Reynaud's syndrome
Contents:
Description:
Reynaud's syndrome - the paroxysmal vasospastic disorder of arterial blood supply of brushes and (or) feet arising more often under the influence of cold or disorders.
Symptoms of the Syndrome of Reynaud:
* The II-V fingers of brushes of feet are surprised preferential, the nose, ears, a chin is more rare.
* During an attack - paresthesias, skin deathly pale, fingers cold.
* Upon termination of an attack - morbidity, feeling of heat and a raspiraniye, skin is hyperemic.
* Gradually trophic changes (flattening or retraction of small pillows of fingers, decrease in turgor of skin, badly healing ulcers) develop.
* During the mezhpristupny period of a brush cold, cyanochroic, wet.
* Existence of internal equivalents in vessels of heart, lungs, kidneys, a brain, with defeat of these bodies is possible, especially at a system scleroderma.
Diagnostic criteria:
* The episodes of bilateral discolorations of skin caused by cold or emotions.
* The kept pulsation on peripheral arteries.
* Symmetry of defeat.
* Absence of gangrene.
* Lack of signs of a general disease.
* Duration of a disease is not less than 2 years.
Reasons of the Syndrome of Reynaud:
Develops at a number of diseases:
* diffusion diseases of connecting fabric, first of all system scleroderma;
* pseudorheumatism;
* general diseases of vessels (arterial hypertension, vasculites, nodular periarteritis);
* diseases of a nervous system (sympathetic nerve knots);
* blood diseases, paraproteinemia, polycythemia, cryoglobulinemia;
* endocrine diseases (toxic craw);
* diencephalic frustration;
* regional compression of a neurovascular bunch (additional cervical edges, defeat of cervical department of a backbone, syndrome of a front scalene);
* influence of professional factors (vibration, cooling).
Treatment of the Syndrome of Reynaud:
Treatment of a syndrome of Reynaud - a complex challenge which solution depends on a possibility of elimination of causative factors and effective impact on the leading mechanisms of development of vascular disorders.
All patient with a syndrome Reynaud recommends to exclude cooling, smoking, contact with the chemical and other factors provoking a vascular spasm in life and on production. Sometimes it is enough to change working conditions (to exclude vibration, etc.) or the residence (warmer climate) that manifestations of a syndrome of Reynaud considerably decreased or disappeared.
Among vasodilating drugs effective remedies of therapy of a syndrome of Reynaud are antagonists of calcium. Nifedipine (Corinfarum, кордафен, etc.) is appointed on 30-60 mg/days. For treatment of a syndrome of Reynaud it is possible to use also other blockers of an input of calcium: verapamil, diltiazem, никардипин.
At the progressing Reynaud's syndrome use of a vazaprostan is recommended (El prostaglandin, alprostadit). Vazaprostan is entered intravenously kapelno in a dose of 20-40 mkg of an alprostadil into 250 ml of normal saline solution within 2-3 hours every other day or daily, on a course of 10-20 injections. Initial action of a vazaprostan can be shown after 2-3 injections, but more lasting effect is noted after the termination of a course of treatment and is expressed in decrease in frequency, duration and intensity of the attacks of a syndrome of Reynaud, reduction of a chill, numbness and pains. Positive action of a vazaprostan usually remains within 4-6 months, it is recommended to carry out repeated courses of treatment (2 times a year).
A specific place in treatment of vascular defeats is held by inhibitors of an angiotensin-converting enzyme (APF), in particular captopril. Captopril is appointed in a dose of 25 mg 3 times a day, use with individual selection of maintenance doses is recommended long (6-12 months).
In treatment of a syndrome of Reynaud it is also used кетансерин - the selection blocker HS2 серотониновых of receptors; about 20-60 mg/days are appointed, it is usually well transferred, it can be recommended to elderly patients.
In treatment of a syndrome of Reynaud the drugs improving the properties of blood reducing viscosity are of great importance: Dipiridamolum on 75 mg and more in days; пентоксифиллин (trental, агапурин) in a dose of 800-1200 mg/days inside and intravenously; low-molecular dextrans (реополиглюкин, etc.) - intravenously kapelno on 200-400 ml, on a course of 10 injections.
At treatment of a syndrome of Reynaud it is necessary to consider need of long long-term therapy and quite often complex use of drugs of different groups.
Medicinal therapy of a syndrome of Reynaud is recommended to be combined using other methods of treatment (hyperbaric oxygenation, reflexotherapy, psychotherapy, physical therapy).
