A Family Doctor's Tale - RAYNAUD'S DISEASE

DOC I HAVE RAYNAUD'S DISEASE

Raynaud's disease is really a rare disease.

So far in 37 years of family practice I have only come across one case of Raynaud's disease.

It was a mild illness but it was confirmed by a heart specialist.

The most important part of treatment was to keep warm and avoid cold climates.


Raynaud's Disease is a rare disease which causes transient vasospasm of small arteries of the hand and sometimes the toes precipitated by cold.

During an attack there is little or no flow of blood to the arteries of the fingers or toes.

Because of no blood circulation, there is typical whiteness and blueness of fingers.

Causes of Raynaud's Disease are:
1.classically cold precipitated, more common in winter.

Sometimes the cold temperature of the freezer can cause an attack of the Raynaud's phenomenon.


2.Emotional factors such as fear and anxiety

It may secondary to other conditions such as:

1.auto immune disease such as SLE (systemic lupus erythrematosis)


2.arterial compression syndrome from cervical ribs


3.hypothyroidism


4.pulmonary hypertension


5.medicines such as ergotamine


6.vinyl chloride exposure


7.low immune patients such as cancer

It occurs more commonly in women and usually rare in men



Symptoms of Raynaud's Disease start off with:
cold extremities with at least 2 of the following changes for diagnosis:
1.blanching and numbness of fingers spreading up to the rest of hand


2.blanching and whiteness of fingers, then blue mottling, followed by red as circulation returns


3.pain during color changes common


4.skin become shiny or wax like


5.feet especially the toes may be involved, also nose and tongue


6. rarely gangrene of finger tips

Diagnosis of  Raynaud's Disease is by:
1.Symptoms and signs as above


2.skin capillary microscopy


3.hand films may show terminal tuft atrophy in vinyl chloride exposure

Complications of Raynaud's Disease are:


1.gangrene of the fingers

Treatment of Raynaud's Disease is by:

Lifestyle Changes:


1.Avoidance of cold temperature


2.Avoidance of emotional upset and stress


3.Avoidance of caffiene, smoking and alcohol


4.Keep body (wear gloves, scarf, warm clothing and socks during cold weather) and environment warm


5.treat underlying cause such as SLE, hypothyroidism, cancer, cervical ribs


Medicines:

1.Avoid medicines such as ergotamine for migraine and anticancer drugs such as vinblastine

2. Use drugs which helps to improve blood circulation such as a.calcium channel blockers
b.reserpine
c.methyl dopa


Surgery

sympathectomy may be done to block the sympathetic nerves which controls the narrowing of the arteries of the hands in very rare cases


Prevention for Raynaud's Disease is by:


1.Avoiding cold temperature and stress

2.Keeping warm by wearing gloves, scarf, warm clothes, and socks

3.Avoid medicines such as ergotamines for headache, caffiene, smoking and alcohol

4. Living a healthy life style with exercises and warm food


Prognosis of Raynaud's Disease:

Prognosis is usually good with response to therapy.

Rarely the disease may cause gangrene of the fingers