Raynauds by drdoc on-line

Raynauds can be seen as a primary problem or secondary to an underlying disease.
It is related to spasm of small blood vessels usually to cold in the fingers and toes.
With vascular spasm - comes the first of the 3 colour cycle-

1 pallor - the digits go white.
2 Then the tissue oxygenation drops and the digits go blue.
3 Finally the vessels dilate and the colour goes red with flushing of the digits.

The damage occurs during the phase where the tissues are not perfused with blood -the pallor phase.
It can be seen secondary to a number of collagen vascular/autoimmune diseases including lupus/Polymyositis/Scleroderma etc.
The spasm of finger blood vessels are not the only vessels that constrict to exposure of the peripheries to cold.
It is demonstrated that if you expose the hands or feet to cold, that internal vessels including the visceral (bowel and esophageal) and coronaries also can develop spasm.
Esophageal dysfunction is well known to occur with Raynauds, and may therefore affect swallowing of food.

 

The therapy is difficult.

1. It is vital that you keep the peripheries warm and this means GLOVES and even warm socks especially in the morning. It is very difficult to avoid cold exposure of the peripheries in a USA winter, let alone one of our mild South African winters, but you have to make a plan.

2. Medications that I have found useful include

a. Nifedipine 5mg twice to three times daily, this is used for hypertension and may produce dizziness

b. Topical TNT Glyceryl trinitrate therapy - applied as a paste in tiny quantity to the fingers. The ointment is actually used by angina sufferers. Too much applied can cause a headache as some is absorbed.

c. Loftyl a vasodilator made by abbot laboratories - one twice a day as required. Again too much may cause slight dizziness by an effect on blood pressure.

d Iloprost, for treatment of Raynauds Phenomenon is still being studied but looks promising

f. Surgical cervical sympathectomy-is an option you often see surgeons performing usually by the time an internist or rheumatologist has seen the case (not surprising as they tend to be more aggressive souls). My experience does not show a good success rate for them and recurrence is frequent post op.

 

Bottom line-----best advice - keep the peripheries as warm as possible--especially in the morning


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