Raynaud's Phenomenon (cont.)
How is Raynaud's phenomenon treated?
Management of Raynaud's phenomenon involves protecting the fingers and the toes from cold, trauma, and infection.
Medications that can aggravate blood vessel spasm should be avoided by patients
with RP. In patients with persistent symptoms, medications that dilate the blood vessels
can be administered.
Patients with Raynaud's phenomenon who have no symptoms
other than the color changes of extremities may require only measures to prevent
complications. Prevention measures are important in primary and secondary RP
regardless of the severity. Simple initial care involves keeping the body warm,
especially the extremities. Warm clothing in colder environments is essential.
Cotton gloves can be helpful while searching the freezer. Room temperatures
should not be too cool. Rubber gloves protect the hands and prevent cooling
while dish washing. Barefoot walking should be minimized. Compression of the
blood vessels by tight-fitting wrist bands, rings, or footwear should be avoided.
Patients should guard their hands and feet from direct trauma and
wounds. Any wounds or infections should be treated early to prevent more
serious infections. Avoiding emotional stresses and tools that vibrate the
hand may reduce the frequency of attacks. Biofeedback can also help to
decrease the severity and frequency of RP in some patients.
Direct and indirect smoking should
be avoided in patients with RP. The chemicals in tobacco smoke can cause blood vessel constriction
and lead to hardening of the arteries, which can further impair oxygen
supply to the extremities.
Care of the nails must be done carefully to avoid injuring sensitive
toes and fingertips. Ulcers on the tips of the digits should be monitored
closely by the doctor. These can become infected. Gently applied finger
splints are used to protect ulcerated areas. Ointments that open the blood
vessels (nitroglycerin ointment) are sometimes used on the sides of
severely affected digits to allow increased blood supply and healing.
Medications that can aggravate symptoms of RP by leading to increased blood vessel spasm include over-the-counter cold and weight-control preparations, such as pseudoephedrine
(Actifed, Chlor-Trimeton, Cotylenol, and Sudafed). "Beta-blockers,"
medicines used for high blood pressure and heart disease, can also worsen
RP. These include atenolol (Tenormin), metoprolol (Lopressor), nadolol
(Corgard), and propranolol (Inderal).
Patients with persistent or bothersome symptoms may be
helped by taking oral medications that open (dilate) blood vessels. These
include calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine
(Cardene), nifedipine (Procardia),
and other medicines used in blood pressure treatment, such as methyldopa (Aldomet) and prazocin (Minipress). Recent research has shown that the blood pressure drug
losartan (Cozaar, Hyzaar) can reduce the severity of episodes of RP
possibly more than nifedipine.
Medications that "thin" the blood, such as low doses of
aspirin or dipyridamole
(Persantine), are sometimes helpful.
Some patients with persistent symptoms can benefit by
adding a medication called pentoxifylline (Trental) which makes the red blood cells
more pliable, thereby improving circulation.
Severe RP can lead to gangrene and the loss of digits.
In rare cases of severe disease, nerve surgery called "sympathectomy" is
sometimes considered. In order to prevent blood vessel spasming, the nerves that
stimulate the constriction of the vessels (sympathetic nerves) are surgically interrupted. Usually
this is performed during an operation that
is localized to the sides of the base of the fingers at the hand.
Through small incisions the tiny nerves around the blood vessels are
stripped away. This procedure is referred to as a digital
sympathectomy.
Research
Researchers have reported finding a
substantial genetic (inherited) contribution both to the symptoms of RP and to
the associated blood vessel changes of patients with Raynaud's phenomenon.
Other researchers are studying nitric oxide and its potential
relationship to Raynaud's phenomenon. A gel is being studied which
might promote local production of nitric oxide in involved digits.
The local nitric oxide, it seems, may open the blood vessels and
improve the impaired circulation.
- Raynaud's phenomenon is characterized by a
pale-blue-red sequence of color changes of the digits, most commonly after
exposure to cold.
- Raynaud's phenomenon occurs because of spasm of blood
vessels.
- The cause of Raynaud's phenomenon is unknown, although
abnormal nerve control of blood vessel diameter and nerve sensitivity to cold
are suspected of being involved.
- Symptoms of Raynaud's phenomenon depend on the
severity, frequency, and duration of the blood vessel spasm.
- There is no blood test for diagnosing Raynaud's
phenomenon.
- Treatment of Raynaud's phenomenon involves protection of
the digits,
medications, and avoiding emotional stresses, smoking, cold
temperature,
and tools that vibrate the hands.
For further information about Raynaud's phenomenon, please visit the
following site:
The Arthritis Foundation (http://www.arthritis.org)
Or you can write to:
The Arthritis Foundation
P.O. Box 19000
Atlanta, Georgia 30326
References: Clinical Primer of Rheumatology, Lippincott Williams & Wilkens, edited by William Koopman, et al., 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.
Last Editorial Review: 9/4/2007
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