Raynaud's Disease

RAYNAUD'S DISEASE (synonyms: morbus Raynaud, spontaneous symmetrical gangrene, asphyxia localis extremitatum), an angiotrophoneurosis characterized by paroxysms of vasomotor disorders, mainly in the extremities of the fingers; it develops on the basis of a disease of the autonomic nervous system. Some authors consider asphyxia localis to be a synonym for Raynaud's disease, whereas in reality it is one of the phases in the course of this disease. It should be noted that females are predominantly affected at a young and middle age; after 50 years of age the disease is very rare. Neuropathic loading is of great importance in the development of the disease, and direct heredity has been observed. Cooling, especially the stay of hands in cold water, psychic traumas, acute and chronic infectious diseases are noted as provoking factors; the connection of Raynaud's disease with malaria has been described (for the pathogenesis of Raynaud's disease see also Angioneuroses, Angiotrophoneuroses, Asphyxia localis symmetrica). The clinical picture is characterized by sharply expressed vasomotor disorders and trophic disturbances, more often at the tips of the fingers, less often on the toes, at the tip of the nose, or on the ears. The disease proceeds in paroxysms. The first phase—syncope localis—is expressed by pallor and cooling of the fingers, accompanied by a sensation of severe pain in them. This phase lasts for several minutes or passes for a time without a trace or gives way to the next phase, the so-called asphyxia localis, characterized by cyanosis, cooling, and pain, sometimes very severe. The second phase lasts somewhat longer and passes into the third—ruber regionaris: the blue color of the hand is replaced by a bright red color, but not continuous, rather in patches. This last phase also lasts several minutes, during which the pain subsides, and the hand assumes a normal color. Paroxysms occur periodically and with varying frequency: sometimes several times a day, sometimes after several months; the intensity is also different; in some the paroxysms are short, almost painless, in others more prolonged and accompanied by severe pain. This first period of paroxysms is replaced after a more or less long interval by the second period—gangrene. During one of the paroxysms, black spots and blisters with bloody-purulent contents appear on the fingers, which break and then dry up; gangrenous foci can be localized or gradually spread and capture neighboring areas; the pains reach great strength. Gangrene can also capture the underlying tissues down to the bone, then the fingers shrink and thin out. Spontaneous detachment of the affected parts is possible. When the painful process is localized on the fingers of the lower extremities, difficulty in walking and standing (dysbasia)—symptoms observed in circulatory disorders on the basis of arteriosclerosis with claudication intermittens (dysbasia arteriosclerotica)—joins the vascular phenomena and pain sensations, but the course of the disease by attacks that occur even in a calm position and the state of the vessel walls allow a differential diagnosis to be made. The duration of the disease varies, sometimes lasting decades. For treatment see Angioneuroses, Angiotrophoneuroses, Asphyxia localis symmetrica.

Treatment see Angioneuroses, Angiotrophoneuroses, Asphyxia localis symmetrica.