A 70 yr old lady with Raynods disease

Raynauds disease
A circulatory disorder caused by insufficient blood supply to the hands and feet and resulting in cyanosis, numbness, pain, and, in extreme cases, gangrene. gangrene.

Types
This can be classified in to two types. 1.Primary 2.Secondary

Primary
Primary Raynaud's disease predisposing factor, is more causes fewer complications. complications. has mild, no and

About half of all cases of Raynaud's disease are of this type. type. Women are five times more likely than men to develop primary Raynaud's disease. disease. The average age of diagnosis is between 20 and 40 years. Approximately three out of years. ten people with primary Raynaud's disease eventually progress to secondary Raynaud's disease after diagnosis. About 15% of diagnosis. 15% individuals improve. improve.

Secondary
Secondary Raynaud's disease is the same as primary Raynaud's disease, but occurs in individuals with a predisposing factor, usually a form of collagen vascular disease. disease. Secondary Raynaud's disease is more complicated, severe, and more likely to get worse over time. time.

Predisposing conditions
Scleroderma Connective tissue disorder: #Systemic lupus erythematosus #Rheumatoid arthritis #Dermatomyositis #Polymyositis Pulmonary hypertension Disorders of the nervous system Trauma Environmental toxins (vinyl chloride) Prescription medications(beta blockers,cytotoxic drugs, cyclosporin, gotamine, sulfasalazine)

Raynaud's attack
Raynaud's episodes can be triggered by cold, either by touching cold objects or by being in a cold environment. Emotions environment. such as stress and anxiety may also play a role. The severity of attacks will vary role. from episode to episode, as well as from patient to patient. patient.

Signs and symptoms

Color change in the fingers, toes, and earlobes when exposed to cold or stress When warmed, the skin color turns back to normal Burning, tingling and pin-andpin-and-needles sensation during color change In rare, severe cases, gangrene can develop at the tip of the fingers. fingers.

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Raynaud's syndrome include: Sex: Female Age: 15-40 years old 15Jobs or leisure activities: Activities that subject the hands to repeated stress may increase the chance of developing Raynaud's. For example: Typing Playing piano Regular operation of vibrating tools, as in construction Exposure to certain chemicals A connective tissue disease Smoking Certain medications.

Stages of Raynauds
Blanching represents the ischemic (lack of adequate blood flow) phase of the phenomenon, caused by digital artery vasospasm. Cyanosis results from deoxygenated blood in capillaries and venules (small veins). Hyperemic phase, upon rewarming and resolution of the digital vasospasm, the digits appear red. Raynaud's can be a primary or secondary disorder.

Diagnosis
At least two of the three color changes occurring during attacks which are provoked by cold and or stress. Episodes have been occurring periodically for at least two years. Attacks occurring in both hands. There is no other identifiable cause for the Raynaud's episodes.

Investigations
A careful history will often reveal whether the condition is primary or secondary. Once this has been established, investigations are largely to identify or exclude possible secondary causes. Digital artery pressure: pressures are measured in the digital arteries before and after cooling the hands. A drop of 15mmHg or more is diagnostic. 15mmHg Doppler ultrasound: to assess flow ultrasound: Full blood count: this can reveal a normocytic anaemia count: suggesting the anemia of chronic disease or renal failure Thyroid function tests: this can reveal hypothyroidism tests: An autoantibody screen, tests for rheumatoid factor, ESR factor, and CRP, which may reveal specific causative illnesses or a CRP, generalised inflammatory process . Antinuclear antibody test. ESR Nail fold vasculature: this can be examined under the microscope

Prevention
Keeping warm by wearing warm clothes, gloves, and socks Avoiding touching cold or frozen objects, or using gloves Avoiding stress Avoiding smoking Avoiding taking decongestants or diet pills that contain phenylpropanolamine

Treatment
Treatment options are dependent on the type of Raynaud's present. Raynaud's syndrome is treated primarily by addressing the underlying cause, but includes all options for Raynaud's disease as well. Treatment of primary Raynaud's focusses on avoiding triggers: Avoidance of any environmental triggers, e.g. cold, drilling, etc. (although emotional stress is a recognized trigger, it tends to be impossible consciously to avoid). Warm clothing for the extremities, e.g. mittens. Hormone regulation and assessment of the type of oral contraceptive pill taken, if any. Contraception which is low in estrogen is preferable, and the progesterone only pill is often prescribed. prescribed.

Stop smoking.

Drug treatment is normally with a calcium channel blocker, blocker, frequently nifedipine to prevent arterioconstriction. arterioconstriction. It has the usual side effects of headache, flushing, and ankle edema, and patients often edema, stop treatment, preferring the symptoms of Raynaud's to the symptoms of the drug. There is some evidence for Angiotensin II receptor antagonists (often Losartan) in reduction of frequency Losartan) and severity of attacks. AlphaAlpha-1 adrenergic blockers such as prazosin can be used to control Raynauds vasospasms under supervision of a healthcare provider. Sildenafil? Sildenafil?

Surgery
Balloon angioplasty End arterectomy Bypass grafting. Endoscopic thoracic sympathectomy.( ETS) Amputation. Amputation.

PT Management
Biofeed back This technique is used to gain control over skin temperature, heart rate, blood pressure, and other involuntary body functions. Mecholyl pulsed phonophoresis TENS Electrical Stimulation Regular Exercise