Raynaud's disease
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Raynaud's disease is a condition characterized by spasm of the arteries, especially in the fingers, typically brought on by cold or vibration. It causes episodes where the affected areas turn white, then blue, then red as feeling returns. There are two main types - primary Raynaud's, which has no known cause, and secondary Raynaud's, which results from an underlying condition like connective tissue disorders. Diagnosis involves tests to distinguish between the types and check for underlying causes. Treatment focuses on avoiding triggers, managing any underlying conditions, and medications like calcium channel blockers or vasodilators to improve blood flow.
![MEDICATION
1. Medications can be helpful for moderate or severe disease.
2. Vasodilators
3. Calcium channel blockers, such as
the dihydropyridines ,nifedipine or amlodipine
4. People with increased severity are prone to ulceration or large artery
thrombotic events and may be prescribed aspirin.
5. Sympatholytic agents, such as the alpha-adrenergic blocker prazosin, may
provide temporary relief to secondary Raynaud's phenomenon.
6. Losartan , and topical nitrates may, reduce the severity and frequency of
attacks, and the phosphodiesterase inhibitors sildenafil and tadalafil may
reduce their severity.[21]](https://image.slidesharecdn.com/2-200814065831/85/Raynaud-s-disease-14-320.jpg)
![7. Angiotensin receptor blockers or ACE inhibitors may aid blood
flow to the fingers,[21] and some evidence shows that angiotensin
receptor blockers (often losartan) reduce frequency and severity
of attacks,[26] and possibly better than nifedipine.[27][28]
8. The prostaglandin iloprost is used to manage critical ischemia
and pulmonary hypertension in Raynaud's phenomenon, and
the endothelin receptor antagonist bosentan is used to manage
severe pulmonary hypertension and prevent finger ulcers
in scleroderma.[21]
9. Statins have a protective effect on blood vessels,
and SSRIs such as fluoxetine may help symptoms, but the data is
weak.[21]
10. PDE5 inhibitors are used off-label to treat severe ischemia and
ulcers in fingers and toes for people with secondary Raynaud's
phenomenon; as of 2016, their role more generally in Raynaud's
was not clear.[29]](https://image.slidesharecdn.com/2-200814065831/85/Raynaud-s-disease-15-320.jpg)
Raynaud's disease
- 1. M R S . C . M A R Y L A L I T H A K A L A A S S O C I A T E P R O F E S S O R A M E R I C A N N R I C O L L E G E O F N U R S I N G V I S A K H A P A T N A M RAYNAUD’S DISEASE
- 2. DEFINITION “A disease characterized by spasm of the arteries in the extremities, especially the fingers ( raynaud's phenomenon ). it is typically brought on by constant cold or vibration, and leads to pallor, pain, numbness, and in severe cases, gangrene.”
- 4. ETIOLOGY Typically, the fingers, and less commonly the toes, are involved. Rarely, the nose, ears, or lips are affected. The episodes result in the affected part turning white and then blue. Often, numbness or pain occurs. As blood flow returns, the area turns red and burns. The episodes typically last minutes, but can last several hours. Episodes are often triggered by cold or emotional stress
- 5. 3 COLORS OF RAYNAUD’S PHENOMENA WHITE BLUE RED
- 7. TYPES There are two main types --- 1. Primary Raynaud's: The cause is unknown. 2. Secondary Raynaud's: which occurs as a result of another underlying disorder / condition. Ex: connective-tissue disorder scleroderma systemic lupus erythematous, injuries to the hands, prolonged vibration, smoking, thyroid disorders, c certain medications, such as birth control pills.
- 8. PATHOPHYSIOLOGY Hyper activation of the sympathetic nervous system Extreme vasoconstriction of the peripheral blood vessels Leading to tissue hypoxia.
- 10. DIAGNOSTIC EVALUATION 1. Distinguishing Raynaud's disease (primary Raynaud's) from phenomenon (secondary Raynaud's) is important. Looking for signs of arthritis or vasculitis, as well as a number of laboratory tests, may separate them. If suspected to be secondary to systemic sclerosis. 2. One tool which may help aid in the prediction of systemic sclerosis is thermography.
- 11. 3. A careful medical history will often reveal whether the condition is primary or secondary. Once this has been established, an examination is largely to identify or exclude possible secondary causes.
- 12. 4) Digital artery pressures are measured in the arteries of the fingers before and after the hands have been cooled. A decrease of at least 15 mmHg is diagnostic (positive). 5) Doppler ultrasound to assess blood flow 6) Full blood count may reveal a normocytic anaemia suggesting the anaemia of chronic disease or kidney failure. 7) Blood test for urea and electrolytes may reveal kidney impairment. 8) Thyroid function tests may reveal hypothyroidism. 9) An autoantibody screen, tests for rheumatoid factor, erythrocyte sedimentation rate, and C-reactive protein may reveal specific causative illnesses or a generalised inflammatory process. 10) Anti-centromere antibodies are common in limited systemic sclerosis (CREST syndrome). 11) Nail fold vasculature can be examined under the microscope.
- 13. MEDICAL MANAGEMENT Secondary Raynaud's is managed primarily by treating the underlying cause, and as primary Raynaud's, avoiding triggers, such as cold, emotional and environmental stress, vibrations and repetitive motions, and avoiding smoking (including passive smoking) and sympathomimetic drugs.
- 14. MEDICATION 1. Medications can be helpful for moderate or severe disease. 2. Vasodilators 3. Calcium channel blockers, such as the dihydropyridines ,nifedipine or amlodipine 4. People with increased severity are prone to ulceration or large artery thrombotic events and may be prescribed aspirin. 5. Sympatholytic agents, such as the alpha-adrenergic blocker prazosin, may provide temporary relief to secondary Raynaud's phenomenon. 6. Losartan , and topical nitrates may, reduce the severity and frequency of attacks, and the phosphodiesterase inhibitors sildenafil and tadalafil may reduce their severity.[21]
- 15. 7. Angiotensin receptor blockers or ACE inhibitors may aid blood flow to the fingers,[21] and some evidence shows that angiotensin receptor blockers (often losartan) reduce frequency and severity of attacks,[26] and possibly better than nifedipine.[27][28] 8. The prostaglandin iloprost is used to manage critical ischemia and pulmonary hypertension in Raynaud's phenomenon, and the endothelin receptor antagonist bosentan is used to manage severe pulmonary hypertension and prevent finger ulcers in scleroderma.[21] 9. Statins have a protective effect on blood vessels, and SSRIs such as fluoxetine may help symptoms, but the data is weak.[21] 10. PDE5 inhibitors are used off-label to treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon; as of 2016, their role more generally in Raynaud's was not clear.[29]