constricts blood vessels.

Avoid overheating; in cold weather, always wear gloves and dress appropriately for the weather.

Raynaud's disease should only be treated under the supervision of a qualified physician. You can get quality medical care in.

Treatment methods

The stage affects how Raynaud's disease is treated.

At stages I and II, conservative methods are prescribed. First of all, it is necessary to eliminate the factors that provoke the attack: cold, emotional overload, occupational hazards. In this regard, clinical recommendations for Raynaud's disease include a categorical cessation of smoking (nicotine increases arterial tone), normalization of the emotional background, exclusion of hypothermia and limb injuries, as well as a change of job if it is associated, for example, with vibrations or excessive physical exertion.

An attack of vasospasm should be relieved by warming the extremities. Warm baths, wrapping, and massage of the affected area are suitable for this.

Drugs for Raynaud's disease include vasodilators (for example, phentolamine) - they improve blood circulation and prevent spasms. In case of ulcers and necrosis, local wound healing ointments are used.

Drug treatment can last for years until the vasodilators no longer provide the desired effect. In this case, a sympathectomy is performed - a surgical intervention in which the nerve fibers that cause vascular spasm are stopped or removed. Necrosis requires necrectomy.

Auxiliary therapeutic methods: plasmapheresis sessions, reflexology, physiotherapy, hyperbaric oxygenation, psychotherapy.

How to completely cure Raynaud's disease is unknown, since the exact cause of the disease has not been established. But if you follow the doctor’s recommendations, the prognosis is favorable. There are cases when attacks of vasospasms suddenly disappeared after changing profession or moving to another climate zone.

Sjögren's syndrome - symptoms and treatment

Treatment is carried out depending on the presence of glandular and extraglandular manifestations and the immunoinflammatory activity of the disease.

Treatment goals:

• achieve remission of the disease according to clinical and laboratory indicators;
• improve the patient’s quality of life;
• prevent the development of life-threatening manifestations of the disease (generalized necrotizing ulcerative vasculitis, severe damage to the central and peripheral nervous system, lymphoma).

First of all, non-drug treatment is recommended for all patients with Sjögren's syndrome:

• You should not stay for a long time in areas with a dry and hot climate;
• use air humidifiers indoors;
• treat foci of infection;
• Constantly use fluoride-containing and anti-inflammatory toothpastes.

Treatment of glandular manifestations

Symptomatic treatment improves the patient's quality of life. To reduce dry eyes, you can use artificial tears based on sodium hyaluronate, etc. They can be used up to 16-18 times a day. To treat dry keratoconjunctivitis, Cyclosporine A eye drops are used. For severe dry keratoconjunctivitis that does not respond to treatment, or if other tear substitutes are intolerant, serum-based drugs can be used [1][2][6][7].

When the salivary glands are damaged, saliva substitutes are used. They are made on the basis of mucin and methylcellulose, they lubricate and moisturize the oral cavity, alleviating the patient's condition.

It is often possible to stimulate the residual function of the salivary and lacrimal glands, for this purpose agonists of M1 and M3 muscarinic receptors are used: Pilocarpine or Cevimeline.

Taking Rebamipide (Mucogen) reduces dry mouth, and an ophthalmic emulsion with this drug helps with dry eyes [7].

Treatment of extraglandular manifestations

The basis of drug therapy for Sjögren's disease is two groups of drugs:

• Glucocorticoids are anti-inflammatory drugs (Prednisolone).
• Cytostatics are antitumor drugs that disrupt the processes of growth, development and cell division. These include Chlorbutin, Leukeran, Cyclophosphamide (Cyclophosphamide).

They are prescribed for systemic manifestations of the disease and high activity of the process, confirmed by laboratory indicators.

If the patient is concerned about recurrent sialadenitis (inflammation of the salivary glands), but there are no signs of systemic lesions or minor extraglandular pathologies are detected (articular syndrome, muscle pain, enlarged lymph nodes, etc.), Prednisolone is prescribed in small dosages.

If the patient does not have systemic manifestations, but there is a large volume of salivary glands (if lymphoma is excluded), diffuse infiltration of the minor salivary glands and moderate severity of laboratory changes, Prednisolone is used in small doses in combination with Leukeran for a year. After this, the patient is transferred to a maintenance dose [1][3][6][7].

Patients with vasculitis are prescribed Cyclophosphamide in combination with Prednisolone. Doses are adjusted depending on the severity of extraglandular symptoms. The dose of Prednisolone for severe life-threatening systemic manifestations is increased.

In patients with such symptoms, pulse therapy with Prednisolone or combined pulse therapy with Prednisolone and Cyclophosphamide can also be used. In this case, at the beginning of treatment, significant doses of drugs are used, then they are reduced and the patient receives moderate or low doses for a long time. Pulse therapy allows you to reduce the daily dose of oral glucocorticoids and cytostatics and avoid complications arising from their long-term use. Long-term use of glucocorticoids can lead to steroid diabetes, stomach or duodenal ulcers, increased blood pressure, etc. Cytostatics reduce the number of neutrophils and platelets, and have a toxic effect on the heart, liver and kidneys. In addition, the use of drugs from both of these groups reduces immunity and increases the risk of infection.

Extracorporeal therapy is an intensive treatment method for Sjögren's disease. This includes hemosorption, cryoapheresis, plasmapheresis, double filtration of plasma, which is carried out simultaneously with pulse therapy. These methods are based on purification of blood and plasma from circulating immune complexes and aggressive autoantibodies outside the patient’s body using special equipment.

Absolute indications for extracorporeal therapy:

• necrotic-ulcerative type of vasculitis;
• glomerulonephritis in combination with increased levels of cryoglobulin in the blood;
• multifocal damage to the brain and spinal cord;
• ischemia of the arms and legs as a complication of vasculitis;
• blood hyperviscosity syndrome.

For vasculitis caused by mixed monoclonal cryoglobulinemia, it is advisable to carry out extracorporeal therapy for a year until stable clinical and laboratory remission is achieved [1][3].