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June 9, 2012
Reynaud's syndrome it is accepted to call the frustration causing strong narrowing of blood vessels of integuments which happens at the person as a result of a severe stress or influence of cold. This disease received the name in honor of Maurice Reynaud who described this illness in 1862. This frustration has paroxysmal, vasospastic character. It is carried to system illnesses of connecting fabric. This disease, according to different data, suffers from 3 to 5% of the population. At the same time a thicket women are subject to attacks of this syndrome. As a rule, Reynaud's syndrome is shown at the person at later age, after 35 flyings. At the same time the Raynaud's disease can arise at people already at fifteen-year age.
Reynaud's syndrome is a manifestation of a so-called phenomenon of Reynaud. In medicine this phenomenon can be subdivided into two look. The Raynaud's disease is defined as primary phenomenon of Reynaud. Its feature is the current regardless of other diseases. Among total quantity of cases of this state the Raynaud's disease occupies about 90% of cases.
Reynaud's syndrome will be defined as a secondary phenomenon of Reynaud as generally this pathology is shown as part of other illness.
Reasons of a syndrome of Reynaud
The most various diseases become the reasons provoking manifestation of a syndrome of Reynaud at the person often. There are data on that, Reynaud's syndrome can be shown at people at 70 diseases.
This state is characteristic of patients with some rheumatic illnesses: system lupus erythematosus, scleroderma, dermatomyositis, pseudorheumatism, Shegren's illness, nodular periarthritis, etc. Reynaud's syndrome is also shown at diseases of vessels: obliterating atherosclerosis, posttrombotichesky or trombotichesky syndrome. Accompanies this syndrome and some diseases of blood: paroxysmal haemoglobinuria, cryoglobulinemia, thrombocytosis, multiple myeloma.
There is also a concept of a professional syndrome of Reynaud which can develop owing to vibration, strong and regular overcooling, and also work with polyvinylchloride. Emergence of a neurogenic syndrome of Reynaud is connected, as a rule, with squeezing of a neurovascular bunch with development of an algodistrofiya, a syndrome of the carpal channel. The so-called medicinal syndrome of Reynaud arises as reaction to reception of some drugs — ergotamine, serotonin, beta-blockers, drugs with antineoplastic influence, etc. After drug is cancelled, such manifestations generally disappear.
It is also noted still a number of diseases which can become the manifestation reason at the person of a syndrome Reynaud.
Symptoms of a syndrome of Reynaud
Reynaud's syndrome is shown in the form of attacks at which there is a spasmodermia. The most often this syndrome is shown on toes and hands, in Bol exceptional cases – on lobes of ears, a nose, lips, language. Very often people who suffer from this disease, do not understand that they have symptoms of a syndrome of Reynaud, believing that similar reaction is only reaction of an organism to influence of cold. In the course of an attack skin color gradually changes: it becomes initial it white, becomes blue later, and after an attack its reddening is observed. At the first stage of an attack the expressed pallor of skin arises as a result of sharp outflow of blood. At the second stage the posineniye of skin occurs as reaction to a lack of oxygen. At the third stage there is a recovery of blood circulation and intensive reddening of a skin half-shelter. At the person not all stages can sometimes be shown during an attack.
Symmetry of discoloration of skin on both extremities is always observed. Duration of such attack, as a rule, makes about 20 minutes. However sometimes Reynaud's syndrome is observed at the patient for several hours. When at the person the attack of a syndrome of Reynaud, his skin always cold is shown, besides sharp numbness is sometimes felt, rubbed sensitivity of different degree, a pricking in the extremities affected with an attack.
Generally at an attack of a syndrome of Reynaud morbidity arises after the termination of an attack. Besides, the patient feels heat and a raspiraniye, the skin hyperthermia is observed. Over time at the patient trophic changes are shown: turgor of skin decreases, small pillows of fingers are involved or flattened, there are ulcers which heal a long time.
This disease often progresses throughout a long time. Initially described symptoms are shown only on tips of several fingers, but later they already arise on all fingers, as a rule, without affecting only a thumb.
In the course of such attack and standing, and on hands drawing as marble which is called mesh the livedo can be shown.
Except the described symptoms of an illness symptoms of a syndrome of Reynaud are shown by numbness, cooling of skin, perhaps, display of pain. Between attacks of a brush of the person often remain cyanotic, skin on them cold.
Diagnosis of a syndrome of Reynaud
There are general and special diagnostic methods of a syndrome of Reynaud. At the same time the Raynaud's disease is diagnosed on condition of an exception of all diseases at which this syndrome can be shown. The exception of diseases has to be confirmed also at further supervision. In the course of research to patients the kapillyaroskopiya on purpose detection and specifications like defeat of vessels of skin is carried out. Besides, in the course of diagnosis carrying out laboratory blood test is appointed.
Carrying out a koagulogramma allows to learn necessary data on properties of blood. Besides, in certain cases for diagnosis of a syndrome of Reynaud carrying out immunological and X-ray inspection is reasonable. Also research of a manual blood-groove by means of ultrasonic doppler sonography, an angiography and other methods is sometimes conducted.
There is also a number of accurate medical criteria on the basis of which establish the diagnosis. This existence of a vascular spasm which arises owing to influence of a stress or cold; symmetry of localization of manifestations of vascular attacks: existence of a normal pulsation of arteries which are probed; periodic manifestations of vascular attacks throughout two and more than flying.
Treatment of a syndrome of Reynaud
Effective treatment of a syndrome of Reynaud depends on that, as far as possible to eliminate those factors which provoke manifestation of this syndrome, and also to provide impact on the mechanisms provoking disturbances in functioning of vessels.
The attending physician will surely advise the patient not to allow first of all overcoolings of an organism, to leave off smoking, not to contact to various chemicals, and also to warn other factors provoking manifestation of a vasospasm. In certain cases rather cardinally to change some working conditions or to move to the district where climate warmer, and Reynaud's syndrome disappears independently.
Treatment of a syndrome of Reynaud provides use of medicamentous therapy in the form of administration of drugs in other cases, having vasodilating influence. In this case effective impact is made by drugs — antagonists of calcium. Most often reception of nifedipine, Corinfarum, kordafen is appointed sick. Besides, other blockers of an input of calcium are applied in the course of therapy also: diltiazem, verapamil, nikardipin.
If at the patient the progressing Reynaud's syndrome takes place, then treatment by Vazaprostan is in that case reasonable. This drug is administered kapelno intravenously, the course makes from 10 to 20 injections. After the third injection drug begins to influence a condition of the patient, however as much as possible its efficiency is noticeable after passing of a full course of treatment by drug. Frequency of attacks, their intensity and duration considerably decreases. Influence of drug remains, as a rule, for from 4 to 6 months therefore it is reasonable to repeat a course of its reception twice a year.
Also in the course of complex therapy of this disease inhibitors of an angiotensin-converting enzyme, namely drug captopril are applied. Reception of this drug is appointed to the long period – of half a year about one year. Doses in which the patient accepts drug, are defined in an individual order by the attending physician. Also at treatment of a syndrome of Reynaud it is applied ketanserin which is mainly appointed by the patient of advanced age.
Except the specified drugs at treatment of a syndrome of Reynaud medicines which improve the general properties of blood are applied, reducing its viscosity. It pentoksifillin, Dipiridamolum and other drugs.
Approach to therapy of this illness has to be obligatory for complex. Each patient needs to realize that treatment of a syndrome of Reynaud can last several years, and at the same time use of the medicines relating to different groups is obligatory.
In the course of complex therapy topical treatment by applications of 50-70% of solution of the Dimethyl sulfoxide for areas which are surprised an illness at attacks is also applied. Such applications are effective as addition to treatment with drugs with vascular and antiinflammatory action.
The attending physician surely pays attention to whether there are in process treatment side effects: hypostases, nausea, headaches, allergy. In a case existence of the similar phenomena the dose of drug decreases, or it is cancelled completely.
Besides, at treatment of a syndrome of Reynaud also other methods of therapy – physical therapy, psychotherapy, thermal procedures, an electrophoresis, acupuncture, reflexotherapy are successfully applied. Also at this illness carrying out massage is shown.
Very seldom at this disease use of surgical treatment which provides removal being near the nerve arteries affected with an illness is reasonable.
In most cases Reynaud's syndrome does not constitute danger. Many patients do not worry in view of not too intensive displays of this illness. However it is necessary to know that in the most difficult cases progressing of a syndrome of Reynaud leads to a gangrenosis and the subsequent amputation of the affected extremity.
Prevention of a syndrome of Reynaud
Now there are no developed methods of primary prevention of a syndrome of Reynaud. As methods of secondary prevention the prevention of impact on a human body of factors which provoke development of a vasospasm is important. Besides, as secondary prevention the drug treatment of a syndrome of Reynaud directed to achievement of remission of the main illness is applied.
People who are subject to attacks of a syndrome of Reynaud should wear warm mittens and socks, waterproof boots in a cold season, to drink hot tea and other drinks. It is also desirable not to abuse kofeinosoderzhashchy drinks which, as well as nicotine, provoke vasoconstriction.
Section: Diseases of vessels