Experts warn against Raynaud Disease triggered by cold weather and stress!
Thoracic Surgery Specialist Prof. Dr. Özkan Demirhan gave information about Raynaud Disease and said, “Raynaud Disease is a vasospastic disease that affects the end points of the body, especially the upper extremities, earlobes and lips. The main triggering factors for common Raynaud Disease are exposure to cold and stress. An important feature is that it is permanent. According to epidemiological estimates, Raynaud Disease affects approximately 5 percent of the general population, but this rate is stated to be higher in cold regions. Raynaud Disease is divided into two: Primary Raynaud Disease (PRH) and Secondary Raynaud Disease (SRH). In Primary Raynaud Disease; There is a significant discoloration of the skin and neural sensitivities in the affected area. It can also be considered a ‘symptom complex’ that occurs with complaints such as pain, loss of sensation or hypersensitivity. The fingertips turn white in some patients, blue purple in some patients, and red in some patients. Although all color changes are required for diagnosis, not all color changes are necessary to diagnose Raynaud Disease. Having at least 2 color changes is sufficient for diagnosis. In addition, Raynaud Disease can also present clinical symptoms such as pain, tingling, numbness and discomfort.”
It can also be confused with other diseases!
Stating that correct diagnosis plays a major role in Raynaud Disease, Prof. Dr. Özkan Demirhan said, “A comprehensive clinical evaluation is necessary in all patients with suspected Raynaud Disease. First of all, we need to rule out diseases that cause complaints and clinical symptoms similar to Raynaud Disease. These are called Secondary Raynaud Disease and treatment is directed towards the underlying disease. These diseases are primarily atherosclerotic vascular disease, Buerger’s disease, Thoracic outlet syndrome (TOS), rheumatological diseases (SLE, Sjögren’s, etc.), vasculitides, myopathies, occupational use of tools that cause hand tremors, drug use, some drugs (Amphetamines, beta blockers, some chemotherapy drugs), carpal tunnel syndrome, frostbite, hypothyroidism, fibromyalgia syndrome.” He gave information as follows.
Detailed evaluation is required at the diagnosis stage!
Providing information about the diagnostic methods of Raynaud disease, Prof. Dr. Özkan Demirhan: “A detailed history should be taken from the patient. It is necessary to question the sequence of color change(s), triggering factors, occupational history (e.g. use of vibrating tools), and potentially triggering or aggravating drug treatments. The age of the patient is important; a family history of Raynaud Disease should be revealed, especially in young women under 30 years of age. Care should be taken to examine the extremity endpoints, that is, the hands. Evidence of digital ulcers and irreversible tissue loss, such as digital pit scars, are symptoms of Secondary Raynaud Disease. A full skin examination should be performed and skin symptoms of Secondary Raynaud Disease should not be overlooked. One of the most important methods to rule out Secondary Raynaud Disease (SRD) or other autoimmune diseases is to examine the nail bed with capillaroscopy and check for antibodies for autoimmune diseases. In primary Raynaud patients, the appearance of capillaries in the nail bed is normal. In Secondary Raynaud Disease, capillaroscopic abnormalities are dilated, including ‘giant’ capillaries, and microbleeds occur. Complete blood count, antinuclear antibody (ANA) and inflammatory markers are routinely ordered. Sometimes kidney and liver tests, thyroid function tests, urine analysis, immunoglobulins electrophoresis and creatine kinase may be ordered. Chest radiography and two-way cervical radiography may be taken (to differentiate TOS). Anticentromere and anti-Scl-70 autoantibodies can be used to differentiate SRH. Testing for antiphospholipid syndrome and fasting lipid profile (e.g., atherosclerosis risk) may be considered. Thermographic tests are performed in some (they measure skin temperature as an indirect measure of blood flow and can help distinguish PRF and SRF).”
Treatment of Raynaud Disease
Informing on the treatment methods of Raynaud Disease, Thoracic Surgery Specialist Prof. Dr. Özkan Demirhan stated that the treatments are planned as medical treatments, surgical treatments and supportive treatments.
He continued his words by sharing the details of the surgical methods applied,
“After diagnosis of Raynaud patients, the primary treatment is medical treatment. Surgical treatment is applied to patients resistant to medical treatment. Surgical treatment is performed in suitable patients with ETS (Endoscopic Thoracic Surgery). This method is the same as the surgical technique used in armpit sweating surgeries. It is performed with a single port under general anesthesia and is applied to both thoracic sympathetic chains (T2-4). Especially patients with ulcers and severe pain benefit from ETS surgery. The aim here is to prevent the activation of the sympathetic system and eliminate vasospasm. Another invasive treatment option is Botox treatment. “I use it very rarely because it is a short-term method that needs to be repeated frequently.”
What should Raynaud patients pay attention to in winter?
Sharing information about the precautions that Raynaud Patients can take, Demirhan said, “I recommend these patients to make changes in their lifestyles. Our first recommendation is that patients stay away from cold and stress. Hands and feet should be kept warm. They can keep their hands warm in cold weather by using gloves and hand warmers. It is very important to maintain body temperature. On the other hand, they should definitely quit smoking because skin blood flow decreases in smoking.”