What happens during an attack
The small arteries in the fingers normally constrict in the cold to conserve body heat. With Raynaud's phenomenon, this reaction is excessive: the vessels spasm so much that the blood flow almost stops, and the finger suddenly turns pale. Then venous blood accumulates in the tissues, and the skin turns blue. When the spasm resolves, blood flow increases, the finger turns red, pulsation, burning and tingling appear. The attack lasts from several minutes to half an hour and usually affects the fingers, less often the feet, the tip of the nose and ears.
- Whitening - spasm of arterioles
- Blue discoloration - stagnation of venous blood
- Redness - restoration of blood flow
- Numbness and tingling during an attack
- The thumb is usually not involved in the primary form
Primary and secondary forms
Raynaud's disease most often begins in adolescence and young adulthood, symmetrically affects the fingers of both hands and is not accompanied by other complaints. Raynaud's syndrome develops later, often asymmetrically, attacks are more severe and can lead to tissue damage. It may be caused by systemic scleroderma, systemic lupus erythematosus, Sjögren's syndrome, vasculitis, as well as taking certain medications, working with a breaker tool, carpal tunnel syndrome, or compression of blood vessels at the neck level.
- Primary: young age, symmetry, mild course
- Secondary: systemic scleroderma and other connective tissue diseases
- Vibration disease in those working with tools
- Taking certain vasoconstrictors and other drugs
- Thoracic outlet syndrome
- Smoking and occupational hypothermia as aggravating factors
Diagnostics
The diagnosis is made primarily by the description of the attacks - the characteristic change in the color of the fingers is quite specific. Next, the doctor’s task is to exclude secondary causes. The key study is capillaroscopy of the nail bed, in which the smallest vessels are examined under magnification: their changes indicate a systemic disease. The picture is complemented by tests for antinuclear antibodies, rheumatoid factor, and inflammation indicators. Ultrasound examination of the arteries of the arms helps to exclude narrowing of large vessels.
- Detailed survey about seizures and profession
- Capillaroscopy of the nail bed
- Antinuclear antibodies (ANA)
- Rheumatoid factor, C-reactive protein
- General blood test
- Dopplerography of the arteries of the upper extremities
How to reduce attacks
The main thing is to prevent hypothermia of the whole body, and not just the hands: with general cooling, spasms occur more easily. Wear mittens instead of gloves, warm shoes and a hat, and remove food from the refrigerator using gloves. Complete smoking cessation is mandatory: nicotine itself constricts blood vessels. It is worth limiting caffeine, avoiding sudden stress and, if possible, changing the work with a vibrating tool. During an attack, warm water, rubbing the hands and circular movements of the arms help.
- Warm multi-layer clothing, mittens and thermal underwear
- Complete cessation of smoking, including passive smoking
- Limiting caffeine
- Warming your hands with warm water during an attack
- Caution with drugs that constrict blood vessels
- Hand skin care, prevention of microtraumas and cracks
Treatment
For mild cases, non-drug measures are sufficient. If attacks are frequent, painful, or lead to skin damage, the doctor prescribes drugs that dilate blood vessels, most often from the group of calcium channel blockers. In the secondary form, the main direction is treatment of the systemic disease together with a rheumatologist. For severe digital ischemia and ulcers, special medications are used in a hospital setting, and sometimes nerve interventions are performed. The selection of therapy is always individual and requires blood pressure monitoring.
- Calcium channel blockers as prescribed by a doctor
- Treatment of underlying rheumatic disease
- Local care for finger ulcers
- Infusion therapy for severe ischemia
- Regular observation by a rheumatologist for secondary forms
- Blood pressure control during treatment