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Raynaud's syndrome

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VOL: 99, ISSUE: 29, PAGE NO: 28

WHAT IS IT?

- Raynaud’s syndrome is a condition in which the blood supply to the extremities, usually the fingers and toes, but sometimes also the ears and nose, is interrupted.

- There are two forms of this condition:

Raynaud’s disease: also known as primary Reynaud’s, is the most common and tends to occur spontaneously with no underlying condition. It is not usually disabling but patients tend to experience great pain and discomfort.

Raynaud’s phenomenon: also known as secondary Reynaud’s, is less common and is associated with an underlying disease, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma or arteriosclerosis. Raynaud’s symptoms are often the first sign that the patient also has a connective tissue disease. This tends to be more serious and an early accurate diagnosis is essential.

INCIDENCE

- Women from the ages of 16 to 40 years old are most commonly affected, especially during the winter months or in areas where colder weather is more common.

CAUSES

Raynaud’s disease:

- Unknown cause, but it is aggravated by stress and cold.

Raynaud’s phenomenon:

- Smoking;

- Scleroderma;

- Systemic lupus erythematosus;

- Rheumatoid arthritis;

- Arteriosclerosis;

- Nerve problems;

- Pulmonary hypertension;

- Certain drugs, such as beta-blockers;

- Injuries;

- Vibrations from machinery (vibration-induced white finger).

SIGNS AND SYMPTOMS

- During an attack the skin blanches, turning very white, then blue, as the tissues become colder. The arteries then relax so that the tissues receive oxygen and the skin turns red. This is accompanied by considerable pain, numbness or tingling.

- The areas suffering from lack of oxygen are well demarcated, often occurring at joint lines.

- The attacks may last from minutes to hours.

- Raynaud’s disease will almost always affect both hands, whereas Raynaud’s phenomenon usually only affects one hand.

PROGNOSIS

- Raynaud’s disease is usually harmless. Normal colour and sensation are frequently restored by heat.

- Raynaud’s phenomenon is more serious and complications can develop. After years of attacks, the blood vessel walls may thicken, causing the blood flow to be permanently reduced. Arteries may be completely blocked from thrombosis and this can lead to gangrene at the tips of the affected fingers or toes.

TREATMENT

Raynaud’s disease:

- Prevention is the best treatment and may mean giving up smoking, changing occupation and keeping warm in cold weather.

- The first drug of choice is a calcium-channel blocker, such as nifedipine. Other groups of drugs used in some patients include topical glyceryl trinitrate, prostaglandin E2, alpha adrenergic blockers, such as doxazosin, and the angiotensin II receptor antagonist losartan.

- Cutting the sympathetic nerves supplying the vessel wall muscles can also be helpful, especially when the lower limbs are affected.

Raynaud’s phenomenon:

- Treatment usually involves correcting the underlying cause and is managed by a rheumatologist. If this is not possible, it may be necessary to treat the symptoms as described for Raynaud’s disease.

NURSING IMPLICATIONS

- Help patients to avoid stimuli that cause vasoconstriction, such as exposure to cold, smoking and stress.

- Pain can be managed by careful warming of the area when vasoconstriction occurs. Hot water must not be used - this can result in burns because of a lack of sensation during vasoconstriction.

WEBSITE

Raynaud’s and Scleroderma Association

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