The term “ Raynaud ” goes back to the French doctor Maurice Raynaud. In 1862 he was the first to describe a cold-caused circulatory disorder in the fingers, which progresses in phases.
Raynaud’s disease is also called Raynaud’s disease, ischemia syndrome, acral ischemia syndrome, or vasospastic syndrome.
Raynaud’s disease ( Raynaud’s disease ) occurs in approximately 4% to 17% of the population; women are affected five to ten times more often than men. The first signs of the disease can appear at a young age; in men, the disease begins later. There is a hereditary disposition.
In Raynaud’s disease ( Raynaud’s disease ), in the broadest sense, there are acral ( = affecting the outer end) circulatory disorders in the hands or feet ( cral ischemia syndrome ); in the narrower sense, it involves functional circulatory disorders ( vasospastic syndrome ). The vasospastic syndrome ( = the pathological narrowing of arteries) or Raynaud’s disease arises from an excessive, functional narrowing of the vessels caused by muscular contraction (= narrowing, tightening) of the tunica media (= middle muscle wall layer of an artery), especially on Fi finger and toe arteries.
Raynaud’s disease ( Raynaud’s disease usually occurs in three phases:
- paleness
- Cyanosis (= bluish discoloration)
- Redness, as a sign of reactive (= occurring in response to a physical stimulus) hyperemia (= increased blood volume)
In some cases, phase 1 does not occur. Pain can occur in phases 1 and 2. In the advanced stage, there may be constant pain.
Raynaud’s disease ( Raynaud’s disease ) occurs in two forms:
Primary Raynaud’s disease
An underlying disease cannot be revealed, which is why Raynaud’s disease is called primary or idiopathic. Typically, this idiopathic Raynaud’s disease occurs symmetrically, with the thumb or big toe usually being spared. The long-term prognosis (= prediction of the likely course and outcome of an illness over a longer period of time ) can be described as more favorablperiodaynaud’s disease than the secondary form .
Secondary Raynaud’s disease
Secondary Raynaud’s disease, also known as symptomatic Raynaud’s disease, is characterized by (usually) asymmetrical (= unequal) involvement of the hands and feet ( acral ischemia syndrome ).
Secondary Raynaud’s disease occurs as a concomitant disease in the following diseases (selection) :
- Arteriopathies (= diseases of the arteries)
- Vascular inflammation in the context of collagen vascular disease (= defect in the immune system with hardening of the connective tissue)
- chronic traumatization (= influence leading to a disorder/illness)
- Poisoning, mainly ergotism in ( migraine?), but also arsenic and lead
If the disease progresses, the growth of the nails and the death of the fingertips can occur. The long-term prognosis (= prediction of the likely course and outcome of an illness over a longer period of time) depends on the underlying disease.
Periods for Raynaud’s disease ( Raynaud’s disease ) :
- Laboratory: blood count, erythrocyte sedimentation rate (ESR), cryoglobulins, antinuclear antibodies
- Skin temperature measurement
- Doppler sonographic blood pressure measurement of the hand and foot arteries
- Light plethysmography (= device for displaying and continuously recording the blood circulation-related volume fluctuations of a body section)
- Cold challenge test
- Angiography to detect occlusions or stenoses (= narrowings)
- Capillary microscopy with a view to possible scleroderma (= generic term for chronic diseases with hardening of the tissue )
Treatment of Raynaud’s disease
Therapy for Raynaud’s disease ( Raynaud’s disease ) :
The priority is, of course, to treat an underlying disease.
Initially, blood circulation -promoting agents such as naftidrofurycirculation-promotinguflomedil will also be tried, and in recent years the prostaglandin in the E1 analog Alprostadil (Prostavasin®) has increasingly been tried.
To treat persistent pain in Raynaud’s disease (disease), therapeutic local anesthesia (= treatment with a local anesthetic or local anesthetics ) in the form of long-term (2 to 3 weeks ), continuous blocks (= anesthesia ) has been used. with a catheter ( * see below) very phaveen.
- The continuous blockade of the brachial plexus (= arm nerve plexus) is suitable for the distal (= away from the center of the body) upper extremities ( = arms ). Since the brachial plexus is rich in vegetative (= affecting the involuntary nervous system ) nerve fibers, in addition to the nociceptive (= affecting the pain conduction) inhibition, there is also a sufficient sympathicolytic (= vasodilating) effect. When the local anesthetic concentration is reduced ration (e.g. 10 to 15 ml bupivacaine, 0.1 to 0.15%), motor function (= muscle strength) is maintained, so that accompanying physiotherapy exercises for the hands are possible (also with exposure to cold for training purposes). The method can be carried out on both sides at the same time ; for safety reasons, in the case of repetitive application (= repeated single administration), this should be done alternately (= alternating) . Another therapeutic option is the blockade (= aesthesia ) of the stellate ganglion (= vegetative switching point in the lateral neck area) in a heaped sequence, optimally in a continuous form with a catheter *.
- Continuous blockade of the sciatic nerve with a catheter * is suitable for the distal lower extremities ( feet) (Klatt et Leser 1994 ) . This nerve also carries vegetative fibers, so the desired sympatholytic (= vasodilating) effect also occurs here , although not as pronounced as in the brachial plexus.
These continuous blockages cause a kind of vascular training in Raynaud’s disease, whereby the causative narrowing of the vessels returns to normal.
Performing continuous blockages with a catheter * usually requires an inpatient stay. Single-shot blocks (= individual anesthesia) are mainly used in the outpatient area. Some authors recommend so-called sympathetic blockades with guanethidine. The active ingredient is also used to treat high blood pressure. The mechanism of action is based on reducing the release of the neurotransmitter norepinephrine from the endings of the nerve cells. The advantage of this intravenous blockade method (= the medication is injected into a vessel leading back to the heart, but where the arm, for example, is temporarily blocked ) is that the effect can last up to 72 hours. The disadvantage is the significantly increased risk of treatment and the pain that occurs compared to nerve blocks.
A series of infusions with lidocaine (2% ) (= a medium-acting local anesthetic ) has also proven to be helpful . Under pulse or ECG control (monitor ), 50, 100and 150 mg are dissolved in 200 ml of table salt 0.9% in ascending doses using an infusion pump (e.g. Infusomat) . one hour, although to be on the safe side for 24 hours should be maintained between the individual infusions.
Lidocaine can also be administered serially using intra-arterial injections (= injections into an artery) into the femoral artery or brachial artery ( = leg or arm artery), depending on the localization ( = place, part of the body). Pain disorder, for example, 1-1.5 ml (= 20-30 mg) 2-3 times a day at intervals of 8-12 hours over 10 days. The local anesthetic reaches the so-called terminal stromal pathway and leads to the desired vasodilatation ( sympatholysis ) with simultaneous pain relief. Even if the blood vein is not exactly hit, a vasodilating effect still occurs because sympathetic nerve fibers (= part of the involuntary nervous system) run around the blood vessel . For this reason, classic neural therapy deliberately infiltrates the vessel.
* In the so-called continuous blockade with a catheter, a thin plastic tube is temporarily (for up to 14 days, but sometimes longer) implanted close to nerve plexuses or the affected nerves. The implantation is carried out through a standard cannula, so there is no need to “cut it open”. Subsequently, the local anesthetic is injected completely painlessly through this catheter several times a day, each time after the previous dose has worn off. In certain cases, a small pump can be connected to administer the local anesthetic through the catheter. The fact that the pain – relieving effect usually lasts beyond the pain-relieving period is due, among other things, to the fact that the so-called autonomic nerves are also affected during this blockade treatment, which, as already explained above, results in a very significant increase in blood circulation results. This is the reason why this treatment method is particularly helpful for pain that can be attributed to a reduced blood supply ( Raynaud’s disease !), inflammatory, or even degenerative processes.
