What are the causes of Raynaud's Syndrome
People suffering from Raynaud's phenomenon should protect themselves from the cold and moisture. The entire body - especially the hands, e.g. with gloves - should be kept warm. Above all, rapid cooling (e.g. with refrigerated shelves) should be avoided. Those affected should also protect themselves particularly well against injuries to their fingers. A Raynaud attack can regress if the hands are warmed up again (e.g. by warm water, rubbing hands or circling arms).
Nicotine consumption (including passive smoking) and vasoconstricting drugs should be avoided. In addition, those affected should protect themselves from vibrations (e.g. by operating certain machines).
Advantages and disadvantages of using drugs that contain estrogens should be carefully considered in women with Raynaud's phenomenon.
It is controversial whether coffee can influence the course of a Raynaud phenomenon. Raynaud patients should therefore check whether coffee consumption leads to a change in the frequency or intensity of the Raynaud attacks.
NoteIn some patients with primary Raynaud's phenomenon, these behavioral measures may be sufficient. In the case of secondary Raynaud's phenomenon, drug therapy is usually also necessary.
Therapy of the Raynaud phenomenon
Calcium antagonists (e.g. nifedipine) are primarily chosen. Calcium antagonists, also called calcium channel blockers, influence the influx of calcium into the vascular muscle cells and thus inhibit the tension in the vascular muscles. This causes the blood vessels to widen. As a rule, drugs are used that release the active ingredient slowly in order to enable a long-lasting effect. The dose is increased slowly over a few weeks. In urgent situations (e.g. when there is a risk of tissue damage due to lack of oxygen), drugs are selected that rapidly release the calcium channel blocker. A common side effect of Raynaud's therapy with calcium antagonists is the development of arterial hypotension (low blood pressure).
If therapy with calcium antagonists does not have an adequate effect or is not possible, (additionally) other drugs can be used.
For some patients, applying a vasodilator nitroglycerin ointment works. When mixed with petroleum jelly, headaches - a common side effect of nitroglycerin - are less common.
Iloprost infusions can be used to prevent and heal finger ulcers in scleroderma. Iloprost has a similar effect to the prostacyclin produced by the body. Prostacyclin leads to an expansion of the blood vessels and an inhibition of the platelet aggregation (first phase of blood clot formation by the pooling of blood platelets).
The endothelin-1 receptor antagonist bosentan can prevent finger ulcers from occurring. The natural hormone endothelin-1 leads to pronounced vasoconstriction. Bosentan inhibits its effect.
Therapy attempts with the following drugs can also be made:
- Angiotensin receptor blockers: inhibit the effect of the vasoconstricting hormone angiotensin-II;
- Phosphodiesterase-5 inhibitors (PDE-5 inhibitors): inhibit the vasoconstricting enzyme phosphodiesterase V (e.g. sildenafil);
- certain antidepressants (SSRIs - e.g. fluoxetine).
In rare cases, if there is a high risk of tissue damage, the sympathetic nerve supply to the blood vessels can be blocked.
The positive effects of the following therapies, which are sometimes used, have not yet been sufficiently proven in clinical studies:
- Botulinum toxin (e.g. botox),
- Low-level laser therapy (treatment with "gentle" laser beams),
- Spinal cord stimulation (influencing the activity of nerve cells in the spinal cord by means of electrical current) and
- heated gloves.
Clinical studies have not shown that behavior therapy is generally helpful for people with Raynaud's phenomenon. However, behavior therapy can be helpful in people with Raynaud's syndrome who suffer from an anxiety disorder, in order to possibly have a positive influence on Raynaud's syndrome, among other things.
The Raynaud Condition Scale (RCS) can be used to check whether behavioral measures or therapy lead to an improvement in symptoms.
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