Raynaud's syndrome is a group of syndromes in which the fingers (toes) become pale, purplish, and then become flushed onset due to cold or emotional agitation. Those without a special cause are called idiopathic Raynaud's syndrome; those secondary to other diseases are called secondary Raynaud's syndrome.
1. The etiology of idiopathic Raynaud's syndrome is unknown and may be related to the following factors
(1) Cold irritation Patients are more sensitive to cold irritation, and the incidence of this disease is higher in cold areas.
(2) Nerve excitement Most patients are sympathetic nerve excitement, which may be related to central nervous system dysfunction and sympathetic hyperfunction.
(3) Occupational factors The incidence of workers who have been engaged in vibrating machinery for a long time, such as pneumatic hammer operators, is as high as 50%, and the specific mechanism is unknown.
(4) Endocrine disorders This disease accounts for 70% to 90% of women. The symptoms are aggravated during menstruation and relieved during pregnancy, which may be related to sex hormones.
(5) Other reasons: heredity, fatigue, infection, etc.
2. Secondary Raynaud syndrome is often accompanied by the following diseases
(1) Systemic scleroderma;
(2) Systemic lupus erythematosus;
(3) Dermatomyositis or polymyositis;
(4) Rheumatoid arthritis;
(5) Atherosclerosis of limbs in patients over 50 years old;
(6) Thromboangiitis is rare;
(7) Primary pulmonary hypertension.
Trauma and drugs such as ergot inducers, vincristine, barbituric acid, etc. can also cause this disease.
It usually occurs between 20 and 40 years old, and there are more women than men. The onset is slow, starting in winter, and the time is short, and the onset of cold or emotional agitation can occur gradually. Generally, it is symmetrical on both hands and fingers, but it can also occur on the toes.
The hands and feet are cold, numb, and sometimes painful. In a typical attack, with the metacarpophalangeal joints as the boundary, the fingers become cold, pale, purple, and then flushed. In the late stage of the disease, the hair on the back of the fingers disappears gradually, the growth of the nails becomes slower, rough, deformed, the skin shrinks, becomes thinner and becomes tighter (scleroderma), and ulcers form around the fingertips or nail beds, which can cause infection.
1. Coldwater test
Putting fingers or toes in cold water at 4 degrees Celsius for one minute can induce the onset of the above-mentioned typical symptoms.
2. Fist test
Clenching a fist with both hands for 1 minute and letting go in a bent state can also induce the above symptoms.
3. Skin ultraviolet irradiation experiment
The skin's erythema response to ultraviolet radiation is weakened.
4. Finger arteriography
If necessary, upper extremity arteriography is performed to understand the condition of the finger arteries, which is helpful for diagnosis.
The diagnosis of Raynaud's syndrome mainly depends on the medical history, the performance of a typical attack, and the above provocation test can be used to make the diagnosis. Raynaud's syndrome should be distinguished between primary and secondary Raynaud's syndrome, and timely treatment of related diseases should be given.
1. General treatment
Avoid exposure to cold environments, and keep the distal limbs warm. Quit smoking.
(1) Calcium ion antagonist nifedipine, diltiazem.
(3) Alpha receptor antagonist prazosin and so on.
3. Surgical treatment
Sympathectomy can be considered for those who do not respond to drugs, but the efficacy needs to be further observed.
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