Raynaud's disease is a condition characterized by episodic vasospasms of the small arteries in the extremities in response to cold or stress. It causes color changes in the affected areas from white to blue to red. It is more common in females and usually affects both hands symmetrically. The vasospasms are due to increased sensitivity to factors like cold or emotions. Treatment focuses on avoiding triggers and using vasodilators to relieve spasms. For severe cases, surgical sympathectomy may be considered.

1. BY-S.APARNA SELVAM
RAYNAUD’S DISEASE

2. It is an episodic vasospasm, i.e. arteriolar spasm.
Definition:
It is a condition characterised by episodic
vasospasm that causes closure of the
small arteries an arterioles of the distal
part of the extrimitiesin response to cold
exposure or emotional stimuli

4. incidence:
# It is seen in females
#usually bilateral.
# It occurs in upper limb with normal peripheral pulses.
# as a result of abnormal sensitivity to cold.

5. Raynaud’s syndrome Sequence
# Local syncope: It is due to vasospasm, causing white cold palm
and digits along with tingling and numbness
# Local asphyxia: It is due to accumulation of deoxy genated blood
as the result of vasospasm causing bluish discolouration of palm and
digits with burning sensation (due to accumulated metabolites)
# Local recovery: It is due to relief of spasm in the arteriole,
leading to return of blood to the circulation causing fl ushing and
pain in digits and palm (pain is due to increased tissue tension)
# Local gangrene: If spasm persists more than ischaemic time
(more than one hour in upper limb), then digits go for ulceration
and gangrene. Does not occur regularly but is an occasional
phenomenon in the cycle

7. Causes for Raynaud’s Phenomenon/Raynaud’s disease:
# Primarily etiology is unknown .
#(environmental conditions)
Working with vibrating tools: Like pneumatic road drills, chain saws, wood cutting, fisher
# (immunological /connective tissue)
Collagen vascular diseases: Like scleroderma, rheumatoid diseases causing vasculitis (all a
# (obstructive diseases)Other causes: Cervical rib, Buerger’s disease, Scalene syndrom
CREST syndrome (Calcinosis cutis, Raynaud’s phenomenon, Esophageal defects, Sclerodac

8. #Drug induced:
Ergol
Betablockers
Cytotoxic drugs
Birth control pills
#Miscellaneous:
Cold agglutinatin
Neoplasia
Neurogenic disorder
Endocrine disorders

9. Types
# Primary Raynaud’s is an idiopathic vasospastic disorder without underlying identifi able ca
Usually there is no signifi cant pain in primary type.
Primary is probably due to increased sensitivity of alpha 2 receptors to nonepinephrine;
decreased nitric oxide and endothelin 1 in endothelial cells; increased serotonin and thrombo
It is common in females and younger age group.
Usually it is bilateral involving all digits.
# Secondary Raynaud’s is vasospasm due to some underlying cause. Signifi cant pain will be
There are positive autoantibodies
equal in both sexes; occurs at any age group; need not be bilateral.

10. Features
# Commonly bilateral.
# Usually medial four digits and palm are involved. Thumb is spared. # Features
#Repeated attacks are common.

11. Investigations
# Type is identified by angiogram of hand (DSA/MR angiogram)
arterial Doppler/Duplex scan.
#Other investigations required are X-ray of the part
#antinuclear antibody (ANA assay) tests specific for different conditions
#Assessment of segmental blood pressure gradient from brachial-forearm-wrist-fi nge
#finger tip thermography
#nail fold capillary microscopy
#Laser Doppler to assess microvascular perfusion of finger skin—are special methods of
#Other routine investigations for arterial diseases like blood sugar/lipid profi le/hyper

12. Treatment
General measures
#Avoid precipitating factors—protect from cold/proper dress/ hand warmer elec
#Avoid smoking
#Avoid vibrating tools.

13. Medical management
#Vasodilators-Pentoxiphylline,low dose aspirin (75-100 mg per day)
#Calcium antagonist-nifedipine 20 mg is useful.
#Steroids may be useful in case of secondary Raynaud’s.
# ACE inhibitors
#nitrates
# endothelin inhibitors (bosentan), epoprostenol—prostaglandin a potent vasodilator and a

14. Surgical management:
Cervico-thoracic sympathectomy-
It can be done in three approaches;
*anterior
*Axillary
*posterior